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Author Topic: Quad Tendon Rupture  (Read 13661 times)

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Offline ~*Heather*~

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Quad Tendon Rupture
« on: May 22, 2003, 06:45:25 AM »
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!  ;D
R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04

Offline Heather M.

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Re: Quad Tendon Rupture
« Reply #1 on: May 22, 2003, 08:16:52 AM »
Hi, Heather.  [I moved my response from down below to up here--there's more traffic on this thread.]

I saw your response to my post on the other page....you really need to talk with this new doctor about arthrofibrosis (excessive scar tissue) and patella baja.  According to your x-ray reports, that's what you have--patella baja is also called patella infera, and it happens when the patellar tendon contracts due to trauma or scar tissue.  This pulls the kneecap down out of place, causing it to impact the shin bone and the other bones that make up the knee joint.  This in turn causes a LOT of pain, swelling, cartilage damage to the back of the kneecap.  It also basically makes it impossible for your quad muscle to function right and causes a vicious cycle of pain and swelling.    

So while it might seem like your problem is from the quad tendon rupture, it sounds like now your problems are slightly different--patella baja etc.  Also, you don't really know if your lateral release/VMO advancement were effective, because you injured yourself post-op.  So it could be that you are having ongoing tracking problems (of the kind that made your doctor do the lateral release in the first place).  I guess what I'm saying is the quad tendon might not be the culprit, you could be having issues with cartilage damage and scar tissue, or some combination of all three....lucky you, eh?

You should do a lot of research and make sure your second opinion doctor is very, very good at what he does.  I had to hunt high and low to find someone willing to address my problems--patella baja is a frustrating condition and you really need a top notch surgeon to deal with it.  There are a couple of people on the web page here who have it, and one of them (Janet) also has had a lateral release, VMO advancement, and quad tendon rupture.  Only she did hers in the reverse order (quad tendon first, then the other stuff to treat the scar tissue problems).

For your research, you'll want to start in the section below called "Soft tissue healing problems."  Then go to www.google.com and look up some key words:  arthrofibrosis, infrapatellar contracture syndrome, patella baja, patella infera, internal adhesions & knee, quad tendon rupture.  That should get you started for your second opinion appointment.

One other thing to consider--you said you previously had a lateral release, plica removal, and VMO advancement, so it sounds like you were having some knee tracking problems.  That would put your issues in the 'patello-femoral syndrome' category--there's a whole section of posts on this web page for that, too.  Sounds like the quad tendon rupture was a bit of really bad luck.

Anyway, research is the best thing for you to do right now.  Hopefully others will respond with some advice or their stories.  I can't stress enough how important it is to have a really good surgeon who specializes in complex knee issues deal with this.  Most of us on here have had to travel out of state to get this type of treatment--I had to go to Colorado and stay there for a month after surgery.

There are a variety of options--surgical and non-- that are open to you.  I've tried them all, and some are working to improve my life.  I'm still very much affected by the knee, though.  Wish I had better news.  Unfortunately, it takes a long time to recover from something like this.

Hope this helps, be sure to look around for more reading material and talk to your new doctor.

Heather
« Last Edit: May 22, 2003, 08:19:15 AM by hmaxwell »
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 Heather M.

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Re: Quad Tendon Rupture
« Reply #2 on: May 22, 2003, 08:22:38 AM »
Here's a good link to start with...it refers a lot to ACL repair patients getting scar tissue, but the principle is the same.

http://www.physsportsmed.com/issues/2001/03_01/eakin.htm

Heather
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 Janet

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Re: Quad Tendon Rupture
« Reply #3 on: May 22, 2003, 05:38:14 PM »
Dear Heather (sorry this is very long):

Oh, I feel so bad that you are in this situation. I can really empathize with you. My story is this: I fell on a wet floor at work and ruptured my quad tendon. It was misdiagnosed in the ER, but it only took the OS about 10 seconds to diagnose it in his office four days later! I had surgery the next day where he repaired the tear and did a VMO advancement. I was immobilized for almost three months. My quad had completely shut down (as was to be expected), but it didn't want to "wake up."

By five months post-op, it was becoming obvious that I had a scar tissue problem. My ROM was stuck at 60-70. At six months, I had manipulation under anesthesia, chondroplasty and partial synovectomy. I continued in PT for another three months and eventually got ROM to 120. This was after a total of nine months of PT.

At this point, I felt I wasn't getting any better. My doctor disagreed, but didn't do any other tests (not even an x-ray). He kept telling me to be patient. Well, I finally decided to get another opinion (I wish I had done it sooner). So 18 months post-op, I went to a knee specialist. She immediately diagnosed patella baja and confirmed that I more scar tissue, the quad was not working well, the VMO was completely shut down, and my ROM was back to 90. I went for 3 more months of PT where I was able to get back to 120. But I could never regain quad strength and had great difficulty walking, along with pain all the time. So we scheduled more surgery, although she didn't want to if it could be avoided. She removed a ton of scar tissue, cleaned up the back of the patella, and did a lateral and medial release. My patella was so tight, it wasn't moving at all. It was back to PT for another 3 months.

At that point, I had rehabbed from the surgery, and my pain was improved. But my functional ability was still very low, and my quad was still extremely weak. I was sent to PT with a biomechanical expert for another 6 months, where I had some improvement, but eventually had to quit becuase it was causing so much pain I couldn't progress any further. I was then sent to a pain management/functional recovery program run through a Physical Medicine specialist, which (again) helped some, but didn't fix the problem. Everybody threw up their hands and said there was nothing else that coud be done.

I finally decided to get another opinion, and settled on a doctor in our region who has expertise in the area of scar tissue and patella baja problems. I am having more scar tissue surgery in June. We won't be able to tell how successful this surgery is for about 6-8 months post-op.

Anyway, sorry for the LONG answer. HeatherM has given you the best advice. In reading articles and doing your research, you should be able to find the top doctors. Get an appointment and see what they say. I hate to give you bad news, but there really isn't much (if anything) that can be done for patella baja. Even when they remove the scar tissue, the patella position doesn't change because the patella tendon has shortened and thickened. I have been told there is no surgical way to move the patella that has proven good results. Unfortunately, the damage in your knee causes pain, and the pain prevents you from strengthening your quads, and since the quads are the shock absorbers for the knee, your knee takes the shock, which causes more pain....it's a vicious cycle. HeatherM is by far the most knowledgeable person on this forum about these issues. I have learned a lot from her. Keep us posted. Send me a private message if you'd like (click on my name by this message, scroll down to "send a private message"). I'd love to keep the conversation going. Good luck!

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline ~*Heather*~

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Re: Quad Tendon Rupture
« Reply #4 on: May 22, 2003, 06:38:55 PM »
Janet,

I looked on line last night and found patella baja.  Well, it was an x-ray of it and it was my x-ray exactly!  How come this happens?  They really can't fix it?  OMG! That's so crazy!  I will never walk or run again?   I refuse to accept that!  I want my life back so badly. I am in tears as I write this!  I can't go through life with my knee locking in mid stride!  I will do so much other damage to everything else in there! Obviously, you have been down this road so don't be offended that I said I refuse to accept it. I am sure when it's been as long as it's been for you, I will then! :-[  What other exercise can you do to stay in shape?  Why wasn't I warned about this potential problem?  You mentioned you had several surgeries to remove scar tissue....but doesn't that just create more?  I don't want anymore surgeries, can't I just tape it like I used to?  Can't they lengthen the patella tendon?  I know these are questions for my doc, but I'm just venting now! Thank you for your response and I WILL try to message you!
Thanks Heather for your knowledge!  Much appreciated!!!!!!

Heather :'(
R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04

Offline ~*Heather*~

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Re: Quad Tendon Rupture
« Reply #5 on: May 22, 2003, 06:43:25 PM »
Just wanted to add that I have full ROM, so do you still think it's scar tissue?    
R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04

Offline Heather M.

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Re: Quad Tendon Rupture
« Reply #6 on: May 22, 2003, 08:51:43 PM »
Heather,

I'm right in the middle of this whole thing, so I can't really answer your questions.  But I've talked to my doctors and PT, and they are not as pessimistic as Janet's--their opinion was that Dr. Wojtys (Janet's very highly regarded OS) was giving a worst case scenario.

As for improvement, I really do think it's possible.  I'm not at the point of accepting that I will never run again...but I'm darned close.  You get to a stage where you would be happy to do regular things without pain and be happy with that...anyway, I still have plans.

As for your situation:  I'm guessing your knee is catching when you walk because you have such bad quad strength.  The problem is, as long as the patellar tendon is scarred down, you can't get your quad strength back--read my posting from December in the soft-tissue section.  I was EXACTLY where you are--knee locking with every step, stuck with taping and pain meds but making no real progress.  I also had about 130 degrees of flexion, so don't think that scar tissue is only about limited ROM.  I had a my fifth arthroscopy in 15 months to take care of the scar tissue at Christmas, then began a very specialized and aggressive PT program.  I was able to strengthen the quad enough that the catching went away.

I am MUCH better than I was before the last surgery.  However, because the patella is still too low, and it has sunk into the knee joint (infrapatellar contracture syndrome) I am developing severe patellar arthritis.  So it's not necessarily the patella baja that hurts and causes disability--it's the side effects from that.  Patella baja in itself occurs naturally in some people, and they don't have any problems until much later in life.  But because this isn't the natural position for our knees...it causes all kinds of problems.

Cont'd

« Last Edit: May 22, 2003, 09:00:37 PM by hmaxwell »
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 Heather M.

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Re: Quad Tendon Rupture
« Reply #7 on: May 22, 2003, 08:59:21 PM »
There is no real explanation of why it happens to some people--the trauma of the first surgery and the build-up of scar tissue under the kneecap and patellar tendon cause everything to contract.  It is a VERY rare complication, I'm sure you'll be happy to know.

You asked what your treatment options are.  I saw 6 different orthopedic surgeons around the West--all known for their skill in dealing with tough knee problems.  The first three didn't want to do anything, saying that surgery causes scar tissue and it's clear my body doesn't respond well to this.  They gave me no options.  The fourth surgeon said to do a repeat clean-up and do the lateral release again.  The fifth surgeon wanted to do an open TTT, specifically a Maquet procedure, to manually elevate my kneecap out of the joint.  Unfortunately, after a Maquet procedure you are pretty much permanently disabled so I didn't want to go that route.  Other types of TTT leave good function, but not the Maquet for some reason.

The sixth doctor I saw is a specialist in arthrofibrosis.  He said it was a tough condition, but he was willing to try.  He said it would take two or more surgeries with very prolonged recoveries.  I chose this option because he had the most experience and it was the least invasive--the surgeries were scopes.  I had to promise to stay in Colorado for a month post-op and do PT twice a day at a clinic there, then an addition two times a day at home.  I was on crutches for four weeks, which I think really helped.  Read my "Lysis of Adhesions" post.

At this point, I'm about 50% better in terms of function, but the same in terms of pain.  I'll take it.  My surgeon is talking about another surgery to remove further scar tissue, even though I'm able to touch my heel to my butt and hyper-extend my knee.  At this point, it is unclear whether my pain is from scar tissue or arthritis.  I know the worst of my pain is below the knee, where the patella baja hits the shinbone.  I'm in kind of a manic state about my recovery--one day I'm very optimistic, the next I'm not.  It's a real rollercoaster...for a while I was working out like a real person on the elliptical, treadmill, bike, weights...but then the pain started getting worse and worse.

Anyway, from what I've been told here are your options:

1.  Surgery to clean out as much scar tissue as possible.  This is the starting point.  The best results are found when the scar tissue cleanup surgery occurs within six months of the surgery that caused scar tissue in the first place.  Must also address tracking and arthritis problems that resulted from patella baja.  My surgeons all told me there was no way to achieve good results without a clean-up surgery to start the program, and I believe Janet found the same thing.

2.  Immediate post-op PT to restore ROM and quad strength without irritating knee joint to make it produce more scar tissue.  No weight-bearing or exercises that irritate knee.  I also had to have another small procedure called an insufflation to address the scar tissue that was forming as early as 2 weeks post op.

3.  Very specialized long-term PT incl. taping, E-stim to build quad with elliptical and weights, ultrasound, patellar mobilizations, scar tissue massage.

4.  Aggressive pain management:  I see a specialist for this.  She uses acupuncture, lidocaine patches, TENS units, myo-fascial release, narcotics, anti-inflammatories, and SSRI's to help with pain.

5.  Failing the above approach, there are more aggressive surgeries:  Maquet procedure and tenodesis are the most common.  They are both considered salvage procedures for scar tissue and patella baja.  Tenodesis is intended to stimulate the patellar tendon and make it heal itself, the Maquet procedure actually lifts up the point where the patellar tendon inserts into the shin and raises it up to 2 inches, so it's like lengthening the tendon in it's results.  But it's major open surgery and requires bone from your hip as well.  The final option I was given is removal of the patella, which I flat out refused.  It will apparently resolve some pain issues, but causes real disability and makes a total knee replacement in the future very difficult.

I know you want to avoid more surgery, but it often is not an option with patella baja.  Yes, more surgery can create more scar tissue--that's why you have to have a very specialized post-op protocol.  Most surgeons don't know anything about this issue.  They see a couple of cases in their whole careers.  My surgeon in Colorado saw five cases over Christmas when I had my surgery, so I felt very comfortable with him treating it.

You've got lots to think about.  Don't be surprised if you now know more than your doctor about patella baja!  Like I said, it's a rare problem, one that only PFS specialists tend to deal with.

Let us know what your new OS says.

Heather
« Last Edit: May 22, 2003, 09:06:22 PM by hmaxwell »
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 ~*Heather*~

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Re: Quad Tendon Rupture
« Reply #8 on: May 22, 2003, 09:02:28 PM »
HeatherM,

I have been looking at your suggested searches and found out a lot so thanks!  I got depressed about it so I took off for the gym and worked on the Quad...lol! I found some sites that state there is a surgery to correct this, it is involved, but has anyone here tried it? I know you mentioned it in your post.  Is removing scar tissue the way to go?  Would an MRI show scar tissue because I have one coming up and am scared there might be other problems.  I have had 3 surgeries on this knee already, the two I mentioned previously and an IT Band release in 12/99.  I have also had two surgeries on the Right knee for IT band issues.  This all started with the IT Bands, can you believe that?  They seem so minor compared to the probs I am now facing! Thanks so much for your advice, you have been a great help and so has Janet! Thanks for all the time and effort you put into the last post! It's comforting to know that other people like me exist!  Are you the one from the other board that sent me here?  Someone reccommended this site with the name Heather.  Thanks again!  ;)
« Last Edit: May 22, 2003, 09:12:24 PM by Heather »
R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04

Offline Heather M.

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Re: Quad Tendon Rupture
« Reply #9 on: May 22, 2003, 09:17:00 PM »
Hi, Heather.  It looks like we're posting on top of each other.  Which surgery were you looking at for correction of patella baja?  What was the name of the procedure?

As for the MRI, no--it usually won't show scar tissue.  However, it will show the placement of your kneecap and how much damage has been done to the back of your patella, so it's a good way to go.  The only way to confirm scar tissue and contracted patellar tendon is to look with a scope.

I know your concerns about multiple surgeries.  I've now had five on my left knee, plus severe IT band syndrome as a result of all the scarring.  I can't believe your doctor did an IT band release!!!  That's something my surgeon absolutely recommended against because it changes the tracking and placement of the patella--be sure to ask this new doctor about it, because the IT band could play a different role in your condition.  I have a severely inflamed one in my surgical knee because it got scarred down to the bone below the kneecap--the pain goes all the way up to my hip and back.  But I was able to FINALLY calm that down with acupuncture and myo-fascial release, so I'm a much happier person now.

As for surgery--it really seems like a scope to remove the scar tissue is the starting point for improvement/recovery.  Once that crap is in there, there is no getting rid of it except through surgery.  But you've got to do the procedure with someone who has a real plan for preventing the adhesions from coming back as much as possible.  Yes, there will be some scar tissue, but you don't want it rampantly out of control like before.  For me, I think the 2X/day PT and swelling control measures were the key.  I was non-weight-bearing on crutches--basically in a wheel chair--for about 10 days post op.  Then only limited weight-bearing.  As soon as I did more than that, the knee ballooned up and the doctor put me right back on crutches.  Swelling control is key.

Anyway, I know it's a lot to take in.  You're still young, and you haven't had this condition for very long, so maybe you will be able to make a full recovery.  I would definitely ask your doctor if he thinks your pain is from the cartilage issues that led to the lateral release last year, or if it's due to scar tissue.  My surgeon in Colorado told me that until the scar tissue was gone, we couldn't really address whether my knee needed further intervention for the cartilage damage.  Other doctors wanted to go straight for the big arthritis surgery (TTT) and then deal with the adhesions later...it's all in the personal approach of your surgeon.

Good luck, definitely keep us posted.  There are at least 8 people who have posted with the same problem, but only Janet and I post regularly.

Heather

PS yes, I'm the one who sent you to this board.  There are a lot more active posters here than on the other one.....
« Last Edit: May 22, 2003, 09:17:57 PM by hmaxwell »
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 Janet

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Re: Quad Tendon Rupture
« Reply #10 on: May 23, 2003, 05:13:44 PM »
Heather:

HeatherM gave you such a good answer, but I'll try to add a little more.

1.  I was told that patella baja usually occurs after trauma or surgery when the quad is weak and scar tissue forms. Because the quad doesn't have enough strength to move the patella, the patella tendon (which attaches the patella to the tibia) gets scarred down. This causes changes in the tendon itself, where it shortens and thickens. Once those changes occur and are not addressed, there is no way to change the tendon back. No, they cannot replace or lengthen the tendon. And I was told the TTT procedures do not have good results for patella baja, and would not be recommended in my case. Because the patella has "settled down" into the joint, if they move the patella up with a TTT, it will still be hitting the femur. At least that's true in my case.

2. I have accepted that I will never run or kneel again. My dream is to be able to walk normally. Fortunately, while I always have pain, I don't have excrutiating pain. But then again, because it has been four years for me, my whole lifestyle has changed. I know my limits and don't exceed them. I can't even imagine functioning as I used to post-injury. And now my "good knee" is also painful, which is very common with chronic knee problems, (as Dr. W says) "secondary to compensatory weightbearing."

3. Yes, one of the big problems with patella baja is that is causes damage to the articular cartilege behind the patella. I have hope that technology will soon catch up with this problem. They are starting to do some resurfacing behind the patella, but progress has lagged behind other cartilege replacement in other areas of the knee joint.

4.  As for the MRI, Dr. Wojtys told me that MRI's don't really show scar tissue or the condition of the articular cartilege behind the patella. The only way to really know is to look inside the knee. I have had two MRI's and both have been fairly normal. Both times I have ended up in surgery anyway with major scar tissue issues. Before the last surgery, I was  diagnosed with infrapatellar contracture syndrome....basically my patella was completely scarred down and not moving at all. It is still tight, but at least now it moves. I appreciate that my OS didn't overcorrect in releasing it since at least I no longer have tracking problems. She was afraid that further release would cause the patella to become unstable.

5.  Yes, surgery causes more trauma and more scar tissue can form. That is why you need a really top surgeon with special emphasis in arthrofibrosis. It sounds like my rehab protocol this time will be quite different from last time. I will be non-weightbearing for 2-3 weeks. I was told the "trick" to not having the scar tissue reform is to balance getting ROM and quad strength back with not irritating the knee and causing more scar tissue to form.

6. I can't give you any advice about taping. It has never worked for me.

Please keep us posted. And ask any questions you can think of. I sure wish I had found this site earlier. I know so much now that I would never have known. I may have done things differently. Good luck.

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline ~*Heather*~

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Re: Quad Tendon Rupture
« Reply #11 on: May 26, 2003, 11:27:09 PM »
Janet and HeatherM,

I was just wondering what your current limitations are as far as everyday life.  What have you had to give up doing (besides running and exercises).  Also what kind of work do you do now?  I used to work as a dental assistant, but now I find that type of work difficult because I can't be on my knee for hours on end.  Thanks!

Heather
0 : ^ )
R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04

Offline Janet

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Re: Quad Tendon Rupture
« Reply #12 on: May 27, 2003, 03:48:26 AM »
I have a desk job, so I can still work full time. But by about noon, my knees are killing me. Luckily, I don't have to walk around very much at work. But even back and forth a few times has me hurting.

I have trouble sitting with my knee bent to 90, it's usually about 70 comfortably (even though my ROM measures at 120). So whenever we go to a theater or anywhere with limited leg room, I have to sit on an aisle and stick my leg out. I have had to give up going to a lot of sporting events (which I love) because there just isn't enough leg room. I definitely cannot sit in the back seat of a car. All my friends and co-workers know I always get to sit in the front seat!

As for walking, I can walk about 30-45 minutes before I really feel like I can't do it anymore. I start to feel it after about 20 minutes. I swing my leg from my hip because I don't want to bend my knee. I guess everything comes down to that.....I don't want to bend my knee. I even wake up at night sometimes when my knee has been bent too long. It's odd....yes, my knee hurts, but it also has to do with how easily my leg fatigues, probably because my quads are so weak. Sometimes when I go to the mall with my daughter, I can walk a little while then go to a wheelchair. Today was not a good day and I didn't feel like I could walk at all, so we got a wheelchair right from the beginning. We just don't do anything anymore that requires walking.

I also have trouble standing for any length of time. Sometimes even standing in a check-out line is too hard. It does something to my knee/hip/back that is quite painful and makes it very hard to walk once I start moving again.

I can go up stairs with the aid of the handrail. But I can't go down stairs foot over foot at all. We live in a two-story house, and are thinking of moving to a house all on one floor so I don't have to deal with stairs.

This has affected everything in my life. If you can't sit or walk comfortably, about all you can do is lie around. I refuse to give in that much, but I know my limits and stick to them. And it hasn't just affected me. My husband gets extremely frustrated with the whole situation. Thank goodness I was young when I had my kids and now they are grown (24 and 18). And while I look forward to being a grandparent someday, I know I won't be able to babysit on my own because I can't kneel or chase kids around.

I know that sounds bleak. But I don't feel life is bleak. I have gotten past the depression and now find ways to do the things I really want to do and let the other things go. Life is still good....just slower, more painful, and different.

Janet
« Last Edit: May 27, 2003, 03:50:28 AM by Janet »
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline ~*Heather*~

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Re: Quad Tendon Rupture
« Reply #13 on: May 27, 2003, 07:39:21 AM »
Janet,

Thanks for your reply. Your life sounds like mine almost exactly!  My knee catches and locks when I do try to walk normally.  I still try to do a lot with it and I hate to have to give up, but when I get to the gym I just want to cry.  I focus on keeping my other quad strong because I have alignment probs there too and also IT Band syndrome.  Sometimes it acts up due to overcompensation and then I'm about as good as bed-ridden.  I have a hard time believing that there is no help for us, but then again, I'm new to these problems and still am in denial. I am NOWHERE near out of the depression state and I don't want to give up.  I'm only 26 and I'm going to miss so much in life now. I only wish I knew when this kneecap fell.  It has always looked distorted to me but I was told my the first OS that it was atrophy, that was his answer for everything...atrophy.  He was supposed to be the best in town, but obviously not.  I don't have any kids and I was talking to my husband about that too.  I don't think having them would ever be wise because like you said, you can't chase after them.  It's kinda dangerous to be like this and be with a toddler.  Just one more thing I will miss out on I guess.  I would also worry about trying to carry one for 9 months being this unstabile!  YIKES! How long have you been at this stage?  How did you get through the depression?  Sometimes I just feel like living sucks and I am so jealous of all the things everyone else can do!  What do you do to stay in shape now? I have taken up upper body stuff to maintain lean muscle and to limit the weight gain.  I haven't gained but about 4 pounds, but it's starting! I figure add 5 pounds to that for what my quad used to be and gee, I better diet! LOL!  Thanks again for your responses, they truly help!  It's nice to know I'm not alone.

Heather ;D      
R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04

Offline ~*Heather*~

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Re: Quad Tendon Rupture
« Reply #14 on: May 27, 2003, 07:45:42 AM »
HeatherM,

You mentioned different types of TTT surgeries, the  manquet not having good results.  Would any of the other types be successful in our condition?  I know it's best to avoid surgery, but the way I feel is that I am already disabled, why not try something?  It seems like the MRI and the next visit to the OS is forever away and I can't help wanting a quick fix (don't worry I will do my homework before I do anything!), I'm tired of being this way! I didn't know about any of these potential complications before any of my other surgeries!  I appreciate you sharing your knowledge!  Any info?  Thanks!

Heather  
R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04

Offline Janet

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Re: Quad Tendon Rupture
« Reply #15 on: May 27, 2003, 04:43:39 PM »
Dear Heather:

I don't know how I got through the depression. It probably happened within the last six months. Three years ago when I first found out about the patella baja, I was astounded. However, I still had hope and you should, too. I am much better today than I was then. I had surgery, tons of PT, and went through a functional recovery program during that time. All made a difference. Will my knee ever be normal? No. Am I still hoping for more improvement? Yes, that's why I'm having more surgery in June. Don't give up your life dreams (such as having children). Remember, life can still be sweet, it just may be different. There are lots of truly disabled people who have children. You are young and your life may have changed, but it is not over!! Keep asking questions and finding the best doctors, and I'm sure you'll get some improvement.

Janet

P.S.  I have decided that it doesn't really matter when the baja happened or that my first doctor didn't have a clue. That was behind me and knowing wasn't going to change things. These are the kinds of little decisions you can make that will take some of the stress out of your life right now. There are certain things I just don't allow myself to dwell on. I just turn off that thinking when it pops up, push down the anxiety building in my stomach, and try to stay calm. Easier said than done sometimes, but overall, it works for me.
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

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Re: Quad Tendon Rupture
« Reply #16 on: May 27, 2003, 07:47:17 PM »
Janet,

I just thought that if you caught it early it would be fixable and maybe most of the ability you had pre-surgery would eventually return. What kind of surgery are you having in June?  More scar tissue? I just don't understand with all we have today in modern medicine why there isn't a fix for this besides numerous surgeries and loads of PT.  Please let me know how your surgery goes. Thanks again for all your help!

Heather
R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04

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Re: Quad Tendon Rupture
« Reply #17 on: May 27, 2003, 08:10:51 PM »
Everyone,

I just wanted to add that I have been looking around because I was interested in knowing what the bulge might be on the anterior of my knee, toward the lower lateral side to the left of where patella is now .  It seems to me, that it is a fat pad (OS mentioned it, but then when I told him it just begin 5/7/03..9 months post op, he decided it may not be that).  I read that when the patella lowers it could be "nipping" the fat pad causing it to hypertrophy, to swell and become tender.  This bulge gets bigger with activity such as stationary biking and trying to do leg extensions.  Did anyone out there have this along with patella baja?

Thanks,
Heather
R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04

Offline Janet

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Re: Quad Tendon Rupture
« Reply #18 on: May 29, 2003, 04:58:35 PM »
Heather:

Here is an excellent article for you to read about arthrofibrosis. Even though it talks a lot about ACL repairs, I felt it could have been written about me. I hope you find it interesting.

http://www.physsportsmed.com/issues/2001/03_01/eakin.htm

Yes, my surgery in June will be to remove more scar tissue and assess the damage behind the patella. My OS knows there is scar tissue behind the patella tendon and in the fat pad, and probably other places as well. He is also sure there is damage to the articular cartilege behind the patella. But at this point, we cannot be sure if my pain and functional problems are being caused by the scar tissue or from damage to the articular cartilege. But the arthroscopy was my only option (besides living with it), so I decided to go ahead.

Janet
« Last Edit: May 29, 2003, 05:22:35 PM by Janet »
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

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Re: Quad Tendon Rupture
« Reply #19 on: May 29, 2003, 07:44:13 PM »
Everyone,

I would like to thank everyone who has responded to me and my messages/questions.  You guys are so patient with me and so helpful in making sure I understand my condition!

Janet,
That last article was very helpful!  A little discouraging as I only want to hear someone say, "Yeah sure! Patella Baja?  We can fix that and get you back to your normal life within a years time!".  I know that isn't going to happen realistically!  :(

HeatherM,
Thanks for your article you sent me as well.  I'm still reading it as the terminology is a little "techy" and I want to be sure I understand it totally so I am going slow and looking things up as I go.  I appreciate it very much though!  ;)

I am feeling a little irrational today and I'm just wondering if I should replace the whole knee now...lol.  I'm so depressed, I feel my life is gone!  It's been 1.5 years since I have fuctioned as a normal woman in her 20's.  I feel like giving up.  I guess this is what you call the "bad days".  It just seems no matter how hard I try to get my strength back, something else becomes difficult.  A straight leg raise hurts so bad and just a few weeks ago, I could do one!  I push forward and it pushes me backwards.  :'(

Sorry that I am venting and depressing everyone!  Thanks again to all you lovely people who actually care.  I appreciate your patience with me while I ask 60 billion questions to each of you!  You guys give me hope!  I wish you all the best of luck and I plan on keeping you all posted as to my progress.      

Heather    
     
R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04

Offline Heather M.

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Re: Quad Tendon Rupture
« Reply #20 on: May 29, 2003, 09:23:34 PM »
Aaaagggh.  I typed a nice long response, Heather, but the machine crashed when I submitted it.  That's a hint to be less wordy, I think ;-)

Anyway, you asked lots of questions and I think Janet gave you some great information.  She pretty much summed up the limitations of this condition:  it has affected every aspect of my work, personal, and social life, to say nothing of the lack of exercise and hobbies!  I hate to be a downer, but I've had to give up EVERYTHING I loved--hiking, backpacking, international travel, photography, daily workouts, even taking my dog to the bark park.  

I've dealt with the inevitable depression in a number of ways:  the most important is to control the pain.  Until I started seeing a pain management specialist, I was miserable.  Now I'm taking meds, using e-stim, acupuncture, lidocaine, myo-fascial release...there are a lot of things that help you deal with the pain.  Nothing gets rid of my pain, but then I have very deep chondral lesions (damage to the cartilage on the back of my kneecap).  They aren't all from the patella baja, because I had grade IV chondromalacia when I had lateral release surgery in 9/01--but the damage has progressed at a rapid pace since the baja was diagnosed a year ago.  

You asked how to figure out when the patella baja occurred:  I had to gather all of my surgical reports, office visit transcripts, and arthroscopy videos.  Reading the surgical reports, I found that at my 2nd scope in 2/02 my OS noted that my patella was in a baja position due to scar tissue.  He noted it again at my fourth scope in June 02, and it was even worse in December 02 at op #5.  My surgeons have been very aggressive about catching this early and working to correct it, but circumstance (infection, more scar tissue) have meant a return to patella baja within about 2 months of each surgery.  The scar tissue also causes its own pain, and that peaks at about 3 months post-op and gets worse month by month after that.  The pain causes muscle inhibition, the quad weakens further, and the patella drops lower.  Sigh. 

I've now had 5 scopes in a 15 month period, and am 5 months post-op from the last one.  I'm better than I was before--much better in terms of function.  But the pain is slowly eating away at all the progress I've made....I've tried to stay in shape with supervised PT activities 3X/week and then alternating upper body work with a trainer at the gym.  I'm in a unique situation in that I also have a really bad right shoulder, so I'm limited in what I can do.  I don't want to have surgery on my shoulder, and since my rotator cuff is torn, I have to be VERY careful what I do.

Anyway, I find that focusing on things I can do helps keep the depression at bay.  But my work is impacted, because even though I have a desk job I have a lot of pain just from sitting at the PC!  I'm a writer (novels) so I need to be able to focus...if I'm in pain or on painkillers, that's very hard.  I have to get most of my work done in the early morning, before the pain gets too bad.  It's hard because that means I have to do errands and stuff in the afternoon...I live alone, and when I take painkillers I don't like to drive, so it's a challenge.  I'm probably back to a 3/4 work schedule because of the timing constraints, and I only get in this much work time because I've basically stopped going to PT.  I know, I'm a bad girl, but PT takes 4-5 hours out of my day and I simply have to pay the bills.  I'm going back to PT tomorrow after being out for 3 weeks...I'm sure I'll hear an earful....

Heather
« Last Edit: May 30, 2003, 12:13:58 AM by hmaxwell »
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 Heather M.

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Re: Quad Tendon Rupture
« Reply #21 on: May 30, 2003, 03:47:28 AM »
Sorry, forgot to talk about the TTT's for arthrofibrosis and patella baja.  You're limited to two types of TTT--the Fulkerson and Maquet procedures--because the OS has to actually move the point of the patellar tendon insertion at the tibial tubercle (lump below your knee on the shinbone) in two directions--up and over.  Only Maquets and Fulkersons can do this--and the Maquet is often the only one that can achieve the needed lift, because it uses a piece of bone from the hip to wedge under the tibial tubercle and keep the kneecap raised permanently.  Long-term results from Maquet procedures are not good--they are considered the ultimate salvage procedure before patellectomy. Check out www.patellapain.com under the surgery section.

Fulkerson procedures, when done for subluxing, bad tracking, and patellar placement, have a much better track record.  But it may not be enough to give the lift needed for a patella baja patient.  And even if it does, the damage to the back of the kneecap has to be addressed, because it is the cartilage lesions that will cause ongoing pain.  Fulkersons, when done for  arthrofibrosis, don't have a high success rate, especially as one of the major complications of a TTT is serious scar tissue.  Often, additional scopes are required to clean things up.

And you also asked about the fat pad, and wondered if that was the bulge at the bottom of your knee.  I don't really have a fat pad left--every time you have a scope, part of it is cut away to visualize the kneecap, and in my case it was scarred, so bits had to be removed until it was mostly gone.  I had one doctor tell me they could create a new fat pad out of Gore-tex material.....in my case, the bulge below my knee is my kneecap.  No joke, it's that low.  It swells further after exercise because it's irritated.  Also, I have a band of scar tissue that you can pluck like a guitar, and that also swells after activity.

Knees suck, what can I say?  Like you, I was an active healthy young person.  I'm 33 now, and was 31 when this all started.  Way too young to be having these problems.  I still don't know what I'm going to do, but the pain is really getting worse and worse on almost a weekly basis.  I can't have another scope until fall for work reasons (have a convention in July, then need to finish my current book and start the next one).  I'm not ready to commit to a TTT yet, but if this next scope doesn't improve things significantly I may have to resort to that.  I would also probably need cartilage repair procedure like microfracture or an OATS operation, and again these are open procedures which are known to produce scar tissue due to the patient being immobilized.  Sometimes I feel like there's no winning....but then I remember that last December I was unable to so much as go to the grocery story without my knee popping every step.  I've come a long way since then.  Pain can be dealt with (it's not fun, but it can be done)--mechanical problems are much harder to deal with, and that's what you have until you get the scar tissue removed and have aggressive therapy to prevent it from coming back.

I hope this information helps you.  What did your doctor tell you last week?  Weren't you going to see a new OS?  Since you're in NC, I think you will probably have to travel to see a specialist in arthrofibrosis--Dr. Fulkerson in CT is a good choice, and the Hospital for Special Surgery would be a great choice in NY.  My doctor is in CO, there are other specialists in this field in OH, MI, UT, and NV.  They tend to be linked to research facilities or near ski areas...wonder why.... ::)

Keep posting and try to keep your chin up.  There's lots that you haven't tried yet to address this problem, you need to keep looking for a very skilled PT and OS to help you, along with a pain management doctor.

Heather
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 ~*Heather*~

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Re: Quad Tendon Rupture
« Reply #22 on: May 30, 2003, 05:20:27 AM »
HeatherM,

Thanks for your reply (again!).  I went to a new OS about a week or so ago.  He took x-rays right away and noticed the patella baja.  He didn't mention it to me, but you mentioned it on the other site, so I looked into it.  I then looked at the referral to PT and he wrote patella baja there so I knew at the point I had it.  He told me that he doesn't know much about it and would consult some of his colleagues before my next visit with him. Maybe he'll refer me out to someone more specialized.

He ordered an MRI for June 3rd, then I see him again June 10th.  I was trying to get all the info I could before I saw him so if he could treat me I would understand my options as he explained them.   He did not mention arthofibrosis either.  I'm sure all the terms will be discussed next time though.  

I start PT tomorrow (Friday) but I'm sure they will refer me out too as hubby is Military and I have to go on base for the initial appointment for insurance reasons.  He says they are NOT equipped to do the PT I need.  Referrals and all that suck when you want to get seen by the ones who can help you and not waste precious time being told we can't help you here.  >:(

My knee locks but not everyday, it's usually worse the day after I have tried to do leg extensions and leg raises and ridden the bike for awhile.  I have about 2mm in my x-ray before the kneecap is touching the shin bone, if that much! I also have these ties where the quad tendon repair ties near the bottom of my patella and they are so sore I scream if i touch them or if they touch anything!  I wonder if that is normal?  OS said they were inflamed, but he didn't want to go into any detail about anything until he had the MRI results. I can understand that much!  

I am working on the depression but it's just so hard to accept that so many things are gone!  I agreed to this the first surgery with the dream of running again, I fell afterwards, my own fault! I needed another surgery after that and  I agreed to that surgery because who wants their tendons detached!  Now I would be happy just walking normally and being able to run if necessary.  I know that is what we all want, huh?  Thank you again for all the great information!  I will definitely put it to use!  

I was talking with a girl through email that I found on another site and told her that you girls were here. She used to post here long ago, but back then nobody had patella baja. She said she would be posting back soon.  I think her patella baja has been fixed even though she is still doing the scar tissue surgeries.  Hers was fixed when her Quad tendon was repaired.....lucky her!  She says it's about 75% better than before. She is going to get the technical name for her surgery from her OS.  She explained it to me, but doesn't remember the formal name.  So we all should be seeing her soon.

Talk to you guys soon,
Heather  ;D
« Last Edit: May 30, 2003, 05:25:33 AM by Heather »
R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04

Offline ~*Heather*~

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Re: Quad Tendon Rupture
« Reply #23 on: May 30, 2003, 07:08:46 AM »
Everyone,

Does anyone have severe itching over their incisions?  I mean I thought this was only while they were healing, but my last scar is 9 months old and sometimes I just want to take a wire brush to it!  I don't mean to sound stupid, but what is the real cause of this?  I was told my the OS who did it when I asked, it was histamines.....can any of you expand a bit?  Thanks!

Heather ::)  
R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04

Offline ~*Heather*~

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Re: Quad Tendon Rupture
« Reply #24 on: May 31, 2003, 05:10:48 AM »
Hi everyone,

Here's one more question for you guys.  I went to Physical Therapy today and we are going to do the E-stim and they gave me more home exercises to do.  I'm good with all that, so here's the question....The PT guy was explaining patella baja (just as you girls did ;) ) and told me a story of someone he knew with it, their kneecap ended up ON their tibia....OUCH!  :o This happened with a partial tear of the quad tendon that went undiagnosed.

My question is most people I have talked with regarding this condition had patella baja occur while there was a tear.  I had my tear fixed and then ended up with this.  If my quad is attached then how could this have happened? The tendon should be holding everything in place shouldn't it?  I realize that an imbalance in the extensor mechanism may cause it, but I don't understand what exactly pulled it down. I understand that it could be scar tissue, but my PT confirmed that I didn't have too much where the repair was made (at least by feeling it). That confused me even more.  He made it sound like I didn't have a scar tissue issue.

I have 138 degress ROM except when I lay on my stomach and try to make the leg touch my butt, it is about 90 degrees then excrutiating.  I guess my question is, would I have to have a tear again to have gotten patella baja or is it solely scar tissue/trauma from surgeries? I don't mean to sound stupid or ask the same questions again and again, but could someone give me their thoughts.

Also I wanted to share something that I tried tonight and worked wonders for pain (at least for a little while).  A bottle of vicodin and 2 French Martinis.....no, I'm only kidding!  ;D  Honestly, it's called "ice therapy". You may have heard of it or even done it, but I still thought I would share.  You just make small circles with an ice cube wrapped in a paper towel or wash cloth along the lower portion of the knee, along the patella tendon, or in our cases, the patella itself.  You do it for about 7-9 minutes before any activity, it gives a little relief! It helps me also because where the tendon sutures are attached along the patella pole I have severe tenderness and it relieves that.  Hope you try it!
I also wanted to add my PT confirmed their are some specialist in the NC area, so pray for me to get referred to one of them!

Thanks,
Heather  ;D        
R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04

Offline Heather M.

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Re: Quad Tendon Rupture
« Reply #25 on: May 31, 2003, 05:53:46 AM »
Heather,

You could have had patella baja occur any time after your first arthroscopy.  I've never had any kind of tendon tear in my knee, but somehow I ended up with patella baja after lateral release surgery.  In some people, the trauma of surgery causes quad inhibition, contraction of the patellar tendon, etc.

As for scar tissue, it's impossible to tell unless you go in with a scope.  You can guess about its presence with some tests, but you're just guessing because scar tissue mimics a lot of other conditions (torn meniscus, plica syndrome, and chondral lesions for example).

You can sit on a counter with your legs bent at 90 degrees, place your palm over your kneecap, and then try to straighten your leg.  If you a) can't do it because of pain, b) can do it but only to a certain point b/f you have sharp pain or c) can do it but feel vibration, clicking, popping, etc under your palm....you probably have scar tissue in the anterior interval.  When I do this, I can eventually, with great pain, get my leg straight and hold it there....but when I start to bend it again, it makes the kind of loud, juicy snap that turns heads in the PT clinic.  My OS's med student actually turned pale, thinking he'd broken something!

The problem with the adhesions is that the symptoms vary widely depending on where it's located.  Read through the soft tissue healing problems section, and people will describe all sorts of different sensations--all of us have scar tissue, but it's in different parts of the knee, giving different symptoms.

Hope this helps.

Heather

PS I'm one of those that has the patella resting on the tibia...it's one of the things that causes the constant cracking and popping.  Also, when I had a scope, they could see the damage on my tibial plateau where the kneecap was hitting.
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 Janet

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Re: Quad Tendon Rupture
« Reply #26 on: June 02, 2003, 04:44:40 PM »
Heather:

As for patella baja coming as a result of a tear, I don't think that's the case. When my quad was torn, my x-rays clearly showed the patella in the right place! Like I have said before, I don't know when the baja occurred, but guess it was sometime after the second surgery because it wasn't noted on the surgical record. I never had another x-ray until I changed doctors, and it was discovered then. I have been told it's due to quad inhibition and scar tissue forming and scarring down the patella tendon. As for seeing scar tissue, my OS says you can't see it on x-rays or on an MRI (the MRI might show some, but doesn't give a full picture). I had an MRI that didn't really show anything except effusion, and had extensive scar tissue and patella baja at that point!

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline ~*Heather*~

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Re: Quad Tendon Rupture
« Reply #27 on: June 09, 2003, 05:04:23 PM »
Hello all,

Just wanted to say thanks to everyone who took the time to reply to my posts!  I go to the OS tomorrow and get the results of the MRI.  I will post back then and let you know what he says. I am more than sure I will have more questions and if not, I will share any new information that I have gathered.  Thanks again! I appreciate all the time everyone took to inform me on everything!  You guys are great!  ;)

Heather    
R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04

Offline Janet

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Re: Quad Tendon Rupture
« Reply #28 on: June 09, 2003, 05:49:06 PM »
Good luck at the OS tomorrow. At least now you are more informed about your condition and I'm sure you have lots of questions to ask! I will be really interested to hear what he has to say.

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline ~*Heather*~

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Re: Quad Tendon Rupture
« Reply #29 on: June 09, 2003, 10:56:25 PM »
I called to get my MRI films for my appointment tomorrow and found out that they needed additional films to capture more of the quad!  Good thing I called since they had not notified me yet and my appt is tomorrow!  They sqeezed me in and are having the films read today so the report will be ready in time.  I left with the films and in looking at them I realized that they did comparison films of my right and left knees.  Have any of you seen your films?  My left knee (the one this post is about) looks soooooooooo deformed compared to the right knee!  I mean it looks horrible!  I am scared to death of that appointment tomorrow!  I guess I should calm down and just wait but I wanted to ask if any of you all had experienced the same thing.  Thanks!

Heather  :'(      
R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04

Offline ~*Heather*~

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Re: Quad Tendon Rupture
« Reply #30 on: June 10, 2003, 09:39:56 PM »
WENT TO THE OS TODAY!!!!!!!!!!!!!


Well he went through each MRI film one by one with me.  Explained to me the difference in the right and left  quad tendons. He thinks the other OS may have reattached the quad tendon without realizing it was almost all scar tissue (went 4 months with it ruptured before repair was made). He stated that sometimes healthy tissue and scar tissue on a tendon can look similar.  

Anyway, he thinks this is why the patella fell because the tendon/scar tissue streched out, he also feels it is not healthy.  The patella tendon still looks good but it's slowly changing shape and appears to be just a little thicker and a slight bit curved compared to the Right one.

My knee is locking because it is hitting on the thigh bone when my knee goes from bent to straight.  This means that the top of the patella is hitting the groove and over time it will wear that groove down..OUCH! Also when the MRI scanned my good knee, when its at the bottom of the patella there it is just picking up the top of the patella on the left knee.  So that's a pretty big difference he said.  All ligaments and cartilige look good as of right now.  

Here are my options:

1.  Leave it alone and continue life as it is.  With the possibilty of getting worse over the years.   He says my quad will never come back because of the scar tissue quad repair. The locking will most likely get worse and become more painful. Other than that, my life would be what it is now......nothing! (But at least there are no risks involved)  

2.  Surgery.  He isn't sure what kind though.  He is referring me to a specialist at Duke University because I am in North Carolina already. He spoke with several of his colleagues and nobody felt they had the experience to deal with it. He mentioned the specialist in Cincinattii that someone here mentioned, but for location we agreed to try Duke.  

He explained the type of procedure that needed to be done.  He says I will need a lateral release (not a usual release that we all have had, one towards the bottom part of the knee) on both sides to free up the kneecap and then to have the quad tendon repair redone with removal of the scar tissue which is what the attachment was done with.  >:(  

This could lead to a permanant loss in flexion because they will be advancing the tendon once again and removing all unhealthy tendon.    Also the two releases will cut off blood supply to the patella tendon and this could be cause for weaking of that tendon and lead to possible problems later on as well. He did mention that the patella could be trapped by adhesions and scar tissue only and then in that case that would be the plan of attack, however, the quad repair still has to be redone because that tendon is too stretched out now.  

I told him I didn't want RSD or any of the other complications that could come along with this and he said that they definitely were risk factors but if he were me he would try to get it fixed.  He was a very nice doctor and took so long with me, it was nice! I did not feel rushed at all. He even asked me if I knew of any surgeons that I would WANT to do it!  I was thrilled that he was willing to send me whereever I needed to get this dealt with.  I would love to thank all of you once again for giving me so much information and making this visit so much easier.  It was so nice for him to use terminology and for me to understand it because of all you guys lending me a hand!

Oh yeah! He also thinks the reason the suture ties are sore enough to make me scream is because one of the nerve endings may have tried to grow back and i may have a nueroma under it and that is why it is sticking so far out and excrutiating.

He will be contacting me with the name and number of a Sports Medicine Specialist at Duke soon.  What would you guys do in my situation? Would you leave it alone or chance it with another surgery? Thank you for reading this!


Heather  ???      
« Last Edit: June 10, 2003, 09:46:57 PM by Heather »
R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04

Offline ~*Heather*~

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Re: Quad Tendon Rupture
« Reply #31 on: June 17, 2003, 04:49:46 AM »
Hi all,

Just wanted to add one more thing.  This Wednesday     ( June 18 ) I will be seeing another specialist at Walter Reed Medical Hospital in Washington DC just to get another opinion.  I can't schedule the other appointment (the one at Duke/Chapel Hill NC) until that OS gets back from vacation and that is July 6th.  I just thought I would get one more opinion to go to the one back home with.  The OS at Duke/Chapel Hill is suppossed to be one of the best, so we will see.  Thanks again for all your posts and information!  You guys all know so much and are so smart about this!  

Take care,
Heather
« Last Edit: June 17, 2003, 04:52:24 AM by Heather »
R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04

Offline Janet

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Re: Quad Tendon Rupture
« Reply #32 on: June 17, 2003, 05:07:09 PM »
Heather:

Wow! As if having patella baja isn't enough, now they tell you that the quad tendon needs worked on! At least it sounds like there is something that can be done. I think you are really smart to get other opinions. You can never have too many! This is definitely not "routine" surgery, as they are basically reconstructing your extensor mechanism. My last surgery was also removing the scar tissue that had built up everywhere in my knee, plus the lateral and medial release. I didn't even know I was tracking laterally, but when my OS got in there, she found that I had a lateral strike near full extension.

It sounds like you are getting your opinions from top notch doctors, and that should help you make a decision. Let's hope that since the changes are just beginning to show in your patella tendon, once the quad tendon is repaired, it the patella tendon will be able to return to it's normal length and size. As for loss of flexion, I would ask how much to expect. Many people go nicely through life with less than full extension. As long as the pain would be gone, I think I could live with that. But it seems you don't really have much choice, since living with it the way it is doesn't seem like much of an option! I will be anxiously waiting to hear what opinions you get.

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline Sonia_B.

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Re: Quad Tendon Rupture
« Reply #33 on: June 18, 2003, 04:21:50 PM »
Hi all!
Not sure if this is the right place or not, heather (lilangel) told me about this place.  I used to post here years ago and no one knew what patella baja was then.  I see now that there are several who not only know what it is, but unfortunately also have it.  Nothing like first hand experience  :'(  .  Any way, I just found out that my patella baja started when my old OS did a retinaculer release, he cut too far, cutting into my quad tendon.  This made my knee unstable and I fell, a lot!  Each fall I would tear the tendon a little more.  When the bursa (capsule surounding the knee joint) started tearing, the baja finally showed up on a MRI.  On Dec. 10th 2002, I had surgery to repair the baja.  My new OS took a small piece of my tibia (with my patella tendon attached) and moved it up to place my patella in the correct place.  It is held in place with 2 screws.  He also used a donor hamstring tendon to replace mine.  Mine was unusable because it had been torn for 3 years and (according to OS) "looked like cooked spaghetti instead of a big hunk of steak!"  Makes you wonder what doctors are thinking of during surgery ;D.  I was doing pretty well in PT.  Not very aggressive as in March I had a stress fracture and just re-started PT after that healed, but last week I twisted my bad knee in the mud and have had a lot of swelling and pain since.  In my first PT visit, I had 73 degrees flex (my biggest problem) and yesterday it jumped to 97 degrees.  PT and I are afraid that I re-injured my quad repair or something, as before I was LUCKY to get 2 more degrees per PT visit while being VERY aggressive (while in the wall slide position I would have 30 pounds hanging on my ankle) and now I all of the sudden get 24 degrees without much effort!  I see OS July 16th, and will hopefully know more then.  If anyone else had this happen, or has any questions for me I would be glad to answer!  I have had Patella baja for over 3 years and in that time I have learned way more about knees and insurance than I ever wanted to know :D
Thanks Heather for showing me this site again.  There is a lot more info now than before!
Lots of luck everyone!
Sonia
1st scope 00, 2nd april 01, 3rd nov. 01, patella baja repair 02.  Still not fixed and no help in sight!

Offline Janet

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Re: Quad Tendon Rupture
« Reply #34 on: June 18, 2003, 05:12:22 PM »
Sonia:

Welcome back. Well, sorry you had to come back, but you know what I mean! It's encouraging to know that there was something they were willing to do to address the baja. I'm lucky in that my baja isn't too bad (my patella only dropped about 1/2 inch). But it has been so long now that I am told the changes in the patella tendon are permanent and there is nothing they can do about the baja that has a good chance of working. So we deal with the other issues and try to keep my knee as functional and pain-free as possible. Please keep us informed as to how you're doing.

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline Sonia_B.

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Re: Quad Tendon Rupture
« Reply #35 on: June 19, 2003, 04:53:07 PM »
I finally found out the name of the procedure I had in December.  I can't believe the OS thought I was so stupid!  He kept calling it a "total knee reconstruction" but when I talked to him yesterday about what happened in PT (gaining so much flex), I asked if this was normal for someone recovering from a Fulkerson Procedure.  He was shocked  :o, then asked how I heard that name.  I told him that knee people stick togeather on the internet! ;D Anyway, he admitted that I did have the Fulkerson procedure and gaining so much flex without much effort is not "normal", but I wonder just when did I become normal? 8)  So, now maybe he will talk to me like an adult and not a child!  They will try to get me in sooner (my appt. is 7/16) if they get a cancelation, but I have to have 4 hours notice because thats how long it takes to get to his office!  Wish me luck!
Sonia  :D
1st scope 00, 2nd april 01, 3rd nov. 01, patella baja repair 02.  Still not fixed and no help in sight!

Offline ~*Heather*~

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Re: Quad Tendon Rupture
« Reply #36 on: June 20, 2003, 06:36:13 AM »
Sonia,

I'm glad you are on a new level with your OS! lol!  I went for my second opinion at Walter Reed and that doc there said that he thinks the first surgery I had was too harsh for my original condition. That really upset me! The lateral release was necessary but the medial plication, VMO advancement was NOT necessary.  I couldn't believe it!  It was because of that part that I fell and all this has happened to me!!!!!!!!!! Anyway, he said that it looked as if the other OS did not measure for the quad tendon repair or something because it's all stretched out and that's why the kneecap has fallen.  He physically pushed my patella up a bit, of course it fell again, however, that showed mobility.

My patella tendon is also very loose so as of right now he feels a simple quad tendon repair (repeat of the last surgery) will be the fix.  He advised me that I have about a 60-70% chance of getting it normal again.  He was hestitant to give me more than that because he feels with those surgeries that the tendon can be stretched out and it could repeat and end up as baja again.  

He also said the other OS attached the tendon to my patella at the wrong angle, it should have more toward the back rather than directly on top.  I feel some hope here, I just hope I can get someone to do this before the patella tendon tightens down. Even if it did he still said you can get it lengthened, but then that leaves more room for error and also possible further problems in the future. This particular surgeon is booked until November and I still have the one in Chapel Hill to see soon, so like everyone advised me here, I am getting a zillion opinions!!!!!  I know I need the quad tendon repaired again, but there are differences on whether each OS feels the baja will return or if all pain will be gone.  I hope everyone is doing good!  

Take Care,
Heather
R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04

Offline Heather M.

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Re: Quad Tendon Rupture
« Reply #37 on: June 20, 2003, 07:31:47 AM »
Heather,

This guy from Walter Reed sounds much more optimistic than the other one.  I'm really glad you have the patellar mobility, that means you probably don't have tons of scar tissue causing the patella baja!  That's good news.

It sounds like you have a complex case, and I highly recommend the approach you are doing.  Another thing you might want to try is going to online medical journals and looking up your procedures.  You should be able to get abstracts, statistics from studies, and doctors' names.  That's how I got the word doc I sent you a while ago.

Anyway, I hope things are going well for you.  One new thing that I've discovered is lidocaine patches.  They really help with the pain when I have to do stuff and can't take pain meds.  They are almost dangerous...I wore them daily when I was traveling last week, but you can't use them for more than 12 hours a day.  When I took the patches off...YOWZA.  I guess I might have overdone it.  However, I still highly recommend the patches for those times you simply have to be on your feet.  Also, patellar taping from below in a V shape should help keep your kneecap in the right position, that might help you get by until you can have this addressed.

Were you able to get the records from your other OS?  I have to say, when you told me you'd had an IT band release--YIKES.  That's a really rare surgery.  And LR is usually tried without VMO advancement, though not always.

Anyway, I'm glad you're getting some answers.  How is the rest of your life going?  Yes, we do have lives outside of our knees.....

Heather
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 Sonia_B.

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Re: Quad Tendon Rupture
« Reply #38 on: June 20, 2003, 04:39:01 PM »
Heather,
I'm glad your getting so much info from lots of docs!  The info you have, the better prepared you will be and a better selection of OS's from which to choose!  I wish you luck and please keep us posted!
Sonia :)
1st scope 00, 2nd april 01, 3rd nov. 01, patella baja repair 02.  Still not fixed and no help in sight!

Offline Janet

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Re: Quad Tendon Rupture
« Reply #39 on: June 20, 2003, 04:55:54 PM »
Heather:

Just as I had hoped, it sounds like your patella tendon hasn't changed too much and they can redo the quad repair. Ugh, I'm sure you're not looking forward to going through that again....but at least you have an option that sounds encouraging! As for that OS being booked through November, what did he say about waiting that long? If he thinks that it should be done sooner, I'm sure he will make room in his schedule. But good for you that you are still seeking other opinions. With complicated cases, there usually isn't only one answer and it will be best for you to get all the options on the table before deciding which one will work best for you. It sounds like you're on the right track. Congratulations!

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline parky_13

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Re: Quad Tendon Rupture
« Reply #40 on: July 06, 2003, 11:36:04 PM »
 :'(  I had bi-lateral knee replacement in Dec of 2001. The day after surgery about 10 hours after pt came in to  get a measurement on how far I could bend the knees on my own. As she grabbed the right one she kept on forcing it back until I could feel the quad tendon tear.  I start yelling and screaming at her telling her she had hurt my leg. She didn't say anything just moved to the other leg. My pain at the time was not under control from the surgery. Nothing was working so I was cold turkey at the time. It took about three weeks to confince my dr's and therpist something was wrong. Went in an repaired a 90% tear in the right quad tendon. While that was healing the left quad "blew out" 5 inches going up my thigh. Had to have that repaired. The right one froze up and had to have it relased and scar tissure removed. The wire holding the quad together broke it had to be removed. More scar tissue removed and a release again. Then I fell in my kitchen, went to take step nothing there. I tore both knees the right one 20 % the left one 10%. Dr waited 6 weeks to see if ti would repair itself it didn't went in to repair ti 30 days ago it was torn at 50%. Put in graft everything ok for about 3 weeks indentation the size of a ping pong ball at the top of the knee can not lift leg straight up to painful. Left leg not holding up at all.  I jhave had a total of 7 surgeries since knee replacements. Help//

Offline ~*Heather*~

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Re: Quad Tendon Rupture
« Reply #41 on: July 07, 2003, 02:18:50 AM »
Hello all,

Just wanted to let you all know that I have that appointment with the specialist from Chapel Hill University on August 4.  My b-day is August 18, so I'm hoping he will have news so I can really celebrate! lol.  I'm hoping that he will have the same outlook as this other OS that I saw at Walter Reed.

Heather,
Thanks for the advice, I am continuing to research all that I can.  You have been a tremendous help along with everyone else here.

Janet,
Hope all is well is with you!  I am worrying about you and your surgery!  I see you are back posting so that must be good, huh?

Sonia,
Where are you?  I've been emailing you hun!  Hope you are okay and PT hasn't got the best of you!

Anyone know how long it takes for the patella tendon to tighten down?  I know it must differ for everyone, but if there are stretches I could do or exercises to stay away from......?????


Thanks to all for all the continuing support and best wishes!

Heather
 
R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04