The patello-femoral joint :

Ruptured Patellar Tendon Surgery - - Posted by EngKnee (EngKnee), 8 April 2004

Last week I ruptured the patella tendon in my left knee and as you all know my life has changed since that happened.  My surgery is scheduled for Monday AM and I feel confident in my OS as he has had 27 years experience in his field.  He told me that I would not be able to put weight on it for three weeks after the operation and that I wouldn't be able to start bending for six weeks and that's with the aid of a motion brace.  This is NOT arthoscopic surgery, he will have to cut and drill four holes in my patella to fasten the tendon.  How much pain should I expect to be in?  How long will it last?  Will I ever be able to go back to normal?  Is this a routine type procedure?  I would like to converse with folks out there in cyberspace who have experienced this particular surgery and how they made out and any advice they might have for me going in.  John
Posted by Janet (Janet), 9 April 2004

John:

Good luck as you start on your knee journey. A ruptured patella tendon is not a fun injury (as I'm sure you've already figured out). I had a similar injury, a ruptured quad tendon (which is on the thigh side of the patella). In my case, I had open knee surgery to repair the tendon. I was in an immobilizer for about two and a half months, then went to a hinged brace. But during that time, I was weight bearing after the first week or so. I started PT at about three weeks post-op. I didn't return to work for about 3 months (I have a desk job), but then only for a couple of hours per day. I didn't get back to work full time for about nine months.

If you go to the top of the page and do a "Search" for patella tendon (or similar search words), you will find others here who have had your injury. I know I was told that it would take 12-18 months before I "forgot I had an injury." But I had complications and it has now been five years, I have had four surgeries, and my knee will never be normal. I would not expect that to happen to you. Just remember that the people you talk to on this forum are usually ones who have NOT had a smooth recovery. Good luck!

Janet
Posted by EngKnee (EngKnee), 9 April 2004

Thanks Janet, I sure hope I don't have similar results to yours as it sounds like a living hell that you've experienced.  My OS hasn't given me the least impression of this outcome which has me worried a bit.  But it may be that it is a completely different set of circumstances in that my tendon is the lower one and it evulsed from the knee cap itself, not sure if that has any bearing on it or not.  I sure hope my recovery is more timely than what you experienced for I will have to go back to work at some point in the next year I'm sure.  Thanks for letting me know how to find stuff on this board, I appreciate it very much.  I will let you know how it turns out if you want, I am looking forward to recovery as this injury is very painful while in limbo. John C.
Posted by Nigel (Nigel), 11 April 2004

Hi EngKnee, just read your posts about your patellar tendon repair in last few days. Hope it's going well post-op. I ruptured mine completely one month ago, below the patella. I'm 45, about 165lb. Was repaired in France (I'd been skiing there), with neutralisation wire loop put in. I'm now back home in UK. French rehab protocols seem more conservative than here...French surgeon wanted NO motion for 4 wks then very gradual passive movement. But Brit ortho consultant prescribed physio from 3 wks and I've quickly managed to get to 90 degrees passive flexion. Subjectively, I'm really glad I've been able to get moving early rather than waited 4-6 weeks when I'm sure everything would have locked solid. Very little pain now and starting to put a little weight on the leg (not supposed to, though!). I'm feeling optimistic about outcome although I know it will be frustrating when I get into the real PT phase. Hope that encourages you at the stage you're at, let us all know how you're getting on. What kind of work do you do (or is the user name a giveaway)?
Cheers! Nigel.
Posted by EngKnee (EngKnee), 11 April 2004

Nigel, thanks for the reply to my post, yours was encouraging and I will try to experience it too with the help of the OS and god.  I go under the knife tommorrow morning and don't expect much to happen for at least a week or so since I won't be able to move the knee or put weight on it for at least three weeks per my Docs orders.  I consulted another OS staff and they indicated two weeks would be enough so I guess it's open to interpretation as to the length of incapacity or maybe its the method by which each OS performs the surgery, not sure which.  I will keep this thread alive with my progress and anyone else who can share similar experiences please by all means contribute.  My OS has not recommended any PT post op but did say he would give me exercises to perform in order to regain strength in my knee, time will tell on that.  Best wishes, John C. aka engknee
Posted by EngKnee (EngKnee), 11 April 2004

Nigel, sorry I didn't answer your queries, I do work as an engineer aboard ships and don't expect to be able to work anytime soon also I was wondering what exactly a nuetralisation loop wire is, it's purpose etc., I'm not aware of that terminology.  My OS has told me that he would drill four holes in my Patellar, (kneecap) and attach the tendon with screws, not sure if it's four tendons or just one  screwed four times for extra strength. Any ideas? John C.
Posted by Nigel (Nigel), 12 April 2004

John: in my case the neutralisation device is a wire loop. One end goes through the patella and other goes through the top of the tibia (shin bone). It's to keep pressure off the tendon while healing. Looks like a bit of old fence wire on the xrays, but seems to work. Will probably need to be removed at some stage.

Sounds like your repair might be to a rupture at the patella end of the tendon rather than a mid-section break? Presumably several screws necessary as the tendon is quite wide where it meets the patella. But maybe the gurus can enlighten!?

I'm finding the swelling and stiffness decreasing daily. Ice and elevation in the evenings (when swelling is worst) helps a lot. Also massaging the knee to loosen the skin tightness. Got 100 degrees of flexion this morning! (op+4.5wks).

I have a desk job so I've been back at work since op+1wk - commuting into London has given me a lot of practice on crutches, there are an amazing assortment of stairs and obstacles on our ancient Tube (underground railway) system.

Anyway keep in touch and good luck!

Nigel in UK
Posted by EngKnee (EngKnee), 13 April 2004

Thanks Nigel, I am back at the school where I'm staying to finish a course started before all this happened.  My surgery went well, no complications were revealed to me so I assume none happened.  The rupture ocurred exactly where you assumed and four holes were drilled for that reason.  My leg is elevated with ice being applied, not sure how much good it's doing since there is quite allot of dressing over the incision for the cold to penetrate.  I had a great dinner tonite as the food in the school's cafeteria is fantastic and I feel absolutely great, what a relief!!!  My OS set me at ease before the surgery downplaying the procedure as pretty routine and also shared with me that I should have 100% movement and confidence in a four month period, that doesn't sound so terrible.  I'm very lucky to be at the school at this time since at home I live alone and it would be extremely difficult for me since I can't drive, here no worries as everything is being attended to.  I hope the worst is over and I can get on with my healing.  Keep in touch and keep the faith!  John C.
Posted by Nigel (Nigel), 14 April 2004

John, fantastic to hear your op went well, and you sound in good spirits. Don't worry if you have some down days (or weeks!) too, I've had a couple. Just take it easy as you can meanwhile.

I can well believe you'll get 100% recovery. Our kind of injury/repair, although a major op, seems pretty straightforward compared with some of the things I read about on this board. My PT was very pleased today as I'm up to 125 degrees ROM after 5 wks - 135 is considered full range I think? - although still not allowed to start any active exercises or weight bearing until 6wks when the brace comes off. Maybe that's when the fun and games will really start.

Good luck with yours!

Nigel
Posted by EngKnee (EngKnee), 14 April 2004

Nigel, you were right about good days and bad days last night was a tough one for me as I think I overdid it on my knee and boy did it let me know.  Swelling and pain increased as I was going in the rack for the night so I remembered to elevate the leg with a pillow and put more ice on it so I could at least get some sleep. Today much better but I won't be taking anything for granted any more.  the wire loop you have in yur knee, do you have to have that removed? I think yur ROM is fantastic and I only hope to have that kind of motion in the weeks to come.  I have to go back in about 8 days to get the staples removed, nothing until then just rest and elevation I guess.  What kind of pain medicene were you on?  I'm on percocet 5 mg and it's not very strong, at least not last night it wasn't, I've been eating them religiously every four hours and it helps quite allot.   The weather here is bloody awful, almost as awful as the speech by our president bush last night, that's enough to make you sick.  Hope all is well with you. John C.
Posted by Rosbif (Rosbif), 15 April 2004

I completely ruptured my Patella tendon (mid) at the end of January. Was able to put some weight on it a few days after the op and bagan passive flexing on a CPM machine at the same time. Think that was the key to getting good ROM.

went back to work after 5 weeks. before that it was just too painful.  Still having problems at work with my kee swelling and muscular problems due to my leg being straight out all day. Think this is because I was given the cheap option of a lightweight removable cast. Think a hinged post-op brace would have been better, but I didn't have the choice.

Now 11 weeks post-op with good ROM (don't know how much) and just 3 more weeks to go before i can finally get rid of my immobilisor.  

Things do improve. I'm now walking at home without my cast. The key to recovery is doing you PT exercises to get your quads going again. Don't give up, at first nothing will happen, but they will come back.
Posted by EngKnee (EngKnee), 15 April 2004

Rosbif, misery loves company I guess, I think it's great that we all can share our experiences here on this bullletin board, it's so helpful.  I see you are from Germany and I find it very interesting that methods of recovery do vary somewhat dramatically between docs.  I am not even a week post-op so I don't have any experience to share on recovery just yet but I do know that you have to keep it elevated and rest it as much as possible during this critical time because the more I try to do the more pain I have to endure, so it's all about rest and elevation at this point for me.  I have been told I have a four month recovery for full range of motion and confidence which in my line of work is very important.  Sounds like you are doing well despite the cast and are on the road to full ROM, good luck. John C.
Posted by Rosbif (Rosbif), 15 April 2004

I certainly wouldn't recommend the German system (I'm English working out here). I had to wait 4 days post-op before I spoke to the OS to find out how it had gone. This only hapenned coz I pestered the nurses.

I would certainly recommend getting a CPM machine at home (if your OS allows this). This really made a big difference to me.

i'm just hoping to get back playing hockey by Autumn.

hope your recovery goes well

Tony


Posted by EngKnee (EngKnee), 15 April 2004

Tony, not sure what a CPM machine is?  My doc hasn't talked with me either post surgery so I have to assume that all went well but it could be that he was on vacation when he performed the surgery and hasn't gotten back to the office yet, I'll have to inquire soon to find out.  Is this machine something they have in the US?  How much does it cost to rent or do you have to purchase one? John C.
Posted by kdhfrank (kdhfrank), 16 April 2004

John

I too ruptured my patellar tendon (or should I say my ex OS did it for me), yep...he snapped the sucker in half and told me 4 days later! my recovery has been long and somewhat grueling due to massive amounts of scar tissue in the joint...the new OS that took over my care was able to somehow repair the tendon damage...I dont think I have a wire loop, but he did drill holes and ran sutures through. I spent two weeks in the hospital due to this mess. I then spent 10 weeks on a CPM set at 45 degrees (that is the level of bend my knee would tolerate post repair in the OR before everything fell apart) I was not to contract my quad at all for 10 weeks and had to be non weight bearing on that leg...I also had to wear a knee immobilizer at all times when out of bed...even in shower. I am now 5 months post op, I go to PT weekly and swim 1 to 2 miles every day to increase my quad (it turned into a rubbery blubbery mess) because my knee will not bend past 45 degrees (this will be operated on by a arthrofibrosis specialist in June). My leg no longer hurts like it did but still feels weak and achey after standing for long periods of time. I returned to my job part time at 12 weeks post op and will stay at that level till scar tissue is removed in June. Post operatively I had no complications from the surgery although I do think I have some sensory nerve damage on the area below the scar. The scar has healed nicely (8 inches) and I dont experience much swelling now. Pain during the 10 weeks post op was a challenge though. Worked my way through demerol, loratab, and ultracet. I was also on bextra which I continue to take daily. Otherwise no pain meds. While I dont know the specific protocol for care post op as patellar ruptures are very infrequent, I do know that passive ROM on CPM was important as was protecting the repair by not actively contracting the quads. Dont overdue it as this type of injury truely needs time to heal...will give you plenty of time to use your laptop in bed and watch CNN (my choice for news as my feelings politically echo yours). I did experiece frustration at trying to make it to the bathroom when I really had to pee bad though, and straight legging it on the toilet is an obstacle you are probably wondering how to get around (there is no way). Anyways, take it easy!!!!

Kim
Posted by EngKnee (EngKnee), 16 April 2004

Kim

Thanks for the post and the encouraging remark to me and my stubborn-self.  I'm sorry to read your story of the bad OS and subsequent long recovery period and restricted ROM, hopefully not permanent.  I still haven't talked with my OS to see how the surgery went but I should  see by his orders that he doesn't want to see me for 10 days to remove the staples, duh, so it's probably alright.  I've had similar experiences going to the bathroom in the middle of the night, some nights on an hourly basis or so it seemed in my blurred state, haven't had an accident yet.....I have been going to class in a wheelchair with the left leg elevated and that was cleared by the OS so I guess it's ok.  Good Luck and keep in touch. John C.
Posted by Rosbif (Rosbif), 16 April 2004

Hi John,

a cpm machine is a Continous Passive Motion machine. It bends your knee for you without using the muscles. this link explains it better: http://www.bupa.co.uk/health_information/html/healthy_living/physical/knee/rehab.html

You can rent them. Think here it cost the equiv of $20 per day, but my insurance covered it. You only need it for a few weeks, just until you are able to bend you knee easily yourself. You really should ask your OS about getting one as it is essential for getting good ROM back.

By the way, how did you rupture your tendon?

hope this helps.
Posted by EngKnee (EngKnee), 16 April 2004

Tony,  Thanks for the info per CPM machine I will talk with my OS about it if I can ever get ahold of him.  I got my injury while thinking I could play some harmless pick-up basketball on a rubber surface, ie an unforgiving surface.  I was just dribbling the ball down the court and trying to be cool by not paying attention to my feet and looking around the court for someone to pass to and then Wham!! all these thoughts went racing thru my mind at once but I knew by the sound of crunching walnuts that it was more than a sprain, then I observed by kneecap being out of its traditional place and hole instead, I knew I was done playing for awhile.  John C.
Posted by Nigel (Nigel), 16 April 2004

Kim, we "tendon team" all sympathise with you, you've had a ghastly time. I can now see why the OSs (especially my French one, and to a lesser extent the Brit) stress keeping the immobiliser one for 6wks+. I've been a bit naughty this week taking it off in the office for an hour or so at a time. From here on I'm not tempting fate!

For me pain relief hasn't really been a big problem since about week 2. In the UK all the over-the-counter painkillers are combinations of aspirin, paracetamol (=Tylenol?), ibruprofen and lastly codeine which is a bit stronger but causes constipation!

By the way, how did the rest of you bust your knees? I was skiing, just hit an icy lump a bit hard in a turn and it went snap. But I'm pretty sure it was a result of a bang below the knee about 20 years ago while I was in the Army. I thought I had it finally cleared up some years back but from what I've read you can build up "microtrauma" to the tendon which finally causes the failure. A healthy tendon takes 17 x bodyweight to break. Apparently once you turn 40 you're more likely to break the tendon above the patella but still in my case (I'm 45) the previous injury was below so that's where it broke.

Here's to quads of steel for us all by Christmas!! What about a "before and after" competition?

Nigel
Posted by EngKnee (EngKnee), 18 April 2004

Hey Guys and Girls how's it going?  Not much in the way of activity lately so I figured I'd ask the burning question that we all wanted to ask, that is, how do you take a bath with a knee that doesn't want or can't be moved?  Since my injury on Mar. 31st, I've had two assisted baths, just two!! Of course I've given myself the ol "spit bath" where you just wet a wash cloth and wipe yourself down along with the occasional shampoo session daily but an honest to goodness, feel fresh and clean bath, naaah!  I've had to enlist the help of a long-time friend's wife who just happened to be a nurse, to help me with my now weekly ritual.  The fact that she's a nurse helps to keep embarrassment to a minimum and then only the first time, now I have no reservations at all to strip down and amble my way to the tub in front of her since it's all about keeping a pathetic gimb clean.  I'm sure you all have stories about this all-important aspect of recovery, by all means, share it with the group. John C
Posted by Nigel (Nigel), 18 April 2004

Re baths and showers, I managed okay. At first just leaned into the shower and at least got my head/top half done. With crutches was able to get in/out properly (but carefully!) after about wk2....blissssss!!

I think you can shower while the staples are still in (I certainly did) but they say don't get immerse knee in the bath until staples come out?

I stayed out of bath until about wk4, tried but leg was too tender without the immobiliser. But now (10 days later) I'm hopping in with no trouble. A good place to do passive ROM exercises as deepish water gives a lot of support, also a chance to massage the knee with various gunk my wife leaves around the place. Never thought I'd become Aloe Vera Man but needs must.

A week or two and I bet you'll be able to go solo. Sorry!!

Nigel
Posted by EngKnee (EngKnee), 18 April 2004

Nigel, I forgot to mention the most important aspect to my latest post, that is, the stool inside the tub, without it I doubt I would be able to get in the tub at all.  I'll be happy to be able to do it myself thank you when the time comes but until then I will enjoy the kindness of my friendly nurse.  I like it especially when she does my feet, incredible stuff   John C
Posted by Rosbif (Rosbif), 19 April 2004

I ruptured my tendon whilst waiting for a taxi. I was stood between 2 friends, next moment I'm on the floor after some drunk went flying into the back of my knee. think his shoulder connected with my knee. Unfortunately he wandered off before the Police arrived so I can't sue. My knee was around to the side and I couldn't even stand on my good leg as the pain was so bad.

ref showers - I started off with a bin bag around my cast, but after a couple of weeks started showering without my cast and just being very very careful. Luckily I have a very low shower basin.

My hospital was on the most famous gay street in Hamburg.
On my first morning in there a very effeminate male nurse came in with a wash basin asking if I wanted a bed bath. I politely but very quickly declined  .
Posted by Nigel (Nigel), 22 April 2004

EngKnee/John,

Just seen the ortho at 6 wk point. Good news is he's okay'd me to lose the brace, start active PT and go to full WB as soon as I can bear. I've got 130 degrees of ROM which he said is extremely good at this stage. Quads are shot to hell of course which is to be expected...I can't even lift my heel off the ground when I'm sitting down with leg straight out! Amazing.

Only bad news is he said they need to open the whole knee up (top to bottom) again eventually to take the wire out. Bit of a bummer as I thought it could be done with arthroscope. Wire can stay in if it causes no trouble but apparently they often break eventually.

How are you doing?

Cheers, Nigel

Posted by EngKnee (EngKnee), 22 April 2004

Nigel,
Great News except for the extraction procedure which I was wondering about earlier.  Tommorrow I get my staples removed from the knee so that is some progress I guess.  I too have trouble lifting my ankle off the ground when lying down and I was wondering if I am able to try to work that to the point where I can do it more easily lest I can't do it at all.  I'll have to inquire tommorrow about that.  Looking forward to getting out this weekend, plan to go to a Redskin party where I'll be able to oogle the cheerleaders and get my picture taken with the super bowl trophies, big deal for me.  Might even try to sneak a trip back home in WV to check on the house......I don't want to try too much just yet.
John C.
Posted by Nigel (Nigel), 22 April 2004

John - they didn't let me do any active leg lifting until now in case I pulled the tendon repair apart. Maybe another example of different protocols in different countries. I think US medics favour aggressive early rehab where possible and I have to say that might be right for a lot of people. I've been pushing the boundaries of what they've said I can do, and so far got away with it.

I've just tried walking without crutches this afternoon, and I can just about manage it...sloooowly.

Should be more comfortable after your staples come out. Then you can start loosening up the skin over your kneecap.

Redskins? - you in DC, then?

Nigel
Posted by EngKnee (EngKnee), 22 April 2004

Nigel
Yes I'm a hopeless Redskin Fan, I live pretty close to DC when I'm home and now that I'm in Md. on the eastern shore I'm only about an hour and change away from the stadium.  They are having open house on Sat. where we can meet the players, coaches, cheerleaders et al and enjoy Draft day where we get the fifth overall pick from the nation's best collegiate footballers.  I'm looking for big improvement this year with Coach Gibbs coming back and a bunch of talented new players.  I've got to get out some as this knee business is very boring to my usually great social life.
John C.
Posted by Janet (Janet), 23 April 2004

I'm so glad your surgery went well. You still have a long road of rehab ahead of you, but it's great to hear things are going well now. Dont' be surprised if you have good days and not so good days, encouraging days and frustrating days. One day it will all be worth it.

I had trouble in the shower because I couldn't bend my knee at all. After a couple of weeks of sponge baths and washing my hair in the sink, a real shower felt so good! I would just go in with my crutches. I couldn't never take a bath because I couldn't get in and out of the tub.

As for me, I ruptured my (quad) tendon with a simple fall on a wet floor at work. I went down in a hurdle position with my leg bent behind me. I was able to get up and walk with pain, and I think I tore it all the way when I tried to go downstairs to get to my car. I'll never again laugh at those stupid commercials: "Injured in a slip and fall, call (some attorney)"!

Janet
Posted by Rosbif (Rosbif), 23 April 2004

Nigel,
Not being able to lift your leg straight up is a little alarming at first, but after a couple of weeks of PT you'll be able to manage it no problem. I'm 12 weeeks post-op and now gradually increasing the weight in my ankle weights for the straight leg raise. Although I still have to wear my immobilsor when not at home. Seeing OS on Monday, so hoping I can get rid of it.

Pity about the wire removal. My OS used a dissolvable wire, so no need to go in and remove it. Apparently it should dissolve completely in 3 months.
Posted by EngKnee (EngKnee), 23 April 2004

I wonder why on earth one doc would use a dissolvable wire and another would use one that doesn't so he has to go back in there and remove it, doesn't much make sense to me. Maybe they have an explanation of  it that would satisfy even the harshest critic. I go to get my staples removed today so maybe my doc will let start doing something except what I'm doing which is absolutely nothing.  This helpless feeling has got to start to go away or I'm going crazy    My class here in Md. ends in two weeks at which time I'll have to figure a way to get back home to WV. that should be a royal inconvenience to somebody close to me.  Hopefully someone will have the day off so they can come and rescue me.  When I get home I'll have a whole bunch of new obstacles to hurdle in that I live in the country and I won't be able to drive. This should be fun.  John C.
Posted by Rosbif (Rosbif), 23 April 2004

John, before my surgery a junior doctor told me they would have to remove the wire after 3months. However, when I spoke to the OS after the surgery, he told me that he had used the dissolvable wire so that wouldn't be necessary.

I know all about inconvenience. I live on the 4th floor of a 100 year old apartment building. NO LIFT . The quads in my good leg are now huge from going up and down all those steps with my immobilisor on. Think when my immobilsor comes off I'll be walking in circles.
Posted by EngKnee (EngKnee), 23 April 2004

Rosbif aka Kim I think,  That is incredible what you've endured on crutches, I can't even imagine trying something like that but if I had to I guess I'd just do it like you did, amazing stuff.  I got the staples out just a couple of hours ago and was fitted with a new adjustable brace, set at zero of course, so I feel like I'm finally making some progress.  Also he surprised me by saying it was OK to put weight on the knee as long as its straight, so far I haven't really put much on it because I'm not used to doing it yet but I will try a little at a time until I feel comfortable. It feels abnormal to put weight on it now, imagine that.  Little steps add up to normality I hope.  The tough part for me now is to try and not put on any extra weight as I'm not doing any exercise to burn it off.  I'm sure I've put on at least 10 pounds in the last month and I've got to stop having sweets like ice cream and brownies.  Now where is my nurse I need a bath badly. John C.
Posted by Nigel (Nigel), 23 April 2004

I LOST weight post-op, I think it was being out of reach of the snacks for a while!!

John, I too was chewing the carpet at your stage at not being able to get about. But within a week or so of that I found I could get in my wife's car and, (a) because it's an auto transmission (unusual here in UK) and (b) because it's my left leg that's hurt, I could actually drive it! Well at first I couldn't because it was just too uncomfortable, but by slackening off the top straps of the immobiliser and tilting the seat forward I could fit. Hope you have the same experiences.

Rosbif, what exercises did they give you for quads (and which do you think worked best)?

Nigel



Posted by EngKnee (EngKnee), 27 April 2004

 Hi All Hope everyone is doing well, at least as well as I am today   What a difference a day makes, last fri. I had the ol' staples removed and the Doc gave me the goahead to put weight on the leg so I very gingerly took his advice and started to put some weight on it, it felt real stiff at first, as to be expected I guess.  On Sat. I went to the Redskin Draft Party at the stadium near DC and I walked and walked and walked to the point where I was tired but didn't feel the least bit of pain at that point, so I walked some more.  All told I probably walked over a mile, all over the stadium, the field, the parking lot for over a five hour period, I did rest some but for the most part I was on the go all day.  It was tough to keep up with the cheerleaders but I tried my best  On Sunday I woke up early expecting alot of pain and discomfort and lo and behold I felt great!  I then took Nigel's advice and tried to get into my Truck, very gingerly at first but I did it and it felt absolutely wonderful to be able to go somewhere on my own for the first time since Mar. 30th.  I was fitted with the adjustable brace this time set at zero position and will have to keep it at this angle for four more weeks until end of May.  The Doc didn't recommend any exercises at this time but I feel like I could probably do some but haven't tried too much yet.  Life is good again!  John C.
Posted by Rosbif (Rosbif), 27 April 2004

Good Morning, Unfortunately I injured my right leg so driving is out. Also I drive a manual so it wud be a bit tricky. Think I really got a bad deal with having a cast instead of an adjustable brace. Spend half the time in my physio sessions just trying to release some of the tension from the muscles in that leg, from having it straight all day (now for 13 weeks).

For quads I'm now doing a lot of straight leg raises with ankle weights. Full arc extensions are still a bit too painfull and difficult. Hope things will improve after the end of this week when I remove my cast for the last time.

Rosbif (Tony)
Posted by Rosbif (Rosbif), 29 April 2004

Will finally take my cast off for the last time tomorrow.

Saw OS on Monday. He had a look at the knee, got me to walk a bit without the cast and said it was ok to get rid of it. But then looked at his notes and saw that the OS who did the op, had put 14 weeks post-op with cast (until 6May). So the OS changed his mind and said keep it on.

Its really a bad system here in Germany. I wasn't able to choose the OS coz it was an accident and was taken to the hospital by ambulance. But you cannot see the OS who did the Op after you leave the hospital. The new OS didn't really seem interested, I guess because he didn't do the op.

Anyway I've had enough of wearing the cast   and its coming off.
Posted by EngKnee (EngKnee), 29 April 2004

Way to go Tony, there is hope after all.  My new found freedom is great but my knee still looks terrible, all hard, swollen and numb to the touch, is that the way your was?  I walked all about an old Coast Guard Cutter today in Balt. while on a field trip with my class and was able to get around pretty good without crutches, just the slow careful limp.  My leg looks wierd with my calf muscle almost nonexistent and flab on my thigh up to my rock hard knee, looks totally different from the good leg.  It's still great to be driving though, will try to get home to WV this weekend to check out the homefront. John C.
Posted by Nigel (Nigel), 29 April 2004

Hi Tony & John, glad to hear everyone gritting teeth and looking forward to being brace-free. I've been a week now - they said I should wean myself off it but I threw it straight under the bed and there it stayed. Been to the gym and doing static cycling and rowing machine, quad muscle tells me "you're having a laugh, aren't you?"

Just had this snippet on an email from an old family contact - I told him about my knee and here's what he sent back:
Posted by Nigel (Nigel), 29 April 2004

...continued (sorry hit the alt-s by mistake!):

"I remember my grandfather showing my sons his left knee cap which was liberally spread about his knee. As they marvelled over this he told them that he had been kicked by a horse when he was twelve. They asked what he did next, to which he replied "Went on to school - couldn't afford the doctor". Tough or what? The strange thing was, even at 89 years of age, that knee was completely mobile with no hint of arthritis. Perhaps we should all be kicked by a horse now and again!"

Best, Nigel
Posted by Rosbif (Rosbif), 30 April 2004

Hi John, yes my knee was very swollen and numb for quite a few weeks after my op. Still a little swollen and a small numb area, but it has improved a lot. My quads turned to mush but didn't have any problem with the calf muscle.

Did u have any luck getting hold of a CPM machine?

seems you a lot more mobile than I was at your stage.
Posted by Nigel (Nigel), 30 April 2004

I suppose none of us are going to win beauty contests at this stage. My knee seems to stick out further than it should and when I get tired it feels like the kneecap is overhanging and, well, drooping. I wonder if that's because the quad muscle isn't strong enough to keep it held up? I did some static cycling and rowing yesterday evening and this morning knee felt really good and tightened up, but this evening..drooping again! Anyone else the same?

BTW can't do straight leg raises at all yet, let alone with weights!

Nigel
Posted by kdhfrank (kdhfrank), 30 April 2004

Nigel

actually i must admit...my scar is quite beautiful...for a scar. thought for sure it will be ugly with a zipper like appearance from the staples...but alas, it is very nice, almost invisible...(i am a nov. 03 patellar tendon rupture done by the hands of my old fired OS)...anyways, yes my quad is still mush compared to the right leg yet i am limited in what exercises i can do until my arthrofibrosis procedure is done in june. i think (as explained to my by cincinnati sports medicine) that quad atrophy does cause the knee cap to ride lower due to the shortening of the patellar tendon. it was stressed to me to get back in the water (i am a recently retired competitive swimmer) as kicking with fins will help build up the quad and keep the knee cap from being pulled lower (this is called patellar baja)...seems the expert on this is heather m. on the forum...you can usually find her posts in the soft tissue healing area. my pt also told me of an exercise to build up the VMO. take a small ball and place behind the knee and stand against a wall (heels to the wall) and press back into the ball...you will feel the burn...great exercise and low impact...i would take it easy on major flexion exercises and high impact so as not to cause further problems if your knee cap is riding low...hope this helps!...i can feel my quads getting stronger daily by swimming 1 to 2 miles every day...and yes i could not do straight leg lifts at first either...and then it just happened!

kim from atlanta
Posted by Nigel (Nigel), 30 April 2004

Kim, thanks, that's really interesting. Not sure what the VMOs are but I gather part of the quad muscle?

I've been lucky enough to get back good ROM (now virtually full) quite quickly post-op, so that has tempted me to start high flexion exercises like rowing machine - but maybe I should take it easy on that. My PT recommends slow static cycling with the seat height set slightly low and a high-ish resistance setting to work the quad. I'll definitely try that ball-against-the-wall trick (if I can find one the dogs haven't chewed). I can believe swimming would be good, it's just never been my thing. Maybe I'll just kick a bit in the bath.  

Nigel
Posted by kdhfrank (kdhfrank), 2 May 2004

nigel

the vmo is the tear dropped shaped muscle (very noticeable on bikers). it is that muscle above the knee cap on the medial (inside) part of the thigh...this is how i can best explain it. i think it helps with patellar tracking and stabilization and thus is very important, ask your PT or OS about it...especially since you sound like your knee cap is moving more that it should.

kim
Posted by EngKnee (EngKnee), 2 May 2004

Kim, Nigel, Tony, Janet et al,  This thread continues to amaze me in it's helpfulness to those afflicted with our plight, I for one am learning all sorts of information about things that we took for granted and assumed would take care of itself.  Lately I have noticed a noticeable improvement in my knee, topically speaking, I have used vitamin E liquid on my scar and have seen the lines of the scapel become less and less visible.  The pain has subsided and last night I even slept peacefully without my brace fully cinched up for the first time.  When we all get over the hard part which it seems like most of us have, we will have a new understanding of the importance of the muscles surrounding our knee and in all liklihood we'll be paying more attention to those muscles in our daily workouts.  John C.
Posted by Nigel (Nigel), 2 May 2004

Kim, many thanks for the anatomy lesson. I see what you mean now. I tried the exercise with the ball and will keep at it even though (because?) it hurts!

My knee cap seems to have tightened up and lifted in the last couple of days and I now have some quad function (ie I can actually lift my heel about 12 inches when seated). I've read others on KG saying their quad started to wake up all of a sudden after a few days of exercise, and that's exactly what's happened to me.

Today I stomped around all day without immobiliser, crutches or safety net. A bit Grinch-like, but a huge improvement. Fanntushhticc. As of yesterday I can climb stairs unassisted, just like real people, but I still have to come back down one at a time. What a difference a few days makes once you're out of the *%^$# immobiliser!!

My only niggle is a pinching pain at the top of the inner calf, an inch or so below the knee when I flex it. Feels like something sharp-ish is trapped inside. I don't think it's the wire in there, feels like slightly lower down. Real bore. Hoping it will go away.

You're right John, what a great board. Almost worth busting a knee to find it...   But seriously, it makes me realise how much some people have to put up with. Now I know I've actually had it pretty easy. Touch wood. ANyone skiing next season?

Best to all, Nigel
Posted by Nigel (Nigel), 8 May 2004

Hey chaps, how's it going? I had bit of a setback a couple of days ago, had to hit the painkillers and frozen peas for about 24 hrs, knee swelled right up. Medics x-rayed me to see if wire still in place - apparently yes, and my knee has since got much better, so a bit of a result in the end. They say I probably just over-did the exercise and paid a price for it. Just thought I'd share that in case anyone else has same experience - I suppose while things are still healing you have to be aware it's still a delicate state even if it feels stronger. But, as ever, a bit of rest and ice work a treat if you hit a snag.

Have a great weekend.

Nigel
Posted by kdhfrank (kdhfrank), 8 May 2004

Nigel

I told you guys to take it easy! remember...I am the furthest out post op (and the only girl) I think. This is  a slow, long and difficult recovery process due to the severity of this injury (remember, there are very few of us world wide who are members of this club). Your quads will come back...just takes time. I still think your doc screwed up by putting a wire in that has to come out, mine was disolvable...too much risk for infection to have to reopen...and I wonder if this might not slow the healing process down. I would certainly discuss this with your surgeon. Cheers!

Kim from Pennsylvania by way of Atlanta
Posted by Nigel (Nigel), 8 May 2004

Well, that's me properly told off...but listen to Auntie Kim chaps, SHE KNOWS!!!


Dissolvable wire!?? That's the kind of thing that put Americans on the moon! Over here we're lucky if we get an old piece of coat-hanger. But actually, Apollo 13 is one of my favourite films ever (I'm a Tom Hanks fan anyway).  The bit where they fix the carbon dioxide scrubbers with duct tape and old flight manual covers is priceless. Maybe it's a guy thing, sorry Kim.

Take care.

Nigel
Posted by Rosbif (Rosbif), 10 May 2004

Hi guys, back after a week holiday and a week without my immobilisor. Had to take it easy and use my crutches for the first 5 days just as a safety net. Had a couple of major buckling incedents so it was I good job I had them. Been without crutches since Friday. No problems but still have to take stairs one at a time (I live on 4th floor (believe that is the 5th floor in the States?) with no lift).

Makes life so much easier not having to wear the immobilisor. Knee still very weak, swollen and loose, but gettin there.

Tony
Posted by Nigel (Nigel), 10 May 2004

Tony, wie geht's?? Glad to hear you've taken off the stabilisers. Remember not to go on any of the big roads without a grown-up.  

Take it easy.

Nigel
Posted by Rosbif (Rosbif), 10 May 2004

Thanks Nigel. Think your german is better than mine.

Got rid of the stabilisers, now just need to lose the "Slow Moving Vehicle" sign off my back. Think a bit of time in the gym and swimming pool is called for.

Posted by Nigel (Nigel), 10 May 2004

Yeah but remember to add ballast or something to the good leg or you'll swim round in circles.
Posted by EngKnee (EngKnee), 10 May 2004

OK guys and girls, I've been away as well and apologize in advance for my inattention to this forum but allot has happened in my absence I see  Glad to see that people are up and around and I am happy to report the same as today marks the first time that I'm walking without my brace and my first foray into the shower without a brace or assistance, what a relief Of course it's still swells up on occasion and I have to rest it from time to time but I am sleeping without the brace as well and that is much more comfortable.  I don't go back to the doc until May 25th for the initial adjustment but I plan on being ready for that by testing my confidence and mobility in the meantime, very slowly.  John C.
Posted by Rosbif (Rosbif), 11 May 2004

Hi John, Nice to see you're improvin. Sleeping without the brace really is a big improvement of quality of life. I started doing without OS approval, I'd just had enough of sleeping with my cast on.

I tried a couple of stairs in the normal way yesterday. i.e. not dragging my bad leg up. Felt extremely odd and un-natural. Anybody else had this feeling?
Posted by EngKnee (EngKnee), 11 May 2004

Tony, I think it's great that you are able to get around as much as you do and that you are doing stairs without your brace, I'm having a hard enough time just getting around the house, all on one floor mind you, without my brace and feel very funny trying to do the steps without the brace.  My concern is that since we are doing this w/o OS orders are we doing any harm by this?  I noticed four holes or indentions in my knee, are they where the holes were drilled in my kneecap?  They are located on either side of the incision and seem to be evenly placed vertically along the scar.  I know it's going to be extremely difficult for me to bend when the time comes but I can't wait to get on with this.  John C.
Posted by Rosbif (Rosbif), 11 May 2004

John, I'm quited amazed you haven't started bending you knee yet. I was started on passive bending 2 days after my op.
Posted by EngKnee (EngKnee), 11 May 2004

Tony, that is incredible as I can't even imagine trying to bend my knee that soon but I was told not even to put any weight on it as well so they were really taking it easy, maybe because you had the wire insert you were able to bend sooner, not sure why but that sounds like a possible.  Maybe some of our other posters will share their experience on this.  If you were bending then I guess me walking on it w/o a brace is A-OK.  We haven't broached the subject of injured-knee sex yet but I find it quite annoying sometimes when I can't do what I want and have to patiently await my partner's whim in order to feel like I'm part of the equation if you know what I mean, kinda detached but still enjoying every minute of it, gimps need love too!!!  It's real tough to remember what it was like to have a good knee at this point maybe it will be different once I start bending but right now I can't even think about the pain associated with that first bending motion and how is it going to be effected, the OS?  John C.
Posted by Nigel (Nigel), 11 May 2004

John - I'm also surprised they haven't got you doing knee flexing yet. Like John I was started on passive flexing early on - though in my case 3 wks not 2 days!

Passive flexing is bending your knee leg using your hands, or gravity, rather than with the leg muscles. I would definitely press your OS on this as you can't do much to walk properly until you have at least 90 degrees range of movement (ROM). The longer you leave it, the longer it will take to get the ROM.

By the way I think knee-bending and weight bearing are completely different things from a rehab perspective and it doesn't follow that if you're okayed for flexing you also have green light for WB. Anyone explain this better?

Tony - know what you mean, stair climbing feels definitely a bit "floaty" and I have to go up quite quickly keeping a rhythm. Which is probably what you'd do if you had two good legs.

I'm now commuting on the trains/tube into London every day with just a stick (cane) as a security blanket and it does help a bit on the stairs. Also can cut a dash with it around the office - my childhood hero was John Steed in the Avengers (Tony will know) with his sword stick/umbrella. I can walk almost normally at a slow pace, but when I speed up I'm still lame. Feels like the kneecap is "heavy" which I think is just lack of quad strength. But improving.

Finally, re the sex positions question John, I'm not going there on this thread...but maybe you should wait until you've been okayed for active physio!   John Steed would have laid back and thought of England.

Nigel
Posted by kdhfrank (kdhfrank), 11 May 2004

You boys are bad!!!  Attempting stairs without your (cast?)...do you mean immobilizer (neoprene thingy with velco straps and a hole in the middle?)...your quads are most likely atrophied to the point of a raisin, thus you are lacking the support, strength, and stability of you knee...the potential for buckling is significant and thus could end up rupturing the tendon all over again. You do not want this to happen again, do you? the stairs are not going to speed up the healing process or build the quads...do the excersises, go to PT, get a cane...this you can use to steady yourself if you must go up the steps without your brace. Do the ball against the wall exercise, Estim (hurts like a mother...) and leg lifts...be good and follow your instructions! again I must point out...sounds like a huge difference in post op care...this could be because most O/Ss have never taken care of patients like us. I was put in a cpm right in recovery from the surgery...set to 50 degrees, 24 hours a day for 10 weeks (mostly at night the last 4 weeks)...out of bed I was totally non weight bearing. Sitting on the potty sucked as did sex (sorry but not fun for me)...I did not ask my husbands opinion. I now walk unassisted, swim 2 miles a day and should have my full flexion back after my procedure in June at Cincinnati Sports Medicine...but I have learned to be PATIENT!..and yes, I am back at work as a nurse practitioner chasing little kids with tongue depressors and needles. So your futures also look bright. I was even told I shoud be able to resume most athletics I did prior....think I will give up skiing and jogging though...but I cant wait to get back on my bike...and yes, I can chase my 9 yr. old around and almost catch him...we actually have races up the stairs to the shower...and it is a lot of fun. He usually beats me but I almost catch him. I think the holes next to the scar (not sure which of you chaps this is) might have been where there were drains placed post op. Do you remember this in your post op drug induced haze? I cannot see where the wires were run through my knee at all, but I did have 2 drains  into my knee post op for about 5 days...maybe this is what the scar is. Hope this answers some questions...and remember Auntie Kim knows best!
Posted by Nigel (Nigel), 11 May 2004

Kim - what's Estim??

Nigel
Posted by Rosbif (Rosbif), 12 May 2004

Nigel, Estim is Electro Stimultion. It uses electric pulses to stimulate the muscles. Not supposed to be much use unless you are doing your quad exercises at the same time. I haven't tried it.

Kim, about 4 days post op I was put in a Neofrakt lightweight polyurethane removable cast. http://www.neofrakt.com/introductie_neofrakt.htm

think the hospital used this because it was cheaper than using a hinged immobilisor.
I'm still doing stairs the crippled way. I've tried 2 of the about 70 stairs upto my apartment in the normal way. I didn't feel any pain, but it did feel odd. I've seen some advice to start practising stairs by using a couple of phonebooks to step up on to and then build up to stairs later. Tried it last night and it does seem to work. Pity your thinking of having to give up some sports. I'm hoping to get back playing Field Hockey goalkeeper, but think I have another 3-4 months minimum before I can try.
Posted by EngKnee (EngKnee), 12 May 2004

Auntie Kim, Nigel, Tony et al, I am really confused and surprised at the discrepancies in our individual programs.  Could it be that our injuries were that different?  My rupture was at the kneecap to the tendons that secure the lower leg and I believe yours were to the upper, also my tendons snapped right at the kneecap while some of yours snapped mid-tendon, this might be an explanation as to the differences not sure.  I am concerned enough to begin the question my OS's post-op care and will give him a call sometime soon to see if he can help to assuage my fears.  I hope I don't need my OS's opinion on everything regarding my day to day existence, I'm from the old school that states if it feels good, do it!  cheers John C
Posted by Rosbif (Rosbif), 12 May 2004

John, my rupture was also below the knee. Not sure exactly as the OS was not exactly forthcoming with information.

Did you have the same op? Tendon sewn up and holes drilled through knee cap and leg for a wire loop. If it was you really shud speak to your OS about getting a CPM machine. I have basically got full ROM now, which is mainly thanks to the machine.
Posted by EngKnee (EngKnee), 12 May 2004

PT Crew, I just spoke to my OS and he indicated to me that it was his experience to let the tendon fix heal for a while before he starts bending, just his way I guess.  He wants the repair to have a chance to gain integrity before we bend it. He said the tissue remodels to gradual stress and I quote.  He also was very pessimistic about me walking around without the brace but I assured him that I was being real careful and not overdoing it to which he said that he doesn't want to have to repeat the procedure.  I forgot to ask him some more questions as we do when in that situation, I wanted to ask him what he thought of me going into my hot tub?  Part of me thinks its ok and another part says no way, what do you all think?  Here in West by god Virginia it's hot and humid already, kinda like summer makes me want to get out and play, NOT. John C.
Posted by Nigel (Nigel), 12 May 2004

John, very dangerous for me to comment as an amateur, but I have to say it sounds like your OS is being ultra conservative. This surprises me as even my French OS was happy to go to 60 deg of flexion after 3-4 weeks (although admitedly protected by a wire), and I actually went to 90 deg+. I wouldn't suggest you go against advice, still I am surprised nonetheless. But, as Kim stresses, it will be VERY important to do any exercise in a controlled way as part of a PT programme, not just hack around and put multiple and inappropriate stresses on an unstable joint.

Have you read the Annunziata & Ignacio paper on PT repair on eMedicine? If not I REALLY recommend it. See
http://www.emedicine.com/orthoped/topic246.htm .

In particular they say: "Multiple authors recently have attributed an earlier return to preinjury activity to a more aggressive rehabilitation program with an emphasis on earlier range of motion." Note that's ROM (ie passive flexing), NOT weight bearing.

I can't imagine that the hot tub would be a problem. Wish we had one. I think for sports injuries generally it's recommended to alternate ice with local heat, which all encourages drainage and circulation. Anyone help with this?

Cheers, Nigel
Posted by kdhfrank (kdhfrank), 12 May 2004

Guys

I too am a below the knee cap tendon rupture. I also have an extremely conservative O/S who took over my care after the O/S who ruptured my tendon and was mmediately fired. My O/S repaired the tendon (I also had massive amounts of scar tissue everywhere from the scope last August...you can read my sob tale under crisis in late November of last year. After he did an inital suture job they then flexed my knee to the point where the repair came apart (45 degrees) at this point they did the permanent repair and kept me on CPM up to 45 degrees, he was concerned that if not kept moving more scar tissue would develop. but did not want to jepordize the repair.  Remember that the CPM provides passive ROM so does not contract the quad like active ROM. The Estim was started at 10 weeks post op when I was cleared to start PT (I told you he was conservative)...it was basically to wake up the quads and get them firing again...I only did it 3 times a week for 4 weeks at PT...once I could do a straight leg raise on my own we stopped the Estim.  I have a jet tub jacuzzi in my house and looked forward to my soak. I just had to figure out how to get in and out when no one else was around...no swelling after, and it felt good to just let the leg float (I had no open wounds at this point). Applied ice pack after. While my case may be different then some of yours my recovery was based on the tendon healing (and it is the same tendon that you all are dealing with)...scar tissue would be addressed later...that is why I am having more surgery in June in Ohio. My O/S consulted with this specialist once it was determined that my joint was bound down by this. My rupture was an iatrogenic injury unlike your many sports related injuries and thus complicates everything, but none the less I feel my tendon is now as strong as it was before...I followed my O/Ss plan very closely...he actually had me terrified that if I even went to the pool to watch swim practice I could rupture it again if I slipped on the concrete. I also read the article posted in email above and printed it out. I think the caution stressed is that even once the tendon is healed the quads are weak and thus may cause buckling of knee and injury to the repair. My Pt also has me stand on a step with my affected leg while other leg is about 6 inches above the ground and I do reps of flexing in sets of 5. I also have a giant rubber band attached to a stairway railing that I put my affected leg in and do lateral crossovers against the resistance. I am fortunate to have a gifted PT. I honestly think that a good PT is quite important and if you are seeing one who isnt doing 1 on 1 with you for an hour, then you should find someone else. Hope this answers some questions.

Kim
Posted by Nigel (Nigel), 13 May 2004

Hey guys, walking practically normally today without support or a limp, provided I don't go too fast. Downhill is a bit shaky.

This evening at home I must have forgotten I was a cripple for a second and tried to leap up the first two stairs in one! Soon realised my mistake  , but it's nice to feel mobility is coming back fast.

Hope all's well with all.

Nigel
Posted by Rosbif (Rosbif), 14 May 2004

Hi Nigel, sounds like your recovery is going very quickly. I was operated on end January and am only just starting to do the odd stair upwards in the normal manner. Havn't even tried going down stairs normally yet.

I have developed a bit of clicking in my knee which is a little worrying. Hope your recovery continues.

Tony
Posted by Rosbif (Rosbif), 14 May 2004

Nigel, forgot to mention. Think your were very lucky having your op in France. The health system there is excellent. I lived there for five years and was treated for a badly torn calf muscle.
I went straight to see the doctor from the local first division football club. He had a radiologists and PT in the same building, so he was able to organise everything immediately. It was a cheaper and far better system than here in germany.
Posted by EngKnee (EngKnee), 17 May 2004

Tony, Nigel, Kim et al, just got back from a weekend jaunt to Boston to witness my daughter's graduation from college and was happy to read the latest posts upon my return, sounds like everybody is doing well on their respective recoveries.  I too am fairing pretty good as I was able to get thru airports and cabs and even the subway system without too much trouble, those coblestone streets are kinda tough though.  My knee looks almost normal with little swelling lately and I was able to raise it one time without thinking about it in the forward direction without pain or discomfort.  I guess time will tell on my complete recovery but as for now I'll have to trust the horse I've chosen to ride and make it to the finish line intact.  Keep up the good work folks. John C.
Posted by misslover (misslover), 18 May 2004

i know how you feel i have all these questions myself as i am going throught the same now i have my operation the beginning of june except my operation is on both my knees! as i am only 17 i did not understand all this talk so can i ask a favour could you please let me know how yours went as i would like to talk to someone who has been through it as i am so scared!! thank you good luck and i hope it goes well
Posted by Rosbif (Rosbif), 18 May 2004

Hi Misslover, welcome to the patella tendon cripple section. My op went fine. Woke up after it, with a bit of pain but nothing over the top that a few drugs couldn't deal with. I can't imgine what it would be like to have both knees done at the same time though. I had my leg in a removable cast for 13 weeks and relied on my good leg for going up/down stairs etc.  It will seem as though your leg(s) will never work properly again for a few weeks after the op, but then you will hit a point where you get massive improvements (probably after about 7-8 weeks). Don't let it get you down and just make sure you get a good physio and put lots of work into getting your muscle strength back. Hope it all goes well and don't worry too much about it . Tony
Posted by EngKnee (EngKnee), 18 May 2004

Misslover,  Love the name but don't envy your position at all with your knees, both of them, to be operated on.  None of us on this thread has had that situation but we've all experienced different bouts of treatment, I used to be the rookie knee person, now you are, welcome to the club!!! How did your knees get hurt?  Where are you located?  We have folks on this thread from all over the world.  Tell us a little about yourself and you can read the five previous pages to learn who and what we are about that will bring us all up to speed.  Hang in there and I hope you become a regular contributor to our message board.  Good Luck, John C.
Posted by Nigel (Nigel), 18 May 2004

Hi Misslover, welcome to the team!

Had any kind of op before? If not it's nothing to be scared of. Having had both general anaesthetic and epidural (lower body pain block) myself, I've found both ways actually quite relaxing, although the epidural is pretty weird because you can feel the operation going on but no pain whatsoever...promise!

It might be a shock how big they make the cuts to do tendon repairs. Will look a bit scary when you first see the scars, staples/clips and all. Don't worry, it looks gruesome at first but heals quickly and the scars should virtually disappear after a while. Be prepared for a LOT of swelling, makes your knees look like balloons and "all wrong" but they'll gradually get back to their original shape.

First few weeks post-op will drag but as John and Tony says it then gets much easier.  PROVIDED you take care of yourself and do the physiotherapy exactly as you're told. Sorry, I sound like I'm lecturing my kids! But take note anyway.

Do you have good support at home when you get out of hospital? Loads of practical stuff on this site for post-op coping - hang out on the board as much as you can before you go into hospital.

Ask us any questions you want. Sorry you've got to have this work done, but nice for us to have a new person...we were getting a bit boring!!

All the best, Nigel in England

Posted by Rosbif (Rosbif), 19 May 2004

Just when I was starting to get too confident about my recovery I stepped onto an uneven bit of pavement last night and my knee hyper-extended quite violently. Bloody painful at the time but know aparent damage done. Bit of extra swelling last night but no pain this morning. Will teach me to look where I'm going.
Posted by EngKnee (EngKnee), 19 May 2004

Close Call Tony I think one of the most important aspects of our recovery is not getting too far ahead in our minds about where we are in the healing process.  I struggle with this every day as I gingerly walk around my flat with no brace, no net as it were, as my doctor instructs me that I'm taking risks unnecissarily in order for me to feel like I'm making progress, are we acting without reason?  I think NOT!  We are human beings who got hurt and are
trying to get better every day that's all.  We will make mistakes or missteps that is a given we will hopefully learn from them and get better at not repeating them, that's all we can do.  I'm glad that you are alright and I hope we all can learn from your episode and try to be cognizant of every aspect of our movement in our daily lives. John C.
Posted by Fisnik (Fisnik), 20 May 2004

Hey guys and gals,

Seems like you wouldn't mind an addition to your club. I'd best start by introducing myself:

I'm a 31 year old Kosovar Albanian, who ruptured his Patellar Tendon below the knee playing basketball 2 weeks ago (May 7th) and had a surgery the very same evening (about 4 hours after the injury).

Considering that, as you may well know, Kosovo is far from posessing the latest of the medical techniques and has some very conservative doctors, I am quite concerned about how my rehabilitation is going to progress.

To make things even worse, I happen to be a 2.00m tall person (that's about 6'7") weighing around 130kg (that's about 270lb). So, there's no wonder I have two wires planted on my knee instead of one, and of course they're not the disolvable sort - that would be just too luxurious for this country.

I consider myself lucky to have been operated by the best OS there is in this country and the top physiotherapist is awaiting my appearance as soon as my OS gives the go ahead, which won't be any time soon.

As I said, the doctors here are very conservative and my leg is at this very moment covered in thick cast, which I'll have to keep for another 4 weeks at least, before I can put a brace on and start moving the leg again.

3 days ago I first started using the crutches and have been instructed to put very little weight on the injured leg, which I find a bit difficult, since I'just getting used to them.

I am undergoing a very strict diet, hoping to get rid of some of the weight and have been spending some time exercising the upper parts of my body to at least give myself some ease when lifting my body (and the extra 15kg of cast I have on my leg).

Tomorrow I'll be having my staples removed and expect a visit from my OS to discuss further development. Considering my special circumstances (size and weight), I have a feeling this development is gonna be very long and painful, which really gets me depressed at times, including now.

I am known to be a strong-willed person who doesn't give up easily, and I don't intend to break down just yet.

I have a question, though: What would be an approximate time when an average person with this injury would be able to be partially mobile, meaning without crutches and possibly with a cane? 10 weeks? 12? I would probably have to add a week or two more for every stage of recovery because of my unusual circumstances.

Thanks for 'listening". Wish you all a fast recovery.

Fis


Posted by Nigel (Nigel), 20 May 2004

Fisnik - welcome to another victim! First one we've had from Kosovo on this thread, I think!!

Probably you've already read back through our "case notes". In my case, I started walking without 2 crutches at about op+8 wks, but via one crutch then a stick (cane).

Today I hit op+10 wks and to celebrate I spent the whole day without my stick. That included walking a mile or so around London at practically normal walking pace, as well as up and down lots of stairs. A little discomfort by this evening, and a slight limp when going downhill.

But I don't think I'll be running around very soon, I'm guessing it will be 4-6 wks more at least before I'm ready for anything like that. Holding me back at this point are: (a) knee still tender below patella; and (b) quad muscle atrophy means some lack of stability in that leg. I believe this is quite normal at this stage and I'm happy to "listen to my knee".

Don't know if I'm typical, but maybe not far off. You are younger than me (I'm 45) so you might do better quicker, but don't push it as tendons take a long time.

Hope that helps! Keep in touch.

Nigel (UK)
Posted by Fisnik (Fisnik), 20 May 2004

Cheers, Nigel!

That was a very comforting reply, mate. Very happy to hear you're up and (not just yet) running. Makes me more optimistic about my case when I hear positive things like yours.

Glad you enjoyed London today. I quite miss it (lived there for the past 12 years, came to Kosovo last year) and have planned to spend a part of my summer there, but alas, unpredictable things happen and they somehow have a tendency to mess things up.

My only problem is that my OS insists that my case is very very special (the sheer size of me and the fact that I have 2 wires on my leg) and needs time to heal, and he also insists that my leg does not move for at least 6-8 wks after the op, which concerns me a bit, because from what I could gather, the longer the leg is immobile, the longer the rehab takes.

In the end of the day, I am in no real hurry. Of course I want to see myself back in my feet as soon as I can, but I'm willing to sacrifice the time as long as the knee gets back to it's shape properly. It is tough to move a guy my size around, and I'm sure my knee knows this best.

I am lucky that I can do 90% of my work from home, although there are things I'll be missing from not going to the office, but that is acceptable for the moment.

I live on the fourth floor in a building without a lift and the cast I'm wearing is extremely heavy, so I don't see myself going out much for the next few weeks.

Are there any food supplements (vitamins or the like) that help the healing process? I've come accross some vitamin supplements that claim to have some effects in ligaments and joints, which I plan to take, although I don't really believe they will help much.

I also happen to be a smoker, and from what my doctor told me, since smoking lowers the blood circulation in the body it is very strongly recommended to quit in order to have a speedier recovery. So guys, since I now consider this forum as a place where I can find a bit of comfort about my state, wish me luck and give me a word of support, because as of tomorrow, I'm quitting the darn thing!

Nigel, my wife will be in London from Sat 22 until Tue 26 of this month and if there is anything you can reccomend for treatment please let me know so she could purchase it there, since most of the stuff is unavailable in this country.

Again, thanks for the reply and thumbs up to everyone!
Fis

P.S. I am deffinitely the only one from Kosovo in this thread, since there has only been one case like mine in Kosovo in the last 5 years, and the guy is probably quite okay now.
Posted by Nigel (Nigel), 20 May 2004

Tony in Germany (aka Rosbif) can tell you all about stairs. He lives a few floors up without a lift, I think.

Sorry, lotions and potions not my thing, so can't really say much about the vitamins. Someone did tell me recently there's now solid evidence that fish oils are good for joints, but can't vouch for that and not sure whether there would be much effect over a short time anyway...anyone any knowledge/view?

The only thing I used was E45 cream (presumably anything would do) to soften up skin over the knee. Became really tight around the scar for a long time, although now almost back to normal.

There does seem to be a body of opinion about getting early passive motion going - Rosbif used a ROM machine although I realise that's probably not obtainable in Kosovo. I would have thought the wires would give enough security to allow for some motion and flexing, not weight-bearing of course. I was allowed to start passive ROM exercises at week 2 or 3 even though I had to wear the brace at all other times, including in bed. But your OS probably knows what he's doing.

I wonder whether your doc would agree to put you in some kind of half-brace to leave the knee open, even if he feels the leg must be kept straight. Then you could manipulate the patella gently from time to time. My physio got me doing that from week 2. Apparently it helps to avoid scar tissue and stops patella sticking to your femur.

Did they say they would leave your wires in place, or do they have definite plan to remove them? In my case they want to leave alone unless it breaks, removal means a full-size incision again.

Cheers, Nigel
Posted by kdhfrank (kdhfrank), 20 May 2004

hi guys and welcome to the newbie!

just a quickie...CPM machines can be purchased online and possibly through ebay. check the medical supply site on ebay or check medical equiptment companies online that sell used equipment. Passive ROM is not the same as active ROM, quad is not contracted on a CPM machine but the CPM keeps the joint moving thus prevents scar tissue buildup and a frozen joint...thus prevents a delay in healing. i was on my machine right out of the OR. got to go.
kim
Posted by Fisnik (Fisnik), 22 May 2004

Hey guys,

The newbie is getting used to the crutches, and he's moving around carrying all his weight + the heavy cast on his leg with much more ease than 3 days ago.  

Won't be before end of next week that I'll be able to talk to my OS, as he's abroad, but apparently I've got 2 more wks (with 2 already gone) in heavy cast and then 4 more on a brace, but I suspect it will be a moving one.

The botom line is, I'll be immobile for 8 weeks and that worries me a bit. The swelling has gone down a bit and the cast is a bit more comfortable.

Does it make a difference if I contract my quads on the injured leg from time to time? I do feel a sensation around my patella every time I do that, but no pain. Will this help my quads retain some of the power? Also, does it make a difference if I stretch my foot and make circular movements? I'd guess thiss stuff can only help the leg.

Has anyone got any tips on what I should do? Apparently, it seems like I have lost some weight according to the people who have not seen me in the past 2 weeks. I have a bit of a problem getting on a scale to weigh myself because a) I'm in crutches and b) scales one can find in this country don't go above 100-110 kilos, and I'm definitely heavier than that.

Still exercising the upper body parts and undergoing the strict diet. Hopefully I come out a new man after all this.

Nigel, according to my OS's directions 2 weeks ago, I'll be wearing the wires for a while before they decide to remove them (at least 6 months).

Cheers to all,
Fis
Posted by Nigel (Nigel), 23 May 2004

Fisnik, I'd say foot exercises are probably fine and a good thing to keep your calf muscle in some sort of shape. But watch you don't do too much of that quad contracting, even statically. That's putting direct strain on the repair I think. Maybe you can work up to that soon, but I'd take your physiotherapist's advice on that.

Don't worry too much about your quad, just accept it will turn to blancmange short term but they will come back. The main problem with prolonged immobility is "freezing" of the joint, which I believe can limit the range of movement (ROM) you get back. But I bet you'll be fine. You're quite young and it's not like you're going to be in a cast for months and months. I had my wrist in a solid cast for 6 or 7 weeks a couple of years ago, and after it came off it felt like I'd never be able to bend the joint ever again, but after a month or two and some not-too-hard physio I had full ROM back.

I guess some weight loss is normal after any operation. I lost 4 or 5kg. A good start in the right direction!

Cheers, Nigel
Posted by Fisnik (Fisnik), 23 May 2004

I don't seem to feel any pain when I contract my quads. In fact, I hardly ever feel any pain at all, except when, in some ocasions, while moving the leg to get up or sit down, I yank the cast quicker than I should. Sometimes I get the feeling nothing's happening down there and then get a tingling sensation telling me there is something going on.

I hope this weight loss is not just because of the op, as I seriously need to lose weight before I start the rehab, hence the strict diet.

Wife's in London right now and she's getting me a few kilos of E45   and some ankle weights to keep my healthy leg in shape. They can eventually be helpful sometime during the rehab, too.

I guess I should just relax and wait for the time to pass until the OS says it's time for rehab. I forgot to mention that my tear was very bad, according to him, because it not only tore completely at the base of the patella, but it tore vertically in the middle, too. Must be quite bad, eh? Hence the moving restrictions.

Oh well, I can only hope for the best. Nigel, you seem to be quite experienced in getting yourself in cast.   Things you say, though, are very comforting.

Cheers,
Fis
Posted by EngKnee (EngKnee), 25 May 2004

Welcome Fis to our thread and our predicament, thanks to Kim for finally giving me the courage to get rid of my OS in Md., I haven't moved my knee either passively or otherwise since my operation over 40 days ago.  I get to move it 10 degrees tommorrow with my brace adjustment, big deal.  I'm afraid I'm going to get frozen knee if I don't do something radically different soon so I'm going to get a referal to a new OS near my home in WV and hopefully we can get going on a newer approach asap.  The knee feels OK but looks kinda grotesque with swelling on either side of the patella almost constant.  I asked my OS about all the different techniques discussed here on this thread and all he said is that he is very conservative in his approach, to me that's not good enough I want action!  I'm hoping my new OS will level with me and tell me what needs to be said regarding my rehab or lack thereof.  I'm glad we have new blood to keep this thread going. John C.
Posted by Rosbif (Rosbif), 25 May 2004

Hi Fis. I was in similar position to you. 120kg and 4th floor with no lift. Because of this I had my leg in a light weight removable cast (abt 2 kilo max) for 13 weeks, although I was walking without it in my apartment after about 7 weeks. I was put on the CPM machine 3 times a day from 2 days after my op. I think this was a big help, so you should ask your OS about one.

hope your recovery goes well
Tony
Posted by kneeDave (kneeDave), 25 May 2004

EngKnee:

Hang in there, it's not fun, but does get better.  I broke my left patella on March 2d, had surgery on the 4th.  Luckily I didn't have to get any hardware put in, and I think that "only" suturing was required.  My OS encouraged me to put weight on the bad leg (IN the immobilzer, however) and to do passive and assisted movement with it to increase ROM after the surgery.  But my situation was different from yours.  While it is not so fun, especially at first, moving around was and is the best thing for healing as the blood flow gets going, etc.

Don't be too alarmed when your quads atrophy away and your injured leg looks like a stick.  I was not too happy about mine being in this condition, but after a few weeks of adding stationary biking and straight leg lifts with weights, it is coming back.  Even being able to put weight on it will help, once you are able to do so.

The little advances are what made the difference for me: being able to shower, sit in the front of the car, drive, etc.  Also I am fortunate that my work is not very physical and I have flexible hours.

While I was unable to use my left leg for much, I did sit-ups and push ups, which were especially good while I still had to use the crutches.  Even when I had to use the crutches (about 3 weeks ago) it was nice to get out and "walk" outside.  You might want to pester your doctor about doing straight leg raises in your brace too.

Anyways, hang in there!
Posted by kneeDave (kneeDave), 25 May 2004

Fisnkik, EngKnee and co:

If you can't get access to one of those passive movement machines, you can always do it by just holding your hands under your knee, supporting it and gently moving it.  This is easier to do on a level such as a couch.

Quite a variety in post-op treatment!

I suppose that everyone's injury is slightly different, and also general condition, age, etc. matter too.  I'm 31 and in pretty good shape (was doing heavy weights, running and playing soccer prior to injury) so this may partly explain my OS's more aggressive approach to rehab.

Hang in there gang!
Posted by kdhfrank (kdhfrank), 25 May 2004

john

hang in there! you are only 6 weeks post op and so far you are doing great. the tendon really needs about 10 weeks to heal (it is not stretchy, thus cannot tolerate tension until healed)...i would absolutely advise against straight leg raises (even in immobilizer) until you get the ok from your O/S...i think the previous poster has a different injury then the rest of us...straight leg raises put incredible strain on quad and tendon! dont do this till you get the okay...i think it is better to be conservative over too aggressive...remember, i wasnt allowed to do anything either...but i do think a cpm would be a good idea as this does not put strain on tendon because quad does not actively contract (i dont mean set the thing at 135 degrees at top speed! mine was set to 45 degrees and was slow and smooth!!! and yes, expect to have swelling still...you had a major knee surgery!!!! give yourself a year to get back to normal and do it the right way! you will get there! kim
Posted by EngKnee (EngKnee), 26 May 2004

Hey Gang, thanks for the encouragement , today ended up to be a most beneficial sort in my rehab as the old OS, the one I was thinking of firing, came thru with not one but two adjustments, out to 30 degrees and showed me how to do the next one in a week or so AND gave me the OK to do some simple exercises.  I feel much more relieved at this juncture and I deserve all the reinforcement that I received here today, thanks to Dave, (where did he come from?) for his advice as well, keep posting!  I went to a baseball game tonite in Baltimore and felt much more mobility in walking with 30 degrees of motion in my knee plus my team, The NY Yankees, smoked the O's which was an added treat to my night out on the town.  All in all I want to reassure everyone that I'm feeling much better now that I see incredible improvement in my ROM with no pain and finally I got a plan to exercise and regain my leg strength, this was a big positive step in the right direction.  I tried to get the old OS to give me up to the new one but instead he tactfully gave me what I needed to hear and deflected any thought of being replaced, pretty cleaver I thought.  I hope the rest of us are enjoying a good week as well, excuse me I've got to go do my exercises.......John C.
Posted by Nigel (Nigel), 26 May 2004

Hey John...what's this "smoking O's"? Is that some recreational drug they have in WV? Is it Oreos? Do they have some pain-numbing effect (maybe like bourbon biscuits for us Brits)?

I think we should be told!!  

Nigel
Posted by EngKnee (EngKnee), 26 May 2004

Common' Nigel, the smokin' O's are to describe our local baseball team the Orioles, anyone should know that I must admit you were pretty close when you alluded to oreo cookies as the O's are sometimes referred to as the oreo's but you can't get high off em, at least I've never heard such a thing..... we used to get..... at the games.....a real long time ago when they allowed such shenanigans, I'm showing my age here....anyway the Yanks beat the O's by 11 to 3 thru the chorus of O's fans chanting Yankees Suck, Yankees Suck.....You'd have to have been there I guess  John C.
Posted by kdhfrank (kdhfrank), 29 May 2004

hey mates

i recieved an email from a fellow patellar tendon rupture survivor. i referred him to this website so i imagine he will be posting soon. he emailed me a few articles regarding this injury (coincidentally the one posted on the www.arthroscopy.com website is an O/S right around the corner from where i live. personally. i would not consider him an expert in this area but the article has some great pics. hope all is well with the "hop along" gang...3 weeks till surgery in cincinnati..at least i will get to see the brood x cidada gang in action...i remember then from 17 years ago when we lived outside philly...millions of the little buggers...we loved to stick them on each others backs! kim

here are the sites:

www.emedicine.com/orthoped/topic246.htm
www.arthroscopy.com/patendrep.htm
www.SMA.ORG/SMJ1999/JUNESMJ99/ENAD.PDF
Posted by Nigel (Nigel), 29 May 2004

Would love to see Brood X in action. I gather there's selective advantage in a "prime number" breeding cycle...then predators have to match it exactly or miss the boat??!!

I'm getting on pretty well here in UK (touch wood). Planning to get on a horse tomorrow for first time since op. Think it will be fine, I'm pretty flexible now, just a bit wonky going down stairs and walking downhill. PT is basically just gym work now, no problem with most of it although my lower leg raises are hopeless, can just about manage it without any added weight. Think I'll just have to chill out on that and work up slowly, it doesn't really affect my mobility anyway.

We went to see "The Day After Tomorrow" last evening. Plot is dreadful, but great SFX --- including in real life, they turn up the a/c in the cinema. Take a coat!! Harry Potter/Azkerban on Monday with the kids.

Cheers, Nigel



Posted by John42 (John42), 29 May 2004

Hi Nigel

Can u give me a clue how I can contribute to this board
following my xchange of e-mails with Kim.

Best wishes
JohnK/Manchester UK
Posted by EngKnee (EngKnee), 29 May 2004

John K. ,  You already have mate!  If you want to catch up with the rest of us and what we've experienced so far just read the first six pages of this thread and then post as necessary as you already did, it's that simple really.  Nigel, I can't understand your inability to do leg lifts, do you mean lifts dedicated to the lower leg? John C
Posted by John42 (John42), 30 May 2004

I have been following your various posts and you will all have realised that we have suffered a very - very rare injury and from experience, the majority of Orthopaedic Consultants have very little knowledge as to the treatment and rehab of a Ruptured Patella Tendon.

It`s no consolation to fellow sufferers that there have been so far only 14 fellow sufferers WORLD wide who have registered on the Arthoscopy.com message board, but this valuable site has been taken over by Scammers, originating in the USA,Canada and Eastern Europe.

In my own case (which seems par for the course) I slipped on ice outside my house in January 2003, emergency operation, eight weeks in a cylinder cast, twelve weeks with two crutches, then one crutch for another four weeks and then a walking stick/cane for ten months.   I am 68 years young - so that does not help.

Like others, I have managed to have three baths in all this time, and must take extra care in the shower

Once the cast is removed, the knee bend kicks off (excuse the pun) with about 30/35deg bend and the physio will start to strenghen the quadriceps.  It took me about 4/5 months to reach the important milestone of 90deg bend.  The good leg is 134deg.  The Consultant states that anything over 90deg is a bonus and now some 16 months later, I have 116 deg and will not reach any more.

Driving is of course quite a problem - the first three months my wife used to place me in a prone position on the back seat of the car.  It was nearly five months before I could drive again, but the drivers seat must be as far back as possible.

Lets not kid ourselves, I only know of one person who regained a full bend after 14 months, but he was a very fit policeman.

I was chewing antinflamatories like sweets, but they did not help - however, I have three Co-Codoamol 30/500 tablets each day and these Do help.

I have recently been placed on water tablets because it was explained to me that during the operation, some veins in the leg, above and below the kneecap are sealed, thus restricting the circulation of fluid.

Several good tips worth noting..........

Sleep with a pillow between your legs.

Purchase a "Pedal Exerciser"... in the UK, look at
www.physio-med.com.

An ice pack or a bag of frozen peas (beans if you dont like peas).

It is ironic, that since I retired some five years ago, I am a volunteer in the out patients department of the North Manchester General Hospital - of all places in the Orthopaedic/Fracture clinic, so I see the Consultant/Surgeon and staff every week and I do get lots of advice which I will only be too pleased to pass on.

Please do contact me if you require any further tips, but meanwhile I am off to Vancouver 31 May for two weeks vacation and I am not looking forward to a ten hour flight.

Best wishes to fellow sufferes

JohnK/Manchester UK  
Posted by EngKnee (EngKnee), 30 May 2004

John K., You are so lucky to be going to Vancouver, I am guessing B.C., it's such a lovely place.  While there I imagine you will be taking ferry boat trips to Victoria and Seattle, relatively cheap and scenic to boot.  Last time I was through that part of the world I had some alcohol confiscated on my entry into Canada from the US so be careful of this, declare everything!  You can add allot of experience to this thread and we all appreciate your insights.  I have taken to homeopathic remedies with regard to inflamation lately and it seems to be working.  If anyone is interested I will be happy to post my magic cure. Happy Memorial Day to everyone on this thread regardless of your country of origin, it is this weekend that we Americans honor our war dead and that of all our allies as well, it's a time to reflect on how lucky we are to be living in a relatively free society even though we have a limp.  John C.
Posted by Nigel (Nigel), 30 May 2004

John C - what I meant by lower leg lifts is this: sitting on a chair with leg hanging down at 90 degrees, then raising the lower leg until it's horizontal (or as close as I can get). I'm supposed to work at this until I can do it against a weight - at the moment it's a struggle just to lift the weight of my leg. But coming on slowly.

John K - sounds like you've had a tough time. Although I have no statistical evidence, I'm surprised that you say you don't think many people get back full ROM. I would have thought most people do achieve pre injury range, or as near as makes no difference. I'm 11 weeks post-op and have virtually full ROM (about 130 degrees). I'm an averagely fit 45 year old. I'm just saying this because I wouldn't want anyone reading this thread losing heart about getting back to normal. We need to bear in mind that posters on this board are often people who've unfortunately had post-op complications, or multiple knee problems - not necessarily reflective of the average person who snaps a tendon, is repaired and gets over it okay. Also, not sure how rare patellar tendon rupture really is - my OS (a generalist, not a knee man) says he's seen quite a few. But it's not common, that's for sure.

Hope you enjoy Vancouver, it's a great city. Very big Asian community there - fabulous Chinese food. We were there last year - took the short hop over to Victoria to go whale watching, which was fantastic.

Went riding (horse) today for first time, not as bad as I thought it would be although lack of strength in my left leg meant it won't be winning any Grand Prix dressage prizes! But nice to get back to it.

Cheers, Nigel


Posted by Rosbif (Rosbif), 1 June 2004

Nigel, I'm also struggling with Full Arc Extensions (lower leg lifts). Find it very difficult, a bit painful and have a bit of clicking in the knee. But I understand all this is normal until the quads are strong enough to hold the knee correctly in place.

I've just started attempting downward stairs in my building. Luckily I have hand rails on both sides, so I can do it resonably securely.
Posted by Teresa_S (Teresa_S), 2 June 2004

The CPM machine is a continuour passive motion machine that the injured leg is strapped comfortably into and it is set to the degrees of extension and flexion that the physcian feels is appropriate. the knee is continuously moved from extension to flexion at a speed precet or determined by the doctor. I bought mine off Ebay for abount $350, and the one I had rented was around $48 daily, and soon exceeded the $350. I used it continuously for awhile. IT is often recommended that people sleep in them  immediately postop, depending on the diagnosis, and never be out of them for over 4hours for the first 2-3 weeks. I thought they were pretty well univerally used.They were always used for total knee patients for weeks postop and immediately in the recovery or patient room. It may not be needed in your instance. IT is a way of starting passive rehab that doesn't usually increase pain significantly.Hope that explains it. THe leg is comfortabley padded and supported at all times, is why it doesn' hurt, as the machine is always supporting the knee. Keep us posted. On my last MRI, both my quad and patella tendons were about 10 times normal size, and the radiologist thought maybe severe tendonitis, but the quad, according to my OS , was the result of his cutting it in two. Quad sets were really hard and I had to use biofeedback to even start strengting it. Teresa
Posted by EngKnee (EngKnee), 2 June 2004

Teresa, thanks for contributing your vast knowledge to this thread as we are all becoming better acquainted with our knees and their problems healing .  Sounds like you've been through allot to get where you are now and your description of the cpm machine was the best one yet on this thread.  Unfortunately my doctor hasn't prescribed this treatment to me although I have brought it to his attention, maybe it's too expensive or something but it sounds like you are sold on it's benefits.  I can move my knee just 40 degrees at this point in my brace and the swelling has gone down quite a bit lately so I've been feeling bold and walking around without my brace when in my house. Will this machine make me feel more confident to walk without the brace?  I'm trying to justify the expense in my head so I can convince my doctor to write for one.  John C.
Posted by Rosbif (Rosbif), 2 June 2004

John, I used a CPM machine 2-3 times a day for 30-45 minutes. Used it for about 6-7 weeks. I could really tell the difference if I missed a day.

Don't know if it will make a difference when you're walking at home, but it will make a big difference when it comes to getting full ROM back.
Posted by just (just), 2 June 2004

Hi, I managed to sever the patella tendon 3 weeks ago whilst playing football on a beach on my honeymoon.  I had a deep 10cm horizontal cut from the volcanic rock which severed the tendon but not the sheath. The doctor on board the ship sutured the tendon and the cut. We got back to the UK and the hospital don't seem to think that I will need any further surgery as I can lift the leg but have been put in a leg brace and will be going back in 3 weeks to see how it is going. When I was at the hospital they only took x rays and did not do a MRI is this normal ? Should I ask for a MRI scan when I go back ? I would be interested in hearing from anyone who has had this type of injury before and what sort of rehab they went through.

Thanks

Justin

Posted by Nigel (Nigel), 2 June 2004

Justin - bad luck with the knee.

I don't think MRI is very common for this kind of thing - certainly not on NHS anyway! I've not had MRI for mine, either in France where they operated or on return to UK. Anyone on the thread have an MRI??

The best "Haynes Guide"   to patellar tendon repair I've come across is the one on http://www.emedicine.com/orthoped/topic246.htm
which is referred to by others in earlier posts.

Go easy with the repaired leg as you don't want to risk a full rupture and tendons take a long time to heal.

Let us all know how you get on!

All the best, Nigel (UK)
Posted by kdhfrank (kdhfrank), 3 June 2004

hey mates

following my patellar tendon rupture (thanks to that jerk O/S that did it to me) my new O/S ordered an ultrasound (done by a physician not a tech)...it was easy to see where the rupture was and how far my quad had receded up the leg..(i managed to watch while the tears of despair were running down my cheeks)...i then had an MRI...this may have had more to do with the scar tissue but I am not sure...I do remember being extremely uncomfortable for it and got an additional dose of demerol IV on top of the epidural in my back...i would think that an MRI would be better in Justin's case as it does layer slices and the ultrasound may not be able to penetrate the sheath to see the repair. if the tendon was fully ruptured the repair would probably have been done differently...wire vs. suture...due to the unelastic quality of the tendon itself...(no flexibility...no elasticity) and the need for healing of tendon before active ROM...i question whether a MD on a cruise ship would even be qualified to do this kind of repair as it is extremely uncommon. (yes...it is very rare but  there seems to be a run of us lately)...so again i would have this looked at by a very experienced O/S who has taken care of this type of injury....i thought you guys would find this interesting...most patellar tendon ruptures occur in the male 35yrs. plus, somewhat out of shape recreational athlete...often occurs playing basketball and overdoin..."showing off?" (just kidding) weekend warrior!...should have been drinking a beer and watching the game instead of playing it!...and i know i am not in this group as i am female, 35+ and in incredible shape!!!!...and damnit ENG...you should demand a CPM from your O/S...they are covered by ins...OR SIGN A MEDICAL RELEASE AND GO SEE SOMEONE ELSE!...you are in the U.S. and your insurance certainly has DME coverage!!! i want to see you get better on time...not later.  a CPM will help with passive ROM and flexion which it sounds like you may be having problems with....and in reality this injury can take up to 18 months to repair...heal. do you guys think we could write a book and start charging these O/S for advice? 2 weeks and counting...and yes, i am scared.
love, auntie kim
Posted by EngKnee (EngKnee), 3 June 2004

Auntie Kim, you're the bomb and you hit it right on the head when you described the out of shape, weekend warrior type who is most suceptible to this particular injury.  Thanks to Tony or Nigel for posting the website of the particulars of the injury as they have shown me more of the why it happened to me  I do need to do whatever has to be done in order to get better in a timely fashion as my occupation depends on it.  I still haven't gone back to work and I couldn't if I wanted to.  That's what I'll use to get my outdated OS to agree to more treatment.  I have been doing my exercises and have increased the setting on my brace to 40 degrees lately and I do notice more confidence in the knee and less swelling and no pain just stiffness when I try to take it beyond the setting w/o the brace.  Sorry for the poor chap who got injured during his honeymoon, hope it didn't cramp yur style too much , I can't believe that the ship's doc was able to patch you up so quickly like that, good for him if it turns out alright!  This thread continues to amaze me and keep me on my rehab  Frats, John C.
Posted by Nigel (Nigel), 3 June 2004

Hey Kim - what's all this about "should be drinking beer instead of playing"? Let me tell you, our kind of Weekend Warrior drinks beer, THEN plays.   At our age we need the muscle relaxant effect.

And what about that Justin, what exactly should he have been sticking to, instead of playing football??  

Posted by kdhfrank (kdhfrank), 4 June 2004

mates

i can think of a lot of other ways of rolling around in the sand on my honeymoon that dont include a football...and probably burns more calories!!!! sounds like our beer swigging weekend warriors are getting a little antsy in front of the t.v.!  ...

cheers

kim

ps
Posted by EngKnee (EngKnee), 4 June 2004

Ok guys, I admit I was completely sober when I did my knee but I'm not going to say what I did in the sand on my honeymoon , I can't even remember being married it's been so long ago..... Kimmy I love it when you talk dirty  John C.
Posted by Fisnik (Fisnik), 4 June 2004

Hey everyone,

Long time no see. Been very busy working these days, and haven't been writing since there was nothing to tell, really. I was stuck in the heavy cylinder cast unable to flex the knee at all and, apart from having stitches removed about 2wks post-op. The only exiting thing was getting used to the crutches and being able to sit on the toilet seat. And oh, I turned 31 yesterday.  

Today, however, 4 weeks post-op to the day, was much more eventful:
For starters, I went out  after a month of house prison and noone could convince me to come back home. The first 5 hours of the day were spent queuing at the hospital (hospitals in Kosovo, by the way, are in awful state and they resemble Timbuktu rail stations in Indiana Jones movies), waiting to see my OS, which I finally did. He decided to remove the cast and put an adjustable brace, which was very relieving, especially since he had said earlier that I should be keeping the cast for 8 weeks.

Had an ultrasound, which, according to him, looked quite good and the tendon appears to be healing slowly, but surely.

He reccomended a CPM machine, which is unobtainable in Kosovo, so I need to urgently arrange one from abroad, so I can start flexing that knee - perfect timing for this kind of exercise while watching Euro 2004 soccer championship. Any other ideas than Ebay? Much easier for me to obtain one in Europe, so if any of you knows where I could get hold of one, gimme a shout, please.

He also set my brace to 20 degrees and told me to keep that setting while walking around in crutches, so the knee bends a tiny bit, which for me is really a big improvement, considerin that initially he wanted me completely immobile for 8 weeks.

Had also a chance to ask loads of questions, and I actually impressed him with the knowledge I had gained about this specific injury. Also gave him about 50 pages of printouts I got from the web, in case he hasn't read any of them.  

Doctors here can be very nasty if you appear to be telling them what to do, but he was quite grateful. I kept asking him why haven't I started flexing the knee while everyone else started doing that in week one post-op. He stated that he didn't want to take any chances because of: a) The rarity of this injury, b) My unusual body size and weight, c) The wires they have in Kosovo are of poor quality and seem to snap easier, hence the reason he put two of them inside my leg (not dissolvable, of course - wouldn't be surprised if he'd said they're made of wool or something) and d) He was worried I might do something against his instructions (yes, I look a bit rebellious and arrogant, but sincerely I'm not - must be my appearance). He simply thought that the first month is very critical and he didn't want any complications, so he played the safe card.

Bottom line is, I am very happy to have gotten rid of that heavy cast - feel like a bird wearing the brace. I'm also happy to be bending the knee a bit (yeah, I know, 20 deg is nothing, but it's a start). I'm happy about the fact that I can put quite some weight on the injured leg and don't seem to feel any pain, and that is a good sign, right?

Content with this morning's outcome, I decided to spend the rest of the day roaming the streets of Prishtina, which was very relaxing, especially while visiting my favourite coffee places. Glad to see friends again, particularly those who didn't have a clue about my injury and looked in disbelief at my crutches. Had some comments about my weight (loss), which was very encouraging, too. Most thought I'd gone back to London or something.

Overall, although a day late, today's day was a perfect birthday gift.

I think I wrote a bit more than I intended. Well, can't be bothered to edit stuff out. Too tired from the busy day, so I think I'm off to bed earlier tonight.

Have a good one, all!
Fisnik

P.S. I truly identify myself as a lame Weekend Warrior who thought he could actually fly and ended up immobilised for god-knows-how-long.
Posted by biged (biged), 5 June 2004

Hey guys and gals
My name is Ed and I ruptured both my patella tendons in both knees.  I am 6 weeks out now and just wanted to intro myself.  I am so excited to be able to talk with people that have gone through the same pain and trama I have. I live in Charlotte NC (and of course the weather is beautiful up here on Lake Norman where I live so the cabin fever is driving me nuts)

Posted by kdhfrank (kdhfrank), 5 June 2004

big ed

i would say congratulations on joining our club but i dont want you to throw your cane at me...in this thread you should be able to: know that you are not alone...but close to it. we are all going mad from being house bound and attached to our laptops and computers. we all think...but might not admit it...its kind of nice not working. most of us are out of shape weekend warriors (except for myself of course). we know more about our injury then our orthopedic surgeons. we could probably write a book and become wealthy... at least in euros. we smile and we cry. we just wish we could sit on the toilet like the old days. we support each other and chuckle at our various ingenious ways of figuring out how to do something without our legs. we dream about someday kicking a football (soccerball) or dribbling the ball down the court without crumbling into a sack on the ground...(except me of course). we give each other the strength to meet each day head first...and pass on the tips on how we did it. we are all united in our cause (to get our quads out of the jelly stage) even though our countries are not. and we pray that a fire alarm wont go off so that we dont have to run down 4 flights from our flat. we wish the mailman would have sympathy on us and bring our mail to the door. we wish we  could potty train our dogs...or at least teach them to use the litter box. we have all become comrades and probably all have the same scar. we all know that some day we will be the same as before even though we dont always hear that from our doctors. we would not be friends if we had not found knee guru. welcome. and may your recovery be faster then the rest of us!!! fat chance against me though!

cheers

kim from atlanta (and the only girl/woman here) and a nurse practitioner to boot.
Posted by Fisnik (Fisnik), 5 June 2004

Auntie Kim,

You definetely are an inspiration to us lesser mortals (read: weekend warriors). Although your last post didn't exactly answer the question I keep asking myself all the time (Will I have trouble because I spent the 4 post-op weeks without bending the knee at all?), it at least managed to cease my violent shaking (I AM dead scared) and stopped me from being on the verge of crying.

In case you're wondering, Ed, it was me who wrote a very happy-go-lucky post a few hours ago when I felt really happy about bending my knee a couple of degrees. Now, after reading a bit more about CPM