The SPECIALIST'S OFFICE => Ruptured patellar tendon or ruptured quadriceps tendon => Topic started by: Kaddydee on October 31, 2014, 04:44:53 AM

Title: Anyone had a patella tendon reconstruction for a chronic patella tendon tear?
Post by: Kaddydee on October 31, 2014, 04:44:53 AM
Hi everyone,

I've read a lot of your stories and it's been great to read about the surgery, recoveries and mostly positive outcomes from patella tendon reconstructions.  My case is a little bit different because I have a chronic patella tendon tear (half remaining) and patella alta which happened 2 years ago when a OS got a little excited in a knee manipulation.  When it happened, I couldn't have surgery because of other knee complications so now I've got bigger problems! I've done lots of internet research and have only found 4 journal articles with positive outcomes - it really is a rare situation to be in. 

I've had 3 surgeons look at my patella tendon and all have been scared and reluctant to operate.  They're scared because I reacted, in the past, with Complex Regional Pain Syndrome after a simple arthroscopic surgery (a real concern!) and they're scared that I will go through this big operation and recovery and it won't make a difference (or I'll be worse).   From all my reading, I understand that outcomes aren't always favourable but I really want to give this operation a go.  At the moment, I cannot walk up/down stairs or hills because my knee doesn't bend under any weight. I can't ride bikes, jog, squat and I often trip because my knee doesn't give me any stability.

I am booked in for surgery on the 13 Nov with a surgeon who is willing to have a go.  He will give me a nerve block,  use an allograft tendon, give me lyrica (for the CRPS) and keep me in for 5 nights for monitoring.  Does anyone have any chronic patellar tendon reconstruction stories they can share with me?  I'd love to hear from someone other than an orthpaedic surgeon.  If not,  I will write about my experience and hopefully help others in the future.

Title: Re: Anyone had a patella tendon reconstruction for a chronic patella tendon tear?
Post by: Kaddydee on November 17, 2014, 01:11:51 AM
Hi everyone,

I had my PT reconstruction on Thursday and feeling well enough today to post something.
I didn't get to talk to the surgeon after the op but did talk to another Dr who was in the operation.  He said it all went well and he didn't expect to ever see another operation like it - I think he was quite chuffed to have seen something so unusual.  He said that I had 3/4 of the tendon intact but the other 1/4 was stretched and frayed and all out of shape and that had caused the patella alta.   They used my hamstring, drilled 2 holes and used wire and staples to secure the autograft and existing tendon.  They then xrayed my patellas to make sure they were at the same height.

I had a mid-thigh nerve block for two days which was lovely.  I could feel pain in my hamstring and where they had the tourniquet but thankfully no pain at the front of my knee.  I have had a lot of pain the last couple of days but if I stay on top of the meds (Tramadol slow and quick, Endone, Ibrofen and Paracetemol) then I get by OK.  I have a full leg hinged brace set at 30.   I'll see the surgeon in 2 weeks to look at the wound and work out what we do next.  I'm moving about the house on crutches OK but do find this intensifies the pain so, I only get up when I have to.

Foot is very swollen - I am putting it up and icing.  Not sure what else I can do at this stage.

All in all, things progressing as well as I had hoped.  After my horrific experiences past surgeries this has been a breeze. 

Take Care,
Title: Re: Anyone had a patella tendon reconstruction for a chronic patella tendon tear?
Post by: Stuart Rulka on November 26, 2014, 03:59:08 AM
Kathy, hard for a simple RQT to relate but please keep posting. Thank you.
Title: Re: Anyone had a patella tendon reconstruction for a chronic patella tendon tear?
Post by: Kaddydee on November 27, 2014, 08:54:35 PM
Thanks Stuart,

I will keep posting - if not for someone now then someone like me in the future.

I had my 2 week appointment yesterday.  A few things came up:

1  My knee is BLACK with bruising.  The registrar took the bandages off and said "WOW! Never seen it like that before".  Then the surgeon came in  and agreed.  He promised me that he was gentle in surgery but apologised that it ended up so bruised.  I do bruise easily so I didn't think it was a big deal but it was funny seeing their reactions.

2 My brace has been set at 60 - the aim for the next 4 weeks.  They don't think I'll make it to that but as they said 3 times yesterday, I don't have a normal knee so who knows what will happen.  They are happy for me to start weight bearing (with crutches) as able.  At this stage, I can't get my heel down because of calf tightness so it will be a while before I can even attempt to weight bear.

3 They weren't particularly worried about the stiffness of my calf/acchiles Tendon.  They say that things can stiffen up quickly (and in my case very quickly) I'll start physio next week for my calf and quads.

4  Pain management - they want me to keep taking some of the heavier pain meds (Endone) so that I can get up and about a bit more and start doing physio.   

5  Had a bad night last night and again this morning.  Now, that my big bandage is off, my leg is extra sensitive to outside stimuli (doona cover, breeze etc).  Strange feeling - the outside of my knee is numb and doesn't feel anything and the inside of my knee is buzzing and tingling and hurting.  I've experienced this in the past (10 times worse) with Complex regional Pain syndrome.  I may cover it at night so I can sleep better and then start massaging and desensitizing it through the day.

I think that's all.  I'll see what happens when I start physio.  It will be a long journey.....

Title: Re: Anyone had a patella tendon reconstruction for a chronic patella tendon tear?
Post by: Stuart Rulka on November 29, 2014, 02:30:46 AM
Kathy, it will indeed be a long journey but with the help of a really good (and I can't overemphasize this enough ) Physiotherapist you will get back to (almost) I have stated elsewhere I firmly believe that once the surgeon has completed his area of expertise ( the surgery) the advice of the physiotherapist takes precedence. Once again good luck and keep us informed. Remember , many of us can not relate to your particular ( peculiar) circumstance but we are all behind you!
Title: Re: Anyone had a patella tendon reconstruction for a chronic patella tendon tear?
Post by: Kaddydee on December 02, 2014, 12:56:44 AM
I totally agree about the physios, Stuart.  I've had a great team working with me over the last couple of years.  Every few months they all got together and spent an hour working out solutions to my different problems.  When a couple of surgeons gave up on me the physio persisted and got great results.

I had my first post op physio session yesterday at the hospital.  My range is 10-25.  It doesn't hurt to bend but it has completely stiffened up.  This has happened in the past with me so I know that with perserverence I'll gradually get the bend back.  I've got 3 main exercises - heel stretches, co-contraction of my VMO and hamstring (struggling to even activate these muscles!) and gentle bending of knee.

I've got an old fashion pulley system that a hospital gave me a couple of years ago.  It works like a CPM machine by I control the movement with my hands.  I'll use this for passive bending and then do some active bends while I've got my leg on the couch.

Feeling good!
Title: Re: Anyone had a patella tendon reconstruction for a chronic patella tendon tear?
Post by: Kaddydee on December 14, 2014, 12:26:45 AM
Hi all,

Well, it was month yesterday post op.  So, what am I up to?
Thankfully, I'm pain free.  My knee is still very inflamed, swollen and bruised but I'm so happy that I'm not battling with pain, like I did last time.
My calf muscle is gradually loosening up so I can nearly put my heel on the ground.  Hopefully, that will be a major breakthrough this week.  I'm looking forward to being able to walk properly with crutches.

My bending, or lack of bending is still a big issue.  I'm still only 10- 30 (passive).  There's only been a 5 degree improvement in 2 weeks. I'm spending about 2 hours a day on bending so I would have hoped to have seen some more improvement. 

My hamstring muscle is getting stronger but my VMO is still virtually non-existant.  We put a muscle stimulator on it last week at physio and even with the machine turned up really high it was hard to detect the muscle working (the slightest little tremor).

I'm been referred to the head physio at the hospital this week for a consultation so we'll see what he has to say. 

I'm not worried, as my knee tends to have a mind of it's own, but gee it would be nice if things didn't take so long! :)