Bone breaks around the knee :
End Of The Road to Recovery? - - Posted by neilatwork (neilatwork), 23 November 2004
Hello to all you experts out there.
I have been down the long road to recovery for over a year now from my fractured patella which I broke in 9/03. To shorten the story, due to pain from the hardware, it came out 1/04 which really put me back on the recovery curve and could only gain 60 degrees ROM. After unsucessfully trying to recover (only got up to 100 ROM) I decided to have arthrocopic surgery for lysis of adhesions and a MUA which I had 9/04. During the last month I have leveled off on my progess and I am at 105 ROM. My physical therapist told me after a year of working with me, he did not think I'd recover and this is where I'll end up. The OS also told me yesterday that due to the injury it is likely I'd never regain full mobility. I only have one more month until my next appt and he will "release" me back to the WC system.
I know my case is not typical and I am grateful I don't have any pain but it is so frustrating thinking about living the rest of my life with limited mobility (I'm in my early 40's). The average person that sees me probably would never know that I have a limitation as I don't walk with a limp but I certainly know it in all the little things we take for granted like taking stairs or bending down to tie my shoes.
I was just wondering if there are others who for whatever reason just will never regain their full mobility and if this is something I should just accept and move on with my life? Will my mobility even marginally improve over time (1-2 years down the road) just from regular activities? Lastly, if I begin to let up on my daily exercises, could my mobility get worse?
Posted by kgrosskurth (Kathy G), 23 November 2004
Since I am not a patella break, I cannot speak with any firm knowledge that my situation will work for you, but it took me quite awhile to regain my ROM, and I still work at it at least 3-5 times a week. If you are at 105, I would say you are not done yet!! I would suggest getting a recumbent stationary bike and using it at the same rate I'm using it - I bought one for under $200 from http://www.fitnessquest.com 
If you get one with different resistance levels, you can also use it to strengthen your muscles too. Again, I am a Tib Plateau baby so my experience may not mirror yours, but if you are past 90 deg. you can pedal a bike (and adjust it so you are forced to bend your leg more and more). Warm your leg up with a little heat before you get started, end with elevation and ice.
Hope that helps, and all the best to you in your pursuit of more ROM!! 
Posted by HHB (MHB), 23 November 2004
Neil,
So glad you have no pain and good use of your recovered knee. You also have hardware no more, right, and serious adhesions were removed earlier I think you said. So what does it feel like when you try to increase ROM with stretch exercises?
Sounds reasonable to me that after the time that has passed with limited use, your quads and hams will have declined in strength and also shortened considerably (ITB too). Could that be part of the ROM limitation? Maybe in this situation lengthening/strengthening them will take a bit longer?
The situation here is different from yours -- 8 mos out from ORIF -- but recovery here was different too. I had adhesions for sure, but at 8 wks reached proper gait/full ROM and now even fuller (150+ like the uninjured knee). My complaint until lately was continued moderate swelling and heat and one screw tip that sometimes hangs up in the quad tendon -- sort of an ouch there.
After OS release at 13 wks, had sessions with a Rolfer, which turned out to be very helpful. In five minutes of massage, she released additional adhesions laterally, and the increase in comfort during range of motion was immediate.
What she told me made sense -- she said that during the early weeks of recovery, the prone position gets a lot of time, and during that down time, plain old gravity can stick the fascia of various muscle groups together -- i.e., hams, quads and so on. When muscle groups are stuck together like that, they sometimes even end up working against each other instead of in compliment. The Rolfer really improved the situation for me.
Wish I had some helpful suggestions, but have no experience with your particular situation. However, I do recall many months ago, my orthopedist brother, when he was trying to encourage me during the first months of recovery, told me that if the recovering knee made 90 degrees, then remaining ROM was almost guaranteed! I of course believed him (an older brother -- you have to), and in this case, he was correct. Here's hoping the same applies to your situation.
Best wishes for continued improvement -- MHB
PS There are some posts somewhere around here (maybe this forum) about "spinning," which helped a poster gain strength/mobility for a broken knee after two years from the break. A particular kind of stationary bike exercise, I think. Am sure a search for "spinning" would bring the posts up for you to read. Again, best of luck.
Posted by neilatwork (neilatwork), 24 November 2004
Thanks for the words of encouragement and the suggestion of trying a bike/spinning. I'll certainly look into it for future home exercise.
In regards to your question on whether a lack of strength in the quads and hams could be my problem. I would guess that really isn't my problem. I've worked so darn hard trying to get this thing right that at my last therapy appointment he told me my bad leg was now stronger than my good leg since I've been doing so many exercises with it.
I certainly hope your brother is right that if you can get past 90 degrees full ROM can be attained. All I do know is that in spite of my efforts I can only get to 105 on my own. I can seem to get more mobility after a good warm-up and with hard pushing from my therapist and I can get close to 120 but 105 seems to be the max unassisted.
Posted by KNEECAP (KNEECAP), 26 November 2004
Im sure you can make it further than 105, you may have some age on you, it just takes longer. I am 17 and it was a little easier. My kneecap was severe and my doctor wasn't sure of the outcome, you will make fine
Posted by lizl (lizl), 13 December 2004
Neil,
Maybe something else is going on in that knee. In my case, for instance, the doc would not have discovered my meniscus damage if I had not insisted on an MRI before the hardware-removal surgery and a full scope during the hardware-surgery. The scope found tears on each menisci and a large fold in one. In other words, the condition of the menisci would have limited my recovery following the hardware removal, if the problems had not been discovered and addressed.
It's been almost a year since that combination surgery, and I do still find little bits of progress. Please don't give up.
LizL
Updated Fri Sep 5 2008