The patello-femoral joint :
has anybody had a tear in their quad? - - Posted by brans (brans), 18 January 2005
hi i have had an ultra sound scan today they found a small tear above the knee into the quad. I have not been able to properly lift and stretch my leg out since my LR in july 04. I have physio 2 times weekly and i do my programme from my physio daily. this has been going on since july 04. I have no quad muscle skinny leg... 
My knee gives way going down stairs ,when i try to walk fast. I have alot of night pain and i hobble every where..
I have maltracking as well prior to my horse riding accident i never had any problems..
Has anybody any information on surgery or rehab protacols for this condition?
I have booked for a second opinion on friday to see a dr privately fingers cross......
Brans
Posted by hmaxwell (Heather M.), 18 January 2005
You might want to look up Heather B's posts--she tore her quad tendon falling after lateral release surgery. It's something that has to be treated effectively right away.
Look up her posts by going to the 'members' link across the top middle of the page, then clicking for alphabetical listings. While there are at least a dozen Heathers, she posts under just "Heather" so look her up that way. You can follow her history and post questions. Hopefully she'll see your message and respond, but she hasn't be on the board much in the last few months.
Heather
Posted by Janet (Janet), 20 January 2005
Brans:
My situation was a different, but still involved the quad. Unfortunately, I ruptured the quad tendon. This required open surgery to repair it and connect it back to the patella (it is outside the joint and cannot be done arthroscopically). I was in an immobilizer almost three months. Believe me, this is a big surgery! But then again, a rupture is a big injury.
Anyway, I think they expect smaller tears can heal themselves. Was the tear in the muscle or in the tendon? Do you think this is a new injury? It's possible the tear happened in PT. So now what does your OS say as far as treatment of this tear?
Janet
Posted by Cid (Cid), 20 January 2005
I dont know if this will help but I had a vmo attachment on both knees. They took sections of my quad and sewed them to my kneecaps for better tracking. It was a full open procedure and I did have one blow out and have to have it redone. recovery is long and slow but you do get the quad back in shape if you work at it.
Good Luck Cid
Posted by hmaxwell (Heather M.), 20 January 2005
Janet,
I'm such a dork! I don't know why I told him to only look up Heather...I guess I got focused on the fact that her injury was identical--an LR followed by a quad tendon rupture and issues after that. You went the other way around, I think. I still should have thought of your name!
It's been a tough week, I guess that's why. It's my excuse and I'm sticking to it.... 
Heather
Posted by pxs (pxs), 20 January 2005
i had a rupture of the medial retinaculum which completely detached the medial retinaculum (ligament on side of patella) quad tendon and VMO from my patella during a dislocation. at the time of this detachment, there was also a tear into the quad tendon and vmo.
i would be encouraged by the characterizaton of your tear as "small" - maybe it is something that can heal on its own and your main issue is just rebuilding it after healing - because surgery to repair these things is pretty major and takes a long time to recover from.
one thing that has always confused me is if there is a bright line between the retinaculum, the quad tendon and then VMO, or if it is just a gradual transition of tissue from ligament to tendon to muscle
Posted by brans (brans), 21 January 2005
hi everyone thankyou for your memos. i am going to see a consultant called mr gunn at milton keynes in uk this afternoon. This is a private appointment as i have had no luck with nhs. My last nhs dr who did the LR wanted me to have a second opinion and reffered me to a specialist which i have just found out is a shoulder and wrist specialist. i do wonder if these doctors know what they are doing. My gp advised me to see this Mr Gunn as he is a knee specialist and is ment to be very good. Sadley if i want an nhs appointment i would have to wait aprox 3 months to see him so 120 english pounds and i can see him today. Its a sad world we live in i just hope i have not made things worse buy doing all these exercises fingers cross................ Ill let you know how i get on .............. 
Brans
Posted by imnotpunk (imnotpunk), 21 January 2005
I ruptured my quad during a manipulation/lysis of adhesions and I'll tell ya, a rupture/tear of muscle can take a VERY long time to properly heal. At PT I have an ultrasound/massage done on the quad to promote healing and break up existing scar tissue (which can make the pain about 50x worse), and I also heat the quad as much as possible.
Good luck with everything!
Best wishes,
Patricia
Posted by brans (brans), 22 January 2005
Hi all back from my doctors appointment. i have been told that i have tendonitis of the patella femoral and this has also been found above the knee linking the quad muscle... i have been told this is due to the fact that my signals from my brain to my knee are saying that i am in pain and this is causing an inflammatory response. the good news is i need no surgery as my main structures are all good that tear is now scare tissue. The doctor said that this has caused me to have the atrophy of the quad muscle and i am now in a cycle which can only be broken by having intense ultra sound treatments from my physio, gentle exercise with a brace and being seen by a pain specialist to have a nerve block. Has anybody had any of these treatments? what was the out come? does anybody have any idea how long this treatment can take re:recovery time?
Brans
Posted by hmaxwell (Heather M.), 22 January 2005
Brans,
I had the same diagnosis after encountering real difficulties in recovering from my first scope (lateral release, among other things).
We bumped up the ultrasound--it was actually done with cortisone cream, which is a procedure called phonophoresis. I really encourage you to talk to your PT about doing this--my knee felt like a million bucks coming out of that! We also did iontophoresis, which is another method to push liquid cortisone solution into the joint--it's a great anti-inflammatory.
As for how long it took....well, in my case the diagnosis was incorrect. The tendinitis was there--severe inflammation of the patellar tendon, as well as enlargement and inflammation of the quad tendon. But the tendinitis was actually secondary to or caused by another condition--severe scar tissue, aka arthrofibrosis. So the scar tissue had trapped my kneecap down below the knee joint itself, doing this by wrapping around the patella and the patellar tendon and almost 'smothering it' with the layers of thick adhesions. This patellar entrapment put a huge amount of stress and traction on my quad tendon, leading it to become inflamed and irritated--tendinitis.
So while the diagnosis was technically correct, my surgeon missed the underlying issues that were contributing to the tendinitis situation. So I was unable to get better. My surgeon was very, very good...he'd just never seen anyone develop serious scar tissue problems after a lateral release, so he didn't give credence to the possibility that it could be causing my problems. I went to a second opinion doctor, but he had the same focus as my original OS (sports medicine--ligaments and meniscal injuries, not complicated knee problems) and missed the boat as well. It was only when I went to see a PFS specialist who got a lot of tough cases referred to him that we were able to develop a plan to deal with the arthrofibrosis effectively--and keep it from coming back.
Heather
Posted by imnotpunk (imnotpunk), 22 January 2005
brans -
As I mentioned in my last post, I have ultrasound and deep tissue massage done every PT session on the quad to help with the scar tissue and to help promote healing. It is very helpful and does make your quad/knee feel a whole lot better afterwards.
I have also had nerve blocks before which basically make you lose sensation in part or all of your leg. I had a few lumbar sympathetic blocks which made my quad feel numb so it was "easier" to stretch and less painful during those intense stretching sessions. It inevitably wasn't the correct path for me because I was misdiagnosed for months (I was told I had RSD..."nothing" wrong with the knee, it was all in my head basically. I later found out that my patellar tendon ahd been completely ruptured, among other things)
Anyways, less pain = easier to break up scar tissue. I would imagine you will need to go through a cycle of the blocks (whether they be LSBs or femoral nerve blocks), one block only lasts for a certain amount of time. If you have an LSB, it may not even work the first time -- it usually take two or three times before you really start to feel the numbness and loss of sensation. My PM doc had me sedated during the blocks, he said it would be far too painful for me to deal with a large needle in the back. Technically, it's considered minor surgery, but don't let that throw you, it's not invasive at all.
I've been having the ultrasound on my quad for about a month now, I initially started out at eight minutes of ultrasound but then went to five. This week my PT decided to go with a three minute ultrasound. The quad feels a TON better -- while you can still feel where the tears are, the tightness and swelling has really gone down, it looks a whole lot better as well.
Best wishes,
Patricia
Posted by brans (brans), 24 January 2005
I saw my consultant today he says that hw will refer me to apain specialist this can take up tp 16 weeks on nhs. He says he will try to see him to see if i can be seen earlier. We discuss the issues around my utra sound scan and i told him of my private appointmet with Mr Gunn. He feels that the pain specialist may try a nerve block or start me on a drug called gabapentin. He has also refferd me to another othopeadic surgeon as i have also got scaring on the tendon from the tear. Sounds like patricia s problem. He said this surgoen would advise the medical approach first but he may offer me another arthroscopy and divide the adhesions. I am seeing my pt on thursday so i will hope she can help me with some ultra sound treatment. I will discuss with her about the steriod creams as suggested by patricia. hay ho more hard work still no direction to what my treatment will be. Lets hope i dont loose any more quad muscle as i wont have any muscle left the rate i am going.
Before my injury my thigh was 52 cm mid thigh now it is 41 cm and i am now getting reffered pain to my hip and sometimes my lower back i am very worried that permenant damage is done and i will not be able to ride my horse this year............
Brans 
Updated Fri Sep 5 2008