Advertisement - Hide this advert





Author Topic: Patellar tendonitis surgery  (Read 62383 times)

0 Members and 1 Guest are viewing this topic.

Offline Volleymarc

  • MICROgeek (<20 posts)
  • *
  • Posts: 4
  • Liked: 0
Patellar tendonitis surgery
« on: December 08, 2005, 04:48:38 AM »
I play lots of competitive volleyball and developed the dreaded Pat Ten. It has been bothering me for about two years. I have been to 4 orthos and 3 told me to live with it or quit playing. Not an Option!! Finally, the fourth dr suggested surgery. I have been though PT twice, rested for months, and taken enough advil and COX2 drugs to kill a horse. And it just keeps coming back and gets worse, so I am thinking about getting the surgery. He says, he wants to go in and shave away the damaged part of the tendon and the scar tissue and maybe do a lateral release. Does this sound like correct? Also, I have a small bump right under the patellar.  He said it was probably scar tissue. Just curious how it turned out for any of you. And how the recovery is. He told be it would be 3 months till I could jump again and would be in a straight leg brace for 2-4 weeks. Does this sound right? Is the surgery worth it? Any ricks involved? Any info would be great. I have read so many things and no of it seems to match up. Just confused if I should get the surgery or not. Thanks...Marc-

Offline shade

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 3161
  • Liked: 0
  • An obstacle is often a stepping stone.
Re: Patellar tendonitis surgery
« Reply #1 on: December 11, 2005, 12:59:40 PM »
Hi,

Here is an article that might answer some of your questions.  Good luck with your decisions.  ~Shade

http://www.orthopaedics.co.uk/boc/v2rinfo9.htm
July '05 (RK) - LR/debridement
Mar '06 (RK) - Open LR + Allograft w/OBI TruFit Plug + Fulkerson TTT
 Feb '07 (LK) - LR + Fulkerson TTT

Offline Heather M.

  • SuperKNEEgeek
  • *****
  • Posts: 4007
  • Liked: 10
    • Check out my photography!
Re: Patellar tendonitis surgery
« Reply #2 on: December 12, 2005, 08:20:19 AM »
Hi there.

I have had the patellar tendon debridement surgery for scar tissue several times.  I haven't replied because I really don't think you want to hear what I have to say ;D  Seriously, if you can't consider giving up volleyball...well, I guess I'd say that your knee doesn't hurt enough at this point.  And if it doesn't, then I wouldn't encourage anyone to do this surgery, as it really doesn't have the best success rate in cases like yours.  That's because the tendinitis is a chronic condition--whatever caused the rampant swelling and development of scar tissue on your patellar tendon will not be changed by the surgery.  You are just looking at having a cleanup.  I kind of see it like this (just analogy here, to shine a different light on things):  pretend you have a slow, persistent bleed in your abdomen.  It is a leaky artery or ruptured capillary or something, caused by the constant upper body torque of serving the volleyball.  So the blood slooooooooowly leaks into your belly, and this causes pain and irritation.   It's starting to affect your game, so you see a doctor.  He tells you:  "If it hurts when you do that, then don't do it!"  You see two more doctors who tell you the same thing--stop doing the activity that causes the problem in the first place, and it will likely clear up.  You see a fourth surgeon who, for whatever reason, offers to go in and clean the blood out of your belly...but leaving the bleeder untouched.  So you likely will be right back where you started, and fairly soon.

I guess what I'm saying is that in theory, it sounds like the debridement of the patellar tendon is a great idea--clean up the area and it will be as good as new.  But what about the conditions that CAUSED the swelling and pain and scarring in the first place?  What are you going to do about those?  Because until you address them, you are just chasing symptoms.  And that's likely why the first four surgeons you talked to wouldn't do anything about your knee.  If you're not willing to stop the activity causing the irritation, then there's not much the medical profession can do to help you....As my surgeon told me once, there is never any problem so bad that it can't be made worse by inappropriate surgery. 

Anyway, this is just my opinion.  I'm not a doctor, nor do I play one on TV  :P  I'm just someone who had a moderate knee problem and went in for surgery...then came out ten times worse.  I went from working out every day and doing distance hikes four times a week to barely being able to get from my car to the grocery store and back without being in agony.  But my condition is unique, and my problems are quite severe.  I also have INCREDIBLY bad medical karma--if it can happen, it will happen to me.  So I'm really not the best person to ask, unless you want to get the bejeepers scared out of you.  I'm just writing my first response on reading your post.  I cringed at the idea of going to doctors until you found one who said what you wanted to hear.  I would take a poll and look at the majority opinion, if the doctors who gave it to me were qualified to treat my condition.

But that's just what I would do in your case.   You're the only one who can decide what to do, and what is right for you is going to be disastrous for someone else, and vice versa.  And you're the only one who knows what the doctors you talked to said, and what their qualifications with patellar tendinitis are.

As for your questions:

Shave patellar tendon and scar tissue, then do a lateral release; does this sound right?  Not to me, but again, I'm not a doctor.  Just someone who had a disastrous lateral release experience.  Not the best person to ask...anyway, the lateral release is most often done to correct patellar tilt.  Sometimes, it is done by doctors in order to correct a mal-tracking kneecap, but my personal belief is that this is a recipe for a bad outcome.  Finally, lateral releases are done to free up a kneecap that has been encased and 'locked down' in scar tissue--usually stuff inside the joint capsule.  I'm not an anatomy specialist, but I don't believe the patellar tendon is inside the capsule...maybe I'm totally wrong here.  Anyway, I've never heard of a lateral release being done on someone for chronic tendinitis.  I have heard of a lateral release being offered as a placebo surgery--you know, the doctor wants to do something to show that they take the patient's pain and issues seriously.  I really don't know what your situation entails, but if you are not scenario one or three above (patellar tilt or patellar entrapment in scar tissue) then I'd recommend doing some serious research about lateral releases.

As for recovery time--everyone is different.  Three months before you can jump again?  It was almost three months before I could walk without crutches following my patellar tendon debridement.  Again, every knee is different.  It sounds like you are in great shape and would likely recover very quickly from any surgery.  But surgery is surgery, and there are always risks.  Aside from the generic surgery risks (infection, etc.), there is the risk that this particular procedure would not make you better.  And that scraping the tendon and/or doing a lateral release could actually make you a lot worse.  Or that the scar tissue could grow back, in extreme abundance--especially if you are are kept immobilized post-op.  Perhaps this is just the way your OS treats lateral release patients--I've not heard of bracing a post-op patellar tendon debridement patient, but about half of the LR patients end up in a brace.

Anyway, I was just made very uncomfortable by the idea of three out of four doctors telling you to stop the activity that is antagonizing your knee and provoking this severe swelling.  That being said, if you are serious about continuing with athletics, I'd consider seeing a doctor who is serious about keeping athletes on the field.  Like my surgeon, who took on Ronaldo (Brazilian soccer player, kind of a Pele for the new generation) and the patellar tendinitis he had in both knees.  If you want to stay in sports, see a sports medicine specialist.  Get more than one opinion--meaning find other doctors who see athletes with this condition who also recommend surgery.

Again, here is my disclaimer:  I've had terrible experiences with knee surgery, and that no doubt colors my opinion.  I'm not athletic anymore, because of my terrible knee surgery experiences.  And I would give anything to take back the first surgery I had, where I went in with some moderate knee issues and came out essentially disabled.  I'm the worst case scenario, and it's VERY RARE to have an outcome like mine.  But it does happen, even when you see the BEST surgeon and dedicate yourself to PT and have the best attitude and go into surgery with NO KNOWLEDGE of the potential complications (I'd never even heard of having excess scar tissue in a joint, so I had no idea it could happen to me--ignorance is bliss).  So it's not like I was lazy or had a bad attitude or read the encylopedia of knee conditions and am a hypochondriac.  I just ended up having an outcome that is an extreme outlier on the bell curve.

So that's my story, and it is probably an extremely rare one.  But just to be safe, I recommend that people do way more research on their conditions than I did.  You know what they say about hindsight.....

Heather

PS I almost didn't repsond to this post, and then I almost edited my reply because I felt like I might have been too honest.  But you did ask...and this is obviously just my opinion, and shouldn't be substituted for the advice of a specialist knee surgeon--or three of them.  Four.  Maybe half a dozen.  Anyway, I hope you're not offended by my opinion, and I hope you take it in the spirit with which it is offered:  lots of regrets for the way I did things and full of the hopes that no one has to go through what I did in the future.
« Last Edit: December 12, 2005, 08:30:37 AM by Heather M. »
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline australia

  • Regular Poster
  • ***
  • Posts: 58
  • Liked: 0
Re: Patellar tendonitis surgery
« Reply #3 on: December 14, 2005, 01:22:53 PM »
I have had patellar tendonitis for 18 months, and it started to get better in the past 3 months.  From doing a lot of reading about various treatments for patellar tendonitis, I came to the following conclusion on surgery:

1.) It is something that is rarely done for PT, and should rarely be done, for the following reasons:

2.) It is NOT 100% effective.  Perhaps only 60% of the time it may help.  And then, only if it is done by a real expert!  Even if it is successful, you may still have some degree of lingering PT pain.

3.) There could be all kinds of complications during the surgery or in recovering from the surgery.  Infection, for example. 

4.) Orthopedic surgery can increase your chances of getting osteoarthritis later on.

5.) The rehabilitation from surgery can be many, many months.  Perhaps a year.  I wouldn't risk jumping just 4 months out of surgery!

6.) There can be complications during physical therapy after surgery.   If you don't do the right things and are not supervised correctly by an expert physical therapist, you can develop problems, including tendonitis!  Your weakened condition following surgery can set you up for a lot of problems in physical therapy.

7.) There are other alternatives to surgery, which I'd consider first:  1) Extracorporeal Shockwave therapy -- it is done in Canada and Europe, but has not yet been approved by the FDA in the U.S.  2) Sclerosing injections -- you need to go to Sweden to do this, and go back for a number of treatments.  There's one doctor/professor who has written a lot about this.  3) "Eccentric exercises" using a "slant board" under the guidance of a Physical Therapist who knows how to guide you through this.  You will need to ask around.  Few physical therapists know about this or the proper protocol for these exercises. 4) Wear special two-tier patellar straps -- those that go above and below the patella -- if you must play v-ball.;  5) Avoid jumping/playing volleyball for a year and see what happens.

8.) If you go to enough orthopedic surgeons for evaluations on what you should do, there will always be some doctor that suggests surgery -- whether it is really appropriate for you or not.  This is because the surgeon gets paid a lot more money to do surgery than to recommend physical therapy.  I'd go to many orthopedic surgeons, and only if the vast majority say surgery, then I'd consider it.   

9) There are a number of different kinds of surgery used for PT and there is no "gold standard" way of doing it.  This is problematic to me that surgeons can't agree on the best course of action.
 
« Last Edit: December 14, 2005, 01:25:19 PM by australia »

Offline Volleymarc

  • MICROgeek (<20 posts)
  • *
  • Posts: 4
  • Liked: 0
Re: Patellar tendonitis surgery
« Reply #4 on: December 15, 2005, 02:47:08 AM »
Thanks for the feedback. Well, giving up volleyball is not an option. Especially for a year!!! Heather, you mentioned that the LR is not used for PTentonitis, correct. But I also have a tracking problem and thats why he suggested that. Its not 100% that he is going to do it. My OS said he will scope it and see. As for getting a specialist, he is a sports med knee specialist. He told me that its not a very common surgery, but he has done it about 20 times and feel comfortable  from looking at my MRI that this will help. I really hope this guy is not after a christmas bonus. But I feel comfortable and trust him. As Austrailia mentioned. there are several ways to do this surgery and the way he does it is a bit different. He told me I would be playing again in 3 months. THe sugery is set up for Dec. 27th. I dread the straight leg brace for 2-3 the most. Being a pharmaceutical rep I drive a lot and this will keep me out of work. Wish me luck......

Offline BBall12

  • Forum Faithful
  • ****
  • Posts: 171
  • Liked: 0
  • User's Text
Re: Patellar tendonitis surgery
« Reply #5 on: May 19, 2006, 06:50:09 AM »
I have had patella tendonitis for almost 2 and a half years following my acl recon in dec. 2003.

One year ago i had the patella tendon debridment for my patalla tendonitis pain and it seemed like it might have worked...so i started playing basketball again and played to much and the tendonitis is back just as bad as it was before.

I am not sure this stuff will ever go away, it is so painful to jump and run now.

Can a lack of quad strengh cause patella tendonitis to return?

After the surgery and now the tendnitis is back i do not know where to go from here.

Offline jumpnsumpn

  • MICROgeek (<20 posts)
  • *
  • Posts: 1
  • Liked: 0
Re: Patellar tendonitis surgery
« Reply #6 on: January 31, 2011, 10:57:12 PM »
I play the same sport and your case is almost the same as mine.....went to dr. today and after a scope last year and prp injections etc etc....Im in the same boat as yourself.  Surgery has been put on the table and he has done everything in mind to keep me off the table.  Just wondering how you turned out?

Offline laffnboy

  • MICROgeek (<20 posts)
  • *
  • Posts: 1
  • Liked: 0
Re: Patellar tendonitis surgery
« Reply #7 on: February 28, 2011, 05:08:40 AM »
I am about to post the issues I have been having after my debridement surgery 5 months ago. In short - do not do it! It has been a complete failure and I am now worse than I was before the surgery. My doctor has now told me that he does not know why I am in worse pain than before the surgery and I should find another doctor. Just what I want to hear!

-Andrew

Offline HelbrassUK

  • MICROgeek (<20 posts)
  • *
  • Posts: 1
  • Liked: 0
Re: Patellar tendonitis surgery
« Reply #8 on: June 02, 2011, 12:05:46 AM »
Hi

Very new to this site, but thought I would reply to this post.

I'm from the UK and had Patellar Tendonitis Surgery the end of 2010 - December.  I had tried all different treatments over several years and ended up trying 'Electro something' treatment to the tendon, this was completed between Oct09 to Dec09.  I had 3 tries with this and tbh it caused more pain than good.  I then had a MRI scan March 10 and from this my surgeon placed this op on the table, as i had several pockets on my tendon that where causing the issue.  We had talked about this op 2 years earlier but decided the time was not right and try other things.  I Waited until december to have the op, it was carried out in my local Hospital by a surgeon that had mentioned Dr Steadman a few times, and when i made some enquires my surgeon is higly rated in this type of op, so was happy to wait.  Also seems a very 'rare' op around here as I was only the second person in 2010 to have it done at this hospital, and he did 3 the year before.  Out of the 3 in 2009 that he did, 2 went back to playing Football and one to Rugby - one of the football players is not as good as another but was without the problems he had before the op so again very positive from my point of view.

By the time the surgeory had arrived the tendon was in a worse state and ended up having a 1/3rd of it removed - the middle part, i also had the cap shaved and cleaned etc.  I was on crutches for a good 8 weeks.  Was meant to start physio 8 days after but we had bad snow (yer i know 50mm of snow and uk falls to its feet  ;)  ), so this was delayed a few days to inbetween Chritsmas and New year - tbh was glad as it was sore as heck and the staples had been removed (12 in total) would had been a lot worse with the staples in the wound lol

I am now 6 months post op, still having physio twice a week and the knee is still sore.  First thing in the morning it feels great, but once I have started the day it soon kicks in, the pain aint bad enough to be taking big tablets anymore (but some Co-Codimal 8/500 take the edge off).  I am back to driving, could not manage it before March - just due to pain and lack of strength to operate the clutch - sorry its my left knee.  The tablets I found that worked for me after the op were 30/500 co-codimal with some anti-flam tablets.

I do my exercise's 3 times aday, live in a 3 story house so the knee is well used, but the biggest thing that shocked me is the complete lack of strength - so like the OP says jumping is a big no-no.  I still can't stand up and ride a bike, can sit on a exercise one nps at all, but as soon as you stand like climbing a hill, no strength and plenty of pain.

The pain is different now as well, so I do feel like it worked - well did something to improve me, the pain i get now is from the tendon and most of the times its from the points they cut.  Physio is interesting as i'm starting to get to the point that the pain/restriction of movement is getting in the way - like im on a plato and still at the same point.  So my physio has started this last 10 days to 'tape' my tendon and this has done a lot, can do more exercise ad with less pain, so i'm hoping this will get me over this plato i'm on.  Only downside as a bloke the tape does half smart when you take it off  ;)  perhaps i should shave my knee lol

Sorry if this post is in the wrong place or not the right subject but this site is mental and tbh would have liked to have found it before i started down this road - as my physio says "still a lot of strength to build back into the knee" but i can see progress, muscle tone is coming back and shape is not too far off my right knee, i think what i'm saying if you do go down this route... think about the recovery, i was thinking 4 weeks and back to swiming etc, 6 months down the road if i swim breaststroke I 'crab' across the pool, and I feel like there is the same again before I'm back to where i was before the op - which was not fantastic.

If you have any questions drop them on here and I will answer them the best i can

Offline Jack0502

  • MICROgeek (<20 posts)
  • *
  • Posts: 1
  • Liked: 0
Re: Patellar tendonitis surgery
« Reply #9 on: January 14, 2012, 08:13:04 PM »
HelbrassUK, if you're still around, I wonder if you'd let me know how you're feeling now?

I'm considering the same operation on one of my knees, since I've had this issue for five years. My MRI is scheduled for March, and my doctor and I have talked about this operation. He gives me an 88% chance of success. I've been to multiple doctors, though, and they've told me different things, so I'm not sure. If you'd be willing to share, it'd be helpful to know if you still feel that the operation was successful this far down the line.

Hope you're still around, and thanks.

Offline ALRunner

  • Regular Poster
  • ***
  • Posts: 78
  • Liked: 1
Re: Patellar tendonitis surgery
« Reply #10 on: May 07, 2012, 03:38:07 PM »
live with it or quit playing. Not an Option!!
Actually, these are your very possible options where you like them or not. There is no guaranteed resolution to your problem. If quitting playing will resolve it and you decide not to quit playing and find no other resolution you may really regret that later on when, even after you do eventually quit playing, you still deal with the condition.

I know this thread was created 7 years back, but a few recent bumps.

This condition must be treated very seriously, including a willingness to totally cease the antagonizing behavior. And, even if the surgery is a 100% success, there's no reason in the world to think that going back to the antagonizing behavior without some way to mitigate its damage will not result in a complete return of the condition.

Despite my username I've finally given up entirely on running in the future. My condition is mostly manageable. I am somewhat active, but certainly not where I'd like to be. I see a very good physician next month. I would not consider surgery unless in his opinion the chance of success is very high. If it's "*shrug*,maybe it'll work, maybe not" I'll keep going, because as stated above you can never take back a bad surgery.

Offline knee2no

  • Regular Poster
  • ***
  • Posts: 125
  • Liked: 0
Re: Patellar tendonitis surgery
« Reply #11 on: May 09, 2012, 12:51:50 AM »
What is involved in the surgery to treat this condition?
ALRunner are you located in Alabama?
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not", nor will I fail to call in my colleagues when the skills of another are needed.

Offline aaa

  • Forum Faithful
  • ****
  • Posts: 392
  • Liked: 1
Re: Patellar tendonitis surgery
« Reply #12 on: May 09, 2012, 01:23:27 AM »
lateral release can be the kiss of death for the knee, and i'm not aware of lateral release helping with patellar tendonitis.

if you don't feel your kneecap maltracking is an issue, then i would avoid it at all costs ... the lateral release is really a crapshoot, please consider this very carefully.  many surgeons still perform this almost useless procedure that can also have devastating consequences.

as for the patellar tendonitis, i am sorry to say that i do have to agree with ALRunner.  It is not what you want to hear, but has given you very good advice.

i would get other opinions if possible as for the cause of the pain, there are surgeons who have sub-speciality in the patellofemoral joint, you can find a list of them on this site somewhere.





Offline knee2no

  • Regular Poster
  • ***
  • Posts: 125
  • Liked: 0
Re: Patellar tendonitis surgery
« Reply #13 on: May 09, 2012, 04:20:06 AM »
YB

Who stated that a lateral release is a treatment for patellar tendonitis?

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not", nor will I fail to call in my colleagues when the skills of another are needed.

Offline captainruss

  • SuperKNEEgeek
  • *****
  • Posts: 675
  • Liked: 9
Re: Patellar tendonitis surgery
« Reply #14 on: May 09, 2012, 05:08:57 AM »
The original poster was stating that her OS recommended a LR for her PT.

Any surgery, if not absolutely necessary is a proposition that anyone should really think about.  My condition was different...I had bone on bone pain, swelling...no patella but I was working full time and scuba diving...everything but running my 2-3 miles everyday that I had given up a decade or so ago.  I let an OS tell me have the TKR....you will be 100 percent better and have 10 years pain free. 

Yes, the majority of TKR patients are very happy.  I met an elderly lady who had both done (she is tougher than I am) at one time.  I am in the 1/10th of 1 percent who get complications for a TKR, but if I could turn the clock back, I would slap myself so hard my whole family would fall down at the thought of having a TKR at 47, and moreover, NEVER allow it to happen unless I had to crawl across the floor because I could no longer walk.

I think of all the things I could do before and the few things I had to give up.  Well, now I can't do anything but sit here with my legs numb with pain shooting up them typing because I can't walk on it anymore today.  Yes...volleyball is important to you...or running is important to you.  What about simply being able to go to work and support yourself?  More important or less important?  What about being able to simply walk with your kids...not run..just walk?  More important or less important.

Chances are you may have a very successful surgery.  Just make sure it is the first/best/only alternative.

Russ
80 Shattered patella 5 surg
09  TKR 
09  MUA
09  MUA
09  Knee infected??
10  TKR  Scar Tissue
10  2nd OS  Diagnosis Infection
10  TKR with antibiotic spacer, no joint
4/11  TKR
11  TKR PT
11  TKR
11  TKR  AF diagosis
12/11  HO diagnosed
2012  Intractable Pain
2012  OS split
amputation possible?