Rehab Diary for Patellar Tendon Lengthening Surgery - Months 3 - 6

Below is a summary of months 3 through 6 rehabilitation after reconstruction of my patellar tendon by Dr. Noyes. As always,  I must express my sincere gratitude to the staff at CSM for the treatment that I received.

9/15/07 - 8.5 weeks post-op. I managed to avoid being jabbed with any needles in the last week. On Thursday, I lost the competition with an 80 year old man on the ERMI (the torture chair designed to help bend your knee) he got to flexion of 132 and I got to 131. We had all the patients and PT staff cheering us on. Tim couldn't figure out what all the ruckus was, he just wanted to put someone on the ERMI. By Friday, I had all the therapists shaking their hands, rubbing their thumbs, and huffing/puffing as they tried to work on my knee.

I'm happy to say that I left Cincinnati for home yesterday and slept in my own bed last night. Mom flew home today. It was quite a battle over the last 8.5 weeks to rehab my knee after the surgery and there were many ups and downs. I still have months of rehab to go, but life is so much better now. Following the surgery it was extremely painful to get to 90 to 100 degrees flexion and 0 degrees extension with overpressure, but after a MUA at 3 weeks, a nerve block at 5 weeks, a lot of painful patella mobs (twice a day) between weeks 5 and 7 (patella mobs were done all along, but this timeframe was the worst), and several changes in medications (after week 4), I could see some progress at week 6 and significant progress was made at week 7 and then the recovery just started to take off. Every few days I would gain 5 degrees or so in flexion. I left CSM at 130 degrees flexion (the goal was 120) with overpressure and 110 degrees flexion actively. I can reach 0 degrees extension with relative ease and hang weights just because that is part of my routine more so that I need to do it.

If I can offer one piece of advice to those of you traveling out of town to seek treatment from a doctor who specializes in arthrofibrosis (or the condition that afflicts you), make the commitment in time, finances, and resources to be treated by the PT staff of that doctor. I initially planned on spending 4 weeks in Cincinnati, which would have allowed for 3.5 weeks of PT at CMSOC after my surgery. Every week the therapist and doctor changed the treatment plan depending on my progress (or lack of). If I had gone home 3.5 weeks after the surgery, I would have missed out on the most important treatment options or critical treatment would have been delayed too long. I think there were times that everyone was frustrated with the lack of progress, but we just kept at it until some results were seen. It was tireless dedication by myself and the PT staff. I sure didn't see this kind of result from my first therapist. I will be paying off the lodging expenses and battling the insurance company for many months to come, but it will be worth it in the end. I can't thank Dr. Noyes and the PT staff at CSM enough for what they had done to improve my quality of life.

9/20/07 - 9 weeks post-op. Where did the time go? I have been home almost a week and went to see my hometown PT today for my initial evaluation. This is a new therapist that I have not seen before and was recommended by a friend of a friend. Given that I just spent 8 weeks at CSM the bar was set pretty high and since my previous hometown PT experience was not too good, my expectations were pretty low. Much to my surprise, this therapist knew about and has treated arthrofibrosis. He observed that my knee was warm. Considering how hot my knee has been, I thought it was rather cool. It was just nice that he acknowledged this as a potential problem. He poked and prodded both legs from the mid thigh down to the ankles and zeroed in on the problem areas in my left knee. Granted the whole knee is a problem area, but he has chosen to work on the areas that have not been treated as aggressively. His technique for addressing the scar tissue on the medial side of the knee is different than anything I have experienced to date. He took a pair of medical scissors and with the pointy end plucked the skin like it was a guitar. The look on my face was probably priceless. This "plucking" was done over an area about 1 in by 2 in and now it looks like I have the measles in that area. I only did a little bit of strengthening work at therapy, so I'm going to have to keep at this outside of PT. This therapist wants me to really focus on stretching my quad every 2 hours. The good note is that I have been able to maintain my active range of motion and improve on it a little (flexion 126). My only concern is that they didn't worry about the extension too much and keep putting a pillow under my knee (which I kept removing). They kept saying that they wanted me to be comfortable. Who needs to be comfortable when they are inflicting pain?

In the days that I have been home, my home PT program has become a little less formal with the rest well deserved. However, I definitely get time in on the ERMI, stationary bike, walking around the neighborhood, balance board, and various strengthening exercises.

9/24/07 - Returned to work part-time today. It wasn't too bad and I didn't have to hobble around with a crutch this time.

10/5/07 - 11 weeks post-op. I had a follow up visit with Dr. Noyes and the PT staff at CSM today.  I have been able to maintain the ROM that I achieved in Cincinnati (0 to 110 actively, and up to 130 with overpressure). I'm real pleased with this, since one of my worst fears was losing ROM once I got home. There is still a lot of pain, stiffness, and crunching under the patella, which I hope will go away with time. Dr. Noyes feels that the warmth that I'm still experiencing is part of the healing process, so I'm back on the Celebrex. The wire will stay in for another 3 months or around January 2008. At least I should be able to get through the holidays before the next surgery and PT.

11/9/07 - 16 weeks post op. Active flexion is 125 and passive flexion is around 135 (I actually hit 141 today, but I don't consider it valid until it's been repeated). There is still a lot of pain and stiffness in the patellar tendon region and crepitus under the patella, which limits a lot of activities. I'm hoping that most of this is due to the wire that is still acting as the patellar tendon and that it will go away once the wire is removed in a couple of months. I'm still doing PT 1 to 2 times a week and the gym 3 or 4 times a week for strength and home exercises for quad control. I still don't do stairs very well, but I'm going to get there eventually. My gait is normal, so everyone thinks all is well with my knee. I have no regrets with the surgery. Flexion has improved and pain slightly decreased. I just hope that some day I get to the point where life is not all about the rehab, medical bills, and insurance battles.

11/21/07 - 18 weeks post-op. I had another check up with Dr. Noyes and the PT staff last week. Everyone is still pleased with the progress. ROM is 0 extension and 138 passive flexion (120 active). Everyone has agreed that I can ease out of formal therapy and continue with the gym and home exercises. The wire will be removed in mid to late January along with an arthroscopic debridement to address some of the scar tissue. I'm really hoping that takes care of most of the pain and stiffness.

12/5/07 - 20 weeks post-op. I have stopped going to formal PT, but the gym is my new best friend 3 to 4 times a week. I continue to maintain the ROM. There is still a lot of pain and stiffness. Also developing a burning/stinging sensation in the patellar tendon area. I hope that this means that the reconstructed patellar tendon is ready to act on its own and it is kind of fighting the twisted wire ends that are located on each side of the patellar tendon. Surgery to remove the wires is scheduled for January 9. I'm glad the surgery is finally scheduled; the wires need to come out. At times I can feel them kind of moving or the tissue that adhered to the wire kind of tries to pull away from it. It's kind of weird at times. Hopefully, the pain and stiffness will settle down afterwards.

1/4/08 - 24 weeks post-op. There is not much new to report at this time. In the past month I have tried as much as possible to return to my daily activities and the casual observer doesn't even notice that I have this injury. I still hope to one day return to some of the sports and outdoor activities that I enjoy, but for now I work part time and focus on increasing my muscle strength and maintaining my ROM. I can tell that the strength is increasing and the ROM is being maintained, but the pain and stiffness is present all the time. My left thigh is still much smaller than my right. I can see and feel the location of the wires. Surgery is next week to remove the wires and any scar tissue then there will be another round of daily PT.

To be continued in a month or so......

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