The SPECIALIST'S OFFICE => Ruptured patellar tendon or ruptured quadriceps tendon => Topic started by: troxm25 on August 14, 2017, 04:33:13 AM

Title: Significant Patella Alta Post-Surgery
Post by: troxm25 on August 14, 2017, 04:33:13 AM
Thank you in advance for any advice offered. 16-months ago I suffered a simultaneous bi-lateral rupture of my patellar tendons; it involved a 40-year old, his daughter, and a trampoline. I underwent surgery the next day, spent 6-weeks in locking knee braces and increased flexion bi-weekly until I moved to walking braces for approximately 16-weeks.

When the accident happened I was in the middle of a cross country move and was unable to establish continuity of care with the original surgeon. However, I followed his timeline, visited with two other orthopedic surgeons, and received physical therapy for multiple weeks. During the visits, both surgeons noted I had "patella alta."

Today, I suffer from gait instability, knee pain at the top of the patella (feels like the knee cap is getting pushed up), and pain in the patella tendon. I am unable to run and sit at about 65% of my pre injury activities. I was very active prior to the injury.

I am a professional pilot and frequently encounter increased forces on the pedals requiring longer durations of increased forces on the tendon. It is during emergency procedure training. Whenever I conduct this training, my knees are sore for days. I am very concerned about this integrity of the surgery. Is it at all possible for the tendon to continue to lengthen post surgery? Is it possible for the tendon to re-repture from normal stress/daily activities? My surgeon used two separate words to grade my patella alta; "slight" and then 4-months later "significant."Not a radiologist, but my knee cap is not very far from location post-injury?

Thanks again.
Title: Re: Significant Patella Alta Post-Surgery
Post by: madvillain on August 15, 2017, 07:27:21 PM
Man that sucks but I have no advice, can you get in touch with your surgeon?
Title: Re: Significant Patella Alta Post-Surgery
Post by: troxm25 on August 18, 2017, 03:34:33 AM
Yeah, I spoke with my surgeon this week. I am scheduled to get two MRI's next week and I have to schedule CT scans with no contrast in the next week or two. My surgeon is very hesitant to conduct another surgery, that is one of the main reasons I really like him. (My surgeon now is not the one who completed the surgery) The problem, my knee caps are so high they move out of the trochlear groove and "click" back in when walking down stairs, running, etc. So, am I avoiding surgery for a problem that will guarantee surgery when I have no cartilage under my knee cap? I do not know the answer, hopefully these new tests provide my surgeon the information he needs.

Once the tests are complete, he is going to speak with a patellar tendon specialist and recommend the best course of action. Thanks, I will post what my doctor recommends.
Title: Re: Significant Patella Alta Post-Surgery
Post by: troxm25 on August 24, 2017, 03:14:45 AM
Looks like a second surgery to correct the first surgery. Both knee caps are too high causing pain and instability. I have attached my MRI from this week, anyone ever seen a similar problem? Thanks
Title: Re: Significant Patella Alta Post-Surgery
Post by: Beasman on August 24, 2017, 05:28:36 AM
I have the exact same issue following bi-lateral PTR's back in 2013 when I was running the Boston marathon. I have patella alta in both knees following the surgery to repair the ruptured tendons. Mine were complete ruptures and my kneecaps went northward to about mid-thigh. I too cannot run, or jump since my injury and I have attributed that to a combination of the patella alta and weak quads which I was never able to fully rehab. You asked if the tendon will ever lengthen post surgery...mine has not and its been over 4 years now.

As you likely know now, a bi-lat PTR is extremely rare and very few OS's have experience in repairing a double. Due to circumstances beyond my control, I did not have the opportunity to select my OS. I was so lucky I wasn't killed or injured by the terrorist bombs, but the chaos that followed led to my injury near the finish of the race. Gripped with fear, my adrenaline surged and I found myself running at full speed even though I had been completely exhausted having already run 26 miles. In my haste I tried to negotiate a pedestrian railing and suffered the double PTR. Hospitals were literally overflowing with casualties and my injuries were deemed secondary to the dozens of other more seriously injured and rightfully so. It was several hours before I saw a doctor and meanwhile they had me doped to the hilt and I needed to be...the pain was unbearable and relentless. Eventually they did xrays and a MRI. Around the middle of the next day the OS assigned to me said he would operate in the am. I found out later that even though he appeared well into his 70's, he had never done a bilat PTR. I was from out of town like a lot of the runners and was by myself and had no one to advocate for me as to who, when and where I would be operated on. I was so wacky that they could have sent Bugs Bunny in to do the surgery and I would have said go for it!

So he put me in hard casts from butt cheeks to the ankles for 8 weeks. That is some kind of configuration to be in that long, I tell ya. After the casts were cut off, I was shocked how atrophy had diminished my legs, especially my quads. Two weeks later when I got back home I started the beginning of several months of rehab. I had to go in the water for most of it because of the kneecap tracking problem which I'm sure you're well familiar with by now. I have since tried to run and I literally cannot. Not sure if it is because the quads are still so weak or if it is more to do with the high riding kneecaps. My kneecaps prior to the injury used to point straight out if I were in a sitting position. Now they point upwards and the right one also points up and out towards the outside of my leg. I have clicking and popping in both knees, especially when going up or down stairs often drawing weird stares from folks several yards away. I've since had 3 dislocations, 2 on the left, one on the right. My knees ache and hurt all the time and after 4 years, oddly enough I have kinda got used to it. In recent months I've also been diagnosed with lumbar spinal stenosis. This is actually causing me more discomfort than the knees so currently I'm pursuing relief for that condition. I'm much older than you as I'm in my mid 60's and since the PTR's I've added 40 pounds in weight putting me at a level I've never been at my whole life since running was my thing going all the way back to high school, I had never had an excess weight issue until now.

I have not ruled out getting something done to try and get my knees close to being back where they were before. Right now, I have two options I'm considering. One is a procedure called tibia tubercle transfer(TTT). This involves the surgeon actually fracturing your tibia so as to re-anchor the lower part of the patella tendon further south of the kneecap in an attempt to bring the kneecap down to the location it should be in for proper tracking within the trochlear groove. You can google it if you haven't heard much about it and then get more of the details on it and what's involved. I'm giving consideration to this option. The other idea I'm considering is making a trip out to the Steadman Clinic in Vail, CO to see Dr LaPrade. He is recognized worldwide for his success in dealing with complex knee injuries and being located in Vail, I'm sure he's dealt with some doozies.  I have visited with several other OS's in my area and most have not suggested anything other than continued physical therapy and losing weight now that I've added those 40lbs. Since I've had some arthritis starting to set in a few years back, a couple have recommended TKR's. From everything I've read about this condition, TKR's will not correct this situation. You mentioned getting with a patella tendon specialist, I have not found anyone near me that specializes in PTR's. They aren't exactly a real common injury even for just single ruptures. The double clearly does require a different protocol in my opinion and certainly an OS with ample experience. On this site you can read of dozens of folks who've had PTR's and a few months or year or two later are back to pretty much doing what they did before. Well, I'm not even close to that and it's most likely due primarily to having an OS who didn't really know what he was doing.

So that is my long and extended story...I hope your surgeon comes up with a good course of action following all your scans and MRI's. I understand your hesitancy to have surgery...I get that. After all, I've now waited over 4 years since my injury w/o another surgery. However, I keep thinking if there is a procedure out there that really can help me and an OS qualified to do it, I'd give it a shot I think. But first I'll likely go see Dr LaPrade and get his assessment before doing anything. I wish you well my friend and sorry for this terribly long reply!
Title: Re: Significant Patella Alta Post-Surgery
Post by: troxm25 on September 09, 2017, 07:45:22 PM

Thanks for sharing your experience, it is truly an incredible sequence of events which led to your injury.

I am very surprised about the initial and post-operative care you received. My surgeon, and physical therapists, mentioned on multiple occasions the importance of surgery immediately following the injury and the importance of moving the joint after shortly after surgery. I was instructed to move the knees to increasing flexions over multiple weeks. This started at 15-degrees (I believe) at week two and increased up to a "full open" setting around week five or six. I would not be surprised if your surgeon and post surgical care led to your problems today.

My doctor would like to complete a tibial tuberosity osteotomy to move the knee caps distally. I am starting with the left knee and then based on results, will move to the right knee. I did contact the specialist, but appointments are scheduling for 4 months from today. Unfortunately, I am not able to wait that long.

I will let you know about the results, good luck to you!