The SPECIALIST'S OFFICE => Ruptured patellar tendon or ruptured quadriceps tendon => Topic started by: ~*Heather*~ on May 22, 2003, 04:33:30 PM

Title: Quad Tendon Rupture, patella infera
Post by: ~*Heather*~ on May 22, 2003, 04:33:30 PM
I am not sure where this goes so I'm posting it here. I have it posted with all the other tendon issues, but someone mentioned here might be a better place in another person's post:

I am 26 years old. I had a surgery in Feb 2002 Lateral release and medial plication (incision in VMO to hold it) I took a fall in march of 2002, my doc didn't discover I ruptured my Quad tendon until July 2002. I had the Quad tendon repair in August 2002. I can't seem to recover from this! It's driving me nuts! I now have a huge bulge in my knee and I saw a new doc today.  He did x-rays and discovered that my kneecap is too far down, almost on the shin bone which is causing it to lock.  This is a BIG problem!  I still can't do a leg raise or leg extension without some lag and a lot of pain! He is not sure if it can be fixed and how he would even go about it!  I am getting an MRI on Jun 3rd and we will take it from there.   Anyone out there who has had this surgery or knows anything about it?? Please help me! Post here or email me directly [email protected] I AM SO DESPERATE!!!!! Thanks for reading : )  
I also just learned that I can put the description of injury under my posts!    
Title: Re: Quad Tendon Rupture, patella infera
Post by: Heather M. on May 22, 2003, 09:32:22 PM
Hi again.

Here are some more things to read:  there is a link on arthrofibrosis.  These docs are in PA, but I think they also practice in the tri-state area.

You didn't say where you were located in the world.

Here are some journal summaries--this is where I found the best information on who is doing research on arthrofibrosis and what the treatment options are:

The surgical treatment of arthrofibrosis of the knee.  Am J Sports Med 1994 Mar-Apr;22(2):184-91 Related.  Cosgarea AJ, DeHaven KE, Lovelock JE.  Department of Orthopaedic Surgery, University of Rochester Medical Center, New York.

Sixty-one lysis of adhesion procedures were performed for arthrofibrosis of the knee between 1981 and 1990. In 43 cases (37 patients) the etiology was prior knee ligament surgery. Ten cases had sustained fractures about the knee and eight had miscellaneous etiologies. Six patients required a second lysis of adhesion procedure. A retrospective analysis of the 43 ligament patients was undertaken to evaluate the results of surgical treatment. All 43 cases were available for followup at an average of 3.6 years. Surgical indications included flexion or extension deficits of > or = 10 degrees or when motion failed to improve despite 2 months of intense therapy. Follow-up assessment included clinical and radiographic evaluation. Flexion improved from 83% to 97% of the contralateral side. Extension deficits improved from 14 degrees to 3 degrees. Only 23 of 37 patients (62%) achieved satisfactory functional results. Radiographic evidence of degenerative changes, soft tissue calcification, and patella infera was found in 89%, 51%, and 9% of the patients, respectively. Patients requiring surgical treatment for arthrofibrosis after knee ligament surgery achieved excellent motion gains, but functional outcome scores were compromised and radiographic findings were concerning. Patients with the localized anterior intraarticular variant or those undergoing lysis of adhesion surgery sooner than 6 months had outcomes comparable with controls.

Here is another journal study, authored by my new surgeon in Colorado:

Lysis of Pretibial Patellar Tendon Adhesions (Anterior Interval Release) to Treat Anterior Knee Pain After ACL Reconstruction
Sports Med/Arthroscopy
Sumant Krishnan, MD Dallas TX
J Richard Steadman, MD Vail CO
Kim Hydeman, BA Vail CO
Matthew Close, BA Vail CO
Anterior knee pain (AKP) after ACL reconstruction is a well documented complication. AKP may be attributed to infrapatellar contracture syndrome--anterior tibial adhesions that restrict patellar mobility. We report results with the anterior interval release for recalcitrant AKP associated with decreased patellar mobility after ACL reconstruction. METHODS: Nineteen consecutive patients with recalcitrant AKP and decreased patellar mobility after ACL reconstruction underwent arthroscopic anterior interval release. Initial ACL procedures were autograft BTB reconstructions; all patients participated in the same postoperative rehabilitation program. AKP was treated with patellar mobilization exercises and NSAID's. Failure of nonoperative treatment was defined as no improvement in functional outcome, assessed by Lysholm scores and patient questionnaires. Minimum follow-up was 2 years. RESULTS: After failure of nonoperative treatment, Lysholm score averaged 68 (range: 18 to 90). Postoperative Lysholm score averaged 85 (range: 68 to 100)(p < 0.0001). Range of motion did not change significantly; instability examinations were all graded zero. Preoperatively, 74% reported moderate to severe pain, 63% reported moderate to severe stiffness, and 58% reported abnormal knee function. Postoperatively, 21% reported moderate to severe pain, 5% reported moderate to severe stiffness, and 16% reported abnormal knee function. Average patient satisfaction at follow-up was 8.0 (1 = very dissatisfied; 10 = very satisfied). DISCUSSION: Pretibial patellar tendon adhesions after ACL reconstruction can be a debilitating source of AKP and poor functional results. We have altered our postoperative ACL rehabilitation program to include aggressive emphasis on patellar and patellar tendon mobilization exercises. Operative intervention (anterior interval release) has been shown in this series to result in significantly improved functional outcomes.

I'm just pasting these summaries from a document I created last year.  If you want the word doc, just let me can be depressing reading, though.

Title: Re: Quad Tendon Rupture, patella infera
Post by: ~*Heather*~ on May 22, 2003, 09:42:27 PM
I would like the document when you have time to send it.  I appreciate all the help you have and are giving to me, I could NEVER tell you!  OMG!  Thanks so much! Do you work now?  I currently do not as my knee hurts and swells badly if I am on it for long periods, plus my hubby wanted me off so I could pursue PT full time and I find THIS instead, geez!  By the way, I am in North Carolina.  Thanks again!  You don't know how much it means to me!    [email protected] if you need an email address to send the doc.  Thanks!

Title: Re: Quad Tendon Rupture, patella infera
Post by: OBXann on May 27, 2003, 05:07:40 AM
  I don;'t know that I have any answers for you, but I had to drop a nite since your case is so very similar to mine. I had a lat release done in Oct 2000 and 3 weeks later I took a fall and ruptured my quad tendon. It was a hideous tear, I was unable to move my leg at all and my kneecap was sagging down quite low. It was fixed the next morning with an emergency surgery, folllowed by 6 wks immoblization. After that, I had terrible trouble with scarring and went through 2 maniplulations and a week in the hospital to get past it. I saw another person replied to you and quoted some info from a Dr Cosegrea (Something like that) at John Hopkins, MD-I tihnk? Anyway, my doc went to him before the 2nd manip and he set up my whole treatment plan as an expert is arthofibrosis. I did get better from the scar tissue. My good news ends there though, as I am still having trouble and now I am awaiting an appointment with Dr Fulkerson to hopefully fix this knee once and for all. I just had to drop a note, I have not come across many people with rupt quads and only you and I after a lat release. I would love to hear how you are doing, what exact problems you are dealing with. Good luck to you! I hope you can get past this.
Title: Re: Quad Tendon Rupture, patella infera
Post by: ~*Heather*~ on May 27, 2003, 05:35:56 AM

I'm not doing too well.  I recently found out that my patella is riding too low (patella infera or patella baja).  That hurts any rebuilding of the quad. I still have 2 inches of atrophy in my quad and I'm 9 months postop.  I am not working because I simply can't. I tried and my knee just balloons up and is too painful .  I have taught myself to compensate by changing my gait, so when I walk, I barely use the quad.  I am now having trouble with leg raises again and never could do a leg extension with any kind of weight.  My shoe was almost too heavy for it.  I was not told of this potential side effect from this surgery. My quad went undiagnosed for almost 3 months and it was 4 months before I could get the surgery.  I hear that most success occur when the surgery is done immediately, like yours.  My surgeon thought when i fell that i only tore the advancement in the VMO, which would mean a partial quad tendon tear not a complete, but when i didnt get any better and had a huge gap where the tear was he finally ordered the MRI.  He was so busy with surgeries that I had to wait an additional month for surgery.  I have totally lost my quality of life.  I can't do anything that I used to.  I have this never ending stiffness and pain throughout.  I can't go up stairs or down stairs properly or without holding on desperately to the railing.  Walking through the grocery store I have pain and also now my knee is locking.  It has a tendency to pop before I can actually get it moving.  I think from the responses that I have received that this because of the position of my patella not necessary related to my quad tendon repair. You metioned that your patella was sagging, did your repair fix that?  If not, you may find yourself in the same boat as me.  Please let me know your limitations and any set back you have encountered.  I definitely want to know more about your situation and see if we can't benefit one another somehow.  Thanks for your response!!!!!!!  

Heather ;D