Stiffness after patella fracture

[Susy]

Can someone please help me!

I fractured my patella into splinters on a tile floor in early June. The tendons were severely damaged; pins were not used to repair the damage. A second arthroscopic surgery was performed in early July. This surgery really set me back. I began PT the third week in July, going only once a week. I cannot bend more than 25 degrees now although I am working very diligently at home to bend. I can see improvement but it is very slow.

The problem is this: my doctor has threatened another surgery in early Oct. if I do not bend. He says it is for cleaning out scar tissue.

Can anyone tell me if my progress is too slow. If so, can anyone suggest a very effective exercise to help with bending? Do I need a new surgery?
I want to avoid this at all costs.

Thank you for answering.

Susan

[Ross]

Susy, I smashed mine in similar fashion (rolled up mat and a bathroom tile floor) back in March.  Mine dislocated and only broke into three pieces but I hear you loud and clear!  The optimistic folk in casualty sent me on my way with an immobiliser and a cheery wave!

Having been the busted femur route only a couple of years back I was dead keen to get my knee moving as soon as possible so as not to lose too much quad condition and started bending the thing at day two, not much but a start (good enough to drive with).  I had it back to nearly full rotation at the time of my surgery (lateral release, clean up of the back surface of the patella, some wire and a couple of pins) at the end of July.  

I got it out of the immobiliser again at day three post surgery (as was my wont just after the great bathroom disaster of 2002!) and discovered a new definition of discomfort.  No PT but personally supervised bending exercises from that point on and drove my car at day five, probably thirty degrees at that time.  Four weeks post-op and I have around 80% rotation but it yells a bit (truth be known so do I!).  I'll get it back but it may take a little longer than I would prefer.  

The beggar keeps on filling up with fluid and gets fiercely hot when I rough it up.  Suspect that if I was a racehorse I'd be dogfood by this but you got to persevere!  

I do lots of leg raises and a leg raise and twist to two o'clock every fifth, my quad is pretty good but there seem to be a lot of arcade quality sound effects coming from the knee when I bend the thing.  Can't say I am really terribly keen to hear the noises or put up with the discomfort but it won't get better on its own!

Hope your feeling better real soon and the thing starts to bend easy for you!

[Susy]

Hi Ross,

Thanks for your reply. Your accident is very similar.
I do leg lifts but haven't tried tilting to the two o'clock.
How often in a day's time did you exercise?

Thanks,
Susy

[Rhonda]

Hi Susy!

I, too,  shattered my patella in early April, with surgery two days later.   (Sledding accident.  Knee vs. Tree- Tree wins)
My ROM came back very very slowly, but now I'm at 132 degrees (much of that coming in the last month).  
ONe thing that helped in the early days was a rental of a CPM machine.  OS wrote a prescription for it, and insurance covered the cost.  Something to consider, esp where you had a second surgery.  But as long as you're improving, however slowly, I would think the "scar tissue removal" surgery (technially, called a "Manipulation"- try searching KNeeGuru archives for this term) might not be a good idea.  Some people have had bad results with that surgery, and I would only use it as a last resort- or at least get second opinion.
My PT was not concered that my ROM came back slowly. As long as it was improving, there  was no rush.  In fact, he felt the stiffness offered some protection against re-injury in the early phases.  
Anyway, my recovery was very slow the first couple  of months- as the OS was afraid I'd rebreak it. I could not even do a leg lift for the first two months- it was like being paralyzed, then the muscles finally started to "wake up" slowly.  After the third month- doc says bone was healed, ditched the brace,  and now it's just a matter of getting muscle strength back.  Now that my restrictions are lifted and the quads "awakened", my recovery has gone into full speed.  As of today, I can walk fast with no limp.  I can walk upstairs fairly easily.  Downstairs is starting to come back now too, slightly better each day.  I do the stairmaster and elliptical  trainer at normal speeds.  (Elliptical was a great help in un-stiffening my knee for ROM and losing my limp) My PT says I can even try running in a month!  I still have a ways to go, but I have seen so much progress in my fourth month that I'm very excited!  The docs even says I can try skiing as early as Feb 2003, (no moguls of course).  I was told pre-surgery that I may never ski again, then that was reduced to taking a year or two off.  Now hearing that I can do easy trails this coming season is huge!  Good thing, as I had bought brand new skis just before my accident.
But I do recall those first three months where it seemed I may never get better.    Hopefully, my story can give some hope.  It's hard to find broken patella stories on the web- its just not that common of an injury.  
I'll send you a message with my email in case you have any specific questions..
Hang in there- it does get better!

Good Luck!

Rhonda

[Susy]

Hi Rhonda,

Thank you for answering my plea for advice! You don't know how much your story has alleviated an overbearing fear and feeling of 'doom' with my slow recovery time...it certainly has given me great hope, and yes, this injury does seem to be uncommon. As I read your reply, it seemed that I was reading about my own situation except for the fact that yours happened before mine. The fact that this type of injury is characteristically a slow recovery (and painful) validates my opinion that it was not at all "in my head" (as those in charge would have had me believe). I was beginning to think that I had not tried hard enough and was even becoming depressed.

Now, however, I feel encouraged by your reply. I, too, have seen progress (leg lifts came last week). I am on a walker or crutches most of the time. I stretch with my child's ball under my knee. I am going to print your letter and post it near my exercise area as a reminder that I can regain ROM and do stairs, too. Also, I am a skier and when I read about your good news, I was elated! I hope you will keep me posted about your skiing adventures.

Can you please tell me, too, what a CPM machine is? I will check this out. I am planning also to get a second opinion and I think you handed me some very good advice regarding Manipulation surgery. I do not think this is necessary and want to avoid it. Also, when did you begin using the elliptical trainer?

Thank you again for relaying your experiences. Hope to hear from you again.

Susy

[Ross]

Susy, I do about twenty leg raises every hour or so, I'm not real formal about waiting for the clock, just when I feel I need a stretch.  Lots of repetitions of light exercise is far better than waiting for the physical torturer to try to bend the beggar for you.  It's your recovery, it goes at your pace!

[Susy]

Hi Ross,

Twenty leg lifts is great....something for me to look
forward to. I think you are right....not confine ourselves to a designated amount of lifts, rather, just do them when needed.

One question: is it normal to get redness, heat and some swelling with these exercises?

Thanks,

Susy

[Rhonda]

Hi Susy!

Glad to hear the letter helped.  The first 2 months were torture - I was in that brace locked straight unless I was doing bending exercises.  My boyfriend and I moved in together 3 weeks after my surgery, but of course, he had to do all the work.  I was out of work for 5 weeks.  I wasn't in a lot of severe "pain", but a whole lot of discomfort and boredom.  Too much discomfort to go out with friends, sit in a movie theatre, etc.  I had been very active, skiing almost every weekend in winter, playing ice and floor hockey, running, etc...  Not only was I feeling lethargic and fat, but exercise/sports had been my main source of stress release, so depression definitely ruled at that time.  The third month was better, since the brace could be unlocked at all times, but I still had to be careful.  It was around that time that I could do leg lifts.  At the 3 month visit with my OS, he told me the bone was healed and I could ditch the brace and be more aggressive with PT.  At first I was very wobbly, and I was still limping as the knee was still stiff from being in the brace so long.
But at the next PT visit (about 3 months after surgery), he put me on the elliptical trainer.  I noticed that for about ten minutes after using this machine, I had no limp.  After a couple of weeks of this routine, the limp was pretty much gone for good.  (I still get stiff if I've been sitting down for a long period of time, like seeing a movie.  I'll limp for few minutes after getting up, but then it loosens up)

TO answer some questions:
A CPM Machine: Continuous Passive Motion machine.  It's a contraption that lifts your knee up and down so that it bends without putting any strain on the joint.  I had one in the hospital the day after surgery, then when I was released, had one delivered to my house that very day.  I had it for about two months.   Initially, I used it 6-8 hours per day (while I lay and watched cheesy daytime TV - Boy do I hate Springer).  When I went back to work, I just used it for a couple of hours each night.  I don't' think people usually have it as long as I did, but they let me have it that long because my ROM was coming so slowly and my originally prescription was only for 3 weeks.   I probably would have been OK just having it 5-6 weeks, then doing ROM exercises on my own.   Ask you OS if he can write you a prescription for one.  It seems to be pretty routine at Mass General Hospital, where I had my surgery.   Where do you live?  If you live in the US and are covered by one of the bigger insurance companies, I would think you'd be able to get a machine.   I am surprised you didn't' have one in the hospital, though.... Below is a link to see what it looks like.
http://rehab.smith-nephew.com/Australiarehab/rehabProducts/prodProfessional/CPM/KinOptKneeCPMMach.htm

As far as the manipulation surgery...  One of my good friends, coincidentally, is an ortho surgical nurse at Mass Gen (she was on there for my surgery!  She jokes to my other friends about being the only one who's "seen my naked kneecap").  One day we were talking about manipulation.  She said that it is done successfully at Mass Gen, but only as a last resort.  She said it is typically done on older, inactive (usually obese) patients who don't do their exercises.  

Just keep up with the ROM exercises every day, and you should be fine.  It would be great to get a machine, but if you can't, try sitting in a chair where your feet don't touch the floor.  Hang the bad leg over, using the good foot to support it.  Slowly lower the feet until it's is just past comfortable and move it up and down.  Try holding it for a few seconds while bent.  That it basically what a CPM machine does anyway.   There are other exercises, too.  But that is the main one I did once I got rid of my machine (and at my desk at work).  If you just keep at it every day, it will come.  Ask your PT what else you can do.

I need to ask- what was the purpose of the second surgery?

Just keep up the good work!

Rhonda

[Ross]

Susy, red, hot, swollen?  Kid we got it all!  Sorry! Yes I am talking about the knee!  Seems to be a feature of any hinge joint that, if you puncture the encapsulation the beggar will swell and get hot with "overuse".  Definition of overuse, "whatever makes it turn red, get hot or swell up"  

We're all different and we all recover at different rates, perseverence is what gets results.  Busted knees can make you pretty miserable but if you persevere you will recover and you have a lot more youth on your side than me mate!

The recovery is in your hands, don't wait for anyone to tell you they have worked a miracle for you, go out and make one of your own!  Take personal responsibility for your recovery and it will happen, wait for someone else to provide a miracle?  Well, TAKE A NUMBER!

Be happy and get on with your life, a busted knee is a nuisance to be overcome and you've got lots of living to do yet!

Have a good knee day!

[ceciliamidd]

Susan,
Bending was one of my big problems at the begining of my patella fracture (9/30/01), I didn't hurt my ligaments but bending was difficult and whenever I tried to bend I cried. You need to get more physical therapy at least 3 times a week, and start getting on a stationary bike and get it lower every time you can, that indeed help me a lot with my bending.
Everytime you have surjury will set you back that is why is so important to do physical therapy, I will try to come back to work next month after 1 year and 2 months out, and I had 3 surjuries that was needed it to solve scar tissue and the removal of the wires and pins.

Best of luck to you

Cecilia