Collateral Ligaments and other non-cruciate tendons & ligaments around the knee :

Ruptured Quad Tendon - - Posted by cmeese (SpringsCycler), 30 June 2004

Hello:

I was just diagnosed today with a ruptured quad tendon (inner quad muscle). It occurred when I fell in a cycling accident. I don't know what the next step is, as the doc. will be reading the MRI tomorrow and making his recommendation.

I've read some *scary* stuff in hear about knee caps floating around after people have had this problem surgically repaired. My doc. seems pretty qualified, as he treats a lot of Oylmpic atheltes here in Colorado Springs.

Does anyone have any advice for me as I likely head into surgey and PT? I'm new to the community but I fear I'll soon be a regular.

TIA
Posted by Heather (Heather), 14 September 2004

Hello there. I wanted to respond because I too had a ruptured quad tendon. Mine occured during a fall while I was post op from a LR and VMO advancement. It was one of the most painful things I've ever experienced. I really feel for you.

A few questions for you:

You said your doc was reading the MRI report tomorrow...and I just realized this post was posted in June. I'll continue with my response in case you are still around.

Mine quad tendon rupture was diagnosed 4 months after the original onset, therefore, I did have kneecap issues following the repair. I ended up with patella baja and had to find an expert surgeon to get me out of that mess. The new OS did a TTT and quad tendon reefing and all is doing well since I had my screws removed last month. It's just been a long haul.

Quad tendon repairs have the best outcome if they are completed within 2 weeks of injury. Sometimes this is not possible, but the sooner you can get it fixed the better off you will be and the more likely you will not have complications. Also if done in a timely manner the success rate increases dramatically.    

As far as advice for heading into surgery? There really isn't anything you can do beforehand because strengthening the quad is impossible due to the injury. You just really have to prepare mentally and get a good support system to help you afterwards.

For PT, don't try to push yourself too hard or force yourself to do something that is painful to you. Things will come back slowly and patience is so important.  As far as I've seen, every PT and OS seem to have their own protocal as far as rehab goes, but it always best to make sure there is good communication between all of you.

I hope you post back and let us know what happens. If you have anymore questions please don't hesitate to ask! Sorry I was so late to respond to this thread.

Heather
Posted by annbaok (annbaok), 18 September 2004

I had an lateral release done four weeks ago and after two weeks of PT, the PT sent me back to the doc b/c my quad muscle was not responding.  I had an MRI today and found that I ruptured my quad tendon.  Will schedule surgery on Monday.  Is this a common problem after lateral releases?  I can not find much info on the surgery performed to fix it, what is involved?  Also what is the eventual recovery and outcome?  How long am I looking at being in a cast and going thru PT?  Any info that you can provide would be extremely helpful!  Also, if someone could point me in the direction of a website that would be helpful in explaining exactly what it is I have done would be great too!  By the way, I am 32 years old, female and live in Oklahoma!  Thanks for your help!  Ann

Posted by Janet (Janet), 27 September 2004

I ruptured my quad tendon after a fall five years ago. I was put in an immobilizer in the ER and had repair surgery five days later. (It would have been sooner, I'm sure, but had to wait over the weekend to see an OS on Monday.) I never had an MRI because it was obvious what my injury was, as I had no quad function at all. I stayed in the immobilizer for about 2 and a half months, then had a hinged brace for a few weeks. I started PT at 3 weeks pos-op. My recovery/rehab did not well, so I won't go into specifics here, since it probably won't happen to you.

Just be aware that a quad tendon rupture is a major injury. I was told it would take 12-18 months to fully recover. Because of my complications, I will never be back to normal. Good luck! Follow your doctor's advise and do everything they say!!

Janet
Posted by annbaok (annbaok), 28 December 2004

Actually, I did not know how to post an update, this was the best that I could do  However, I just wanted to update the information.  I did rupture my quad tendon and it had rolled quite a bit up into my leg.  The doctor had to retrieve it and reattach.  It was a pretty long surgery.  The doctor says my tendons are thin and narrow, and suseptable to rupturing again?!  After surgery, I was in a cast for several weeks and then an immobilzing brace.  After five weeks, I began PT.  After two plus months of PT and a ROM of 90 degrees, I will go back to have a MUA.  The doctor says there is no scar tissue, but feels it is necessary to get me the ROM that I need.  Any advice?  And is this a wise move with the possibility of tendon rupture once again?!  Tell me what you think!  Ann

Posted by hmaxwell (Heather M.), 28 December 2004

Ann,

I have a very low opinion of manipulation under anesthesia as a way for dealing with reduced knee motion!  I'm going to state that right up front.  And I'm a bit mystified why it would be recommended in your case, as you have 'weak tendons' and a previous history of a ruptured quad tendon!  In fact, ruptured tendons/ligaments are one of the main complications of a manipulation--just ten days ago one of our kneegeeks had her quad ruptured during an MUA.

There are better, safer ways to get back knee motion following a traumatic injury like yours.  I strongly recommend getting another opinion from a doctor who sees a lot of scar tissue cases.  Where do you live?  Specialists in this area are kind of few and far between--I'm in Arizona and had to travel 1000 miles to see one.  But it was worth every mile of the trip.  I can't recommend highly enough going to see a very skilled specialist for another opinion.

I did not have any complications of my MUA except for severe muscle spasms that literally dropped me to the floor in pain.  Other than that, no negatives.  But no benefits, either.  My scar tissue bands were ruptured during the procedure, but the scar tissue wasn't removed from the joint...so it just glommed right back together again.  Plus, the manipulation was so traumatic on my joint that it started serious brusing, swelling, and pain.  The inflammation continued for a long time.  When I finally saw a specialist, he said that in my case it is possible that the MUA actually caused MORE scar tissue to form, because it set off the inflammatory process that creates scar tissue in the first place.  It was counterproductive, as was going to PT and having the therapist crank on my leg to bend it while I tried not to throw up.

I really urge you to go to the soft tissue healing problems section and research about scar tissue (also called arthrofibrosis) and manipulations/MUA.  There are also similar posts in the 'struggling with rehab' section.  The general belief of doctors who treat a lot of scar tissue cases is that forceful bending of the knee (which is the whole point of the MUA) can actually do more harm than good.  I've read a lot of journal articles by doctors who deal with a lot of arthrofibrosis cases, and can't think of one of them who advocates doing a closed manipulation/MUA.  Usually, they prefer to go in with a scope and clear out all the scar tissue.  Then the 'manipulation' is done, but only very gently, and with the goal of verifying that there is full range of motion.  The risk of rupturing ligaments or tendons, tearing muscle tissue, and even breaking the patella or other bones in the leg is just too high for them to advocate doing MUAs--this is what I've gotten after a literature review.

If you want to post the region you live in, someone here can very likely give you the name of the closest specialist to you.  Also, I recommend posting in the sections above this one--like the crisis section, struggling with rehab, soft tissue healing problems, etc.  There is a lot more traffic there than in this collateral ligaments section.

Finally, use the search feature to look up 'quad tendon rupture' and MUA and other keywords.  This search will bring up other posts on this board dealing with similar topics.

Heather


Posted by annbaok (annbaok), 28 December 2004

Surgery is set for the morning.  Basically so that I do not have to meet new deductables etc in the new year.  She says there is no scar tissue, just lack of movement.  I live in the Tulsa Oklahoma area and would love a recommendation of a really great OS.  THis is the fouth surgery.  1st was in 90 for a lateral release, 2nd was in August this year.  Another lateral release and scope to clean up and third was the ruptured tendon.  All that I have read is making me really nervous to proceed with the procedure tomorrow!  UGH!

THanks for the advice.

Ann
Posted by hmaxwell (Heather M.), 28 December 2004

PS I've read it three times and still don't understand the doctor's comment--that s/he doesn't believe there is scar tissue, but that you need an MUA to get your ROM past 90.  What on earth does s/he think is restricting your ROM if not scar tissue??!!  You were immobilized in a brace/cast--that is almost guaranteed to cause scar tissue, and it's just accepted as part of the treatment needed to protect your newly healed/repaired tendon.  

I really urge you to see an expert in arthrofibrosis, as what I've read of your doctor's comments just does not match up with the research I've done on arthrofibrosis, ROM limitations, and treatment for flexion contracture....when in doubt, and when further operative intervention is recommended, it's always a good idea to get a second opinion from someone who is expert in the area you are having troubles.  Not all surgeons are equal, and they all can't be experts in each area of knee treatment and therapy.  So I would definitely want to see a doctor that has done research and has clinical experience treating people with your exact condition.  I can't tell you how great it was to finally hear "I know what's going on and I know how to fix it" from my current surgeon.  That happened only after about a year of hearing "I've never seen anything like this" from my original doctor!  I even got a second opinion before embarking on repeated surgeries with my original OS...but I didn't check the background and credentials of that second opinion doctor well enough.  So he wasn't skilled enough to give me a second opinion of my options for treating scar tissue and/or complications of the surgery I had.  I should have done then what I finally did after 5 procedures in 10 months--I took all of my medical documents, operative reports, and PT evaluations and starting plugging the keywords and diagnoses into www.google.com.  Then I found multiple papers on my condition, arthrofibrosis, written by a handful of doctors.  I read through these and picked the two doctors who had done the most work with my exact condition, and saw them for a consultation.  Even then, I was given two totally different treatment regimens!!  But I finally felt like I was getting somewhere.  Don't waste time on a generalist OS or one who doesn't treat at least a dozen patients a year with your exact condition.  You've got a problem that needs to be dealt with relatively quickly, as the timeline for best results is to receive appropriate treatment within 6-12 months of onset of the flexion contracture/scar tissue problems.

This old Forum was so valuable that we have kept it as an archive. It is just for reference. If you want to ask questions or offer advice, there is also a current Bulletin Board which you can access from our home page.