Ruptured Patellar Tendon Surgery

[Bri]

First time posting, have read through quite a lot of the thread some really useful info here.

I'm 35 from Manchester uk and am now 7 weeks post op, ruptured right patellar tendon playing football, was a bad rupture and have a history of patellar tendonitis.  I attended a and e the night I was injured (wednesday), misdiagnosed with ligament tear, put in a cricket splint and crutches and sent home. Appt to see knee consultant following thursday who immediately diagnosed rpt, arranged MRI friday, operated Monday- 12 days after rpt.

Due to the state of the tendon, it was repaired as well as it could be and reinforced using a hamstring tendon autograft, and (as far as I am aware) a 'wire' which 'should break down' once I begin to get more ROM - not been told if this will need to be removed or not.  Released from hospital after an overnight stay, pain was at its peak the first night home - wow let's just say it was pretty bad. 

Orders from surgeon was conservative in comparison to what I have read on here - non weight bearing for 3 months, hinge brace fitted after 3 weeks set to 30 degrees, then increased to 60 at 6 weeks and will be 90 at 9 aiming for 90 degrees at week 12.
 Started physio at week 4 where I was basically given a sheet of non weight bearing exercises - quad sets, SLR, towel pull on ankle to flex, lateral leg movements.  Whilst non weight bearing, physio and os appt every 3 week, then physio will be 2 times a week Group sessions.  No mention of exercises to increase ROM in the meantime, or any patellar mobilisation/massage, or any knee manipulation by pt - should I be doing these? reading through this thread it seems the majority of people were attending pt numerous times a week with these exercises involved.

I am now at week 7 and knee still swollen albeit not as much as originally, hard to touch on the tendon and outside of knee, and warm to touch. Is this normal?  I can now do sitting leg raises 3 sets 10, but my main concern is ROM. I can currently get 50 degrees, but every degree of movement gained I am really working for and struggling to push through - is this normal?  Is it just a case of pushing through the pain/discomfort to obtain rom? Is there a point post surgery where getting ROM speeds up or gets easier? (I hope so)

[John42]

Hi Bri

Welcome to the RPT thread on KneeGuru - I will respond later this morning on more detail in response to your queries.

Which hospital treated you? NMGH? as i was a volunteer in NMGH for 15 years working part of the fracture/Orthopedic clinic. Which part of Manchester do you live? I am in Higher Broughton -
Best/JohnKManchester UK 

[John42]

Hi Bri

Right, have had time to read your post - a RPT injury is a typical football injury, in the UK it is normal to place the leg in a plastercast for 3 months - I think that the recovery time is conservative but time will tell.

The wire in most cases is removed at a later date, but kep an eye out in case it snaps and peeps through the skin.

On your next visit to the pt, ask him/her, have you seen this type of injury before? it`s very rare. You can forget football for the next 12 months.  Remember it takes a long time for the tendon to heal.  The object of the pt, it to stretch and stretch and pt will continue until you reach about 120 rom - anything over that will be a bonus.

Have your good measured as a guidence.  Further tip - sleep with a cushion between your legs - takes the pain away from the injured leg.

Any help/queries etc, give me a ring  792 4798.

JohnK/ Manchester UK

[Bri]

Thanks for your reply john - south manchester, was treated at stepping hill hospital stockport. The surgeons were great to be fair.

My main aim is to get my ROM back as much as possible, I understand I may never reach how it was before but just enough so I can go hill/mountain walking (snowdonia/the lakes etc) - I have already made the decision to hang the football boots up!

[SellaVee]

Hi Bri, I'm also from the UK (Wirral) and was sent home from A&E with a crepe bandage and crutches and told to come back in a week!  The male nurse asked the doc if I needed a splint and was told no as they thought my cruciate ligament was fine.  I’d fallen awkwardly at home and was nearing retirement so I didn’t really fit the demographic, especially as I’m female.

Went back in a week and a different A&E doc (young woman) spotted what was wrong straight away.  She sent for the orthopods who told me to come back in 10 days for the next available appointment.  Meanwhile she put me in a cricket splint. 

Returned in 10 days and saw the consultant (old bloke) who told me that arthritis was the problem, but agreed I should have a scan - the following day.  A week after that, and 3 1/2 week’s after the injury I finally had surgery.

I was really worried.  The good news is that although the extension on my right leg isn’t as good as my left I have completely recovered ROM for flexion and can touch my backside with my heel when stretching.

I eventually read this thread from post no. 1 and another woman write that she did a lot of walking to improve her ROM, so I decided not to worry about numbers, especially since, like you, I was started at 30 degrees.

Doctors in the UK are VERY conservative and I found the NHS physiotherapy to be poor.  So we abandoned plans to go on holiday and I went to a private physiotherapist, who was fantastic.  I credit her with my recovery.

I also had a wire.  It broke in two places eventually and I had to nag the same consultant to have it removed.  Once again he said the problem was arthritis!  I could feel the sharp ends digging in and GP had sent me for an X-ray, which he had in front of him.

I had my surgery in July 2013 so you can go back and read my story if you like.  I think if you click on my name you can read my posts.  I’m pretty sure my knee was hot and swollen at 7 weeks.

This injury is depressing and frustrating and worrying.  This board will do wonders for your morale and will give you the information you need to keep the NHS on their toes.  They do a great job, but sometimes you need to be proactive.

Good Luck.

Sella

[Bri]

Hi Sella

Thank you for your reply, it sounds like you have made a good recovery.

Reading back through your posts, I seem to have had a similar experience to yours with regards to a misdiagnosis and delayed surgery, and issues with the physio received.  Interesting to read about your issues with the wire, and the length fron surgery to wire removal, sounds like you were waiting a while for that.  My surgeon hasn't said if it will come out, just that they may need to snip it.

I'm at 9 weeks tomorrow, with just about 70 degrees ROM.  I had my surgeon and physio appt last thursday and the brace was opened to 90 degrees, I will be returning in another three weeks when my brace will be opened fully and the surgeon will allow me to start weight bearing physio.  I went through a load of questions with the surgeon, and have gotten into the habit of writing things down to ask.

Physio at the moment is every three week 10 min appointments and I'm doin my exercises daily.  I did have to take a couple of days off last week as I strained around my hamstring/back of my knee where the graft has been taken from.

Progress is there, but it's slow.  However this doesnt bother me as long as eventually I can make as good a recovery as possible.

Thanks again for your advice, I have started to read the full thread to get some more insight into the recovery process.

Bri

[madvillain]

Hi Sella

Thank you for your reply, it sounds like you have made a good recovery.

Reading back through your posts, I seem to have had a similar experience to yours with regards to a misdiagnosis and delayed surgery, and issues with the physio received.  Interesting to read about your issues with the wire, and the length fron surgery to wire removal, sounds like you were waiting a while for that.  My surgeon hasn't said if it will come out, just that they may need to snip it.

I'm at 9 weeks tomorrow, with just about 70 degrees ROM.  I had my surgeon and physio appt last thursday and the brace was opened to 90 degrees, I will be returning in another three weeks when my brace will be opened fully and the surgeon will allow me to start weight bearing physio.  I went through a load of questions with the surgeon, and have gotten into the habit of writing things down to ask.

Physio at the moment is every three week 10 min appointments and I'm doin my exercises daily.  I did have to take a couple of days off last week as I strained around my hamstring/back of my knee where the graft has been taken from.

Progress is there, but it's slow.  However this doesnt bother me as long as eventually I can make as good a recovery as possible.

Thanks again for your advice, I have started to read the full thread to get some more insight into the recovery process.

Bri

It's great you're doing the exercises daily.  It's a lot easier to arrest muscle loss than rebuild.  It sounds dumb but sit ups and straight leg raises were a couple of my go to things during this stage.  The situps WILL activate your quads.  Iso sets and heel slides also good.

I'd try and push your surgeon to clear you for braceless activity ASAP.  At 12 weeks you should ideally be able to use the rowing machine and maybe even exercise bike.  I found both incredibly important during this stage to build ROM and help clear out scar tissue.

Also, walking on uneven ground (up and down on gentle inclines) is critical at this stage to train yourself how to walk again.  I blew out both mine at the same time so it was a bit more important (didn't have a reference point from a good knee) but the tendency is to "lock" your knee after surgery when a proper gait actually has a bit of bend at the knee.

You can read my post history here not so humble brag but I blew past the 99% percentile for non pro athlete recovery from my ruptures.  In fact I just completed a massive leg day finishing with two sets of 8x rep 300lb trap bar deadlifts yesterday.  A 7:50 mile on the treadmill was my warmup.  I still hike, play tennis, frisbee, run, do plyometrics, ladder drill, and so on.  In some ways I'm more athletic now because I train harder and I lost a bunch of weight after the injury.  I did give up basketball, but hey can't win 'em all.

 I'm 36 so similar age.  I got lucky with my surgeon and surgery but at this point your recovery is effectively up to you. 

Seems like you have a great attitude don't be afraid to push it a little more with your surgeon when you meet them and don't be afraid to take your rehab and physio into your own hands as well.  From the Internet and this forum I know more about recovery from ruptured patella tendons than I'd wager almost every sports therapist.  This is a very rare injury relatively so many don't have the proper experience with it.

Also, as far as supplements and tools like into gua sha scraping tools and Cissus.  Cissus is a great supplement for tendon and joint health.  The gua sha tool is to help break down scar tissue and help with ROM.

[Bri]

Hi madvillain thanks for your reply, good to see someone making a full recovery, and I totally agree about you taking charge of your own recovery.

An update from me, at week 15 now and out of the brace with improvements in strength (still a massive way off something comparable to my good leg) meaning I can pretty much walk confidently without a crutch but with a slight limp. Working on this via the treadmill.  Still descending stairs one at a time however, but I'm satisfied with the strength improvements which are tangible.  I do have a slight extensor lag preventing me from full terminal extension but I am working on this.

Now onto my main issue - ROM. I have a wire in which is restricted to 90 degrees to protect the repair/reconstruction.  Sign off letter for physio from surgeon stated that this may limit ROM, however he expects this to snap naturally during physio/as I gain functional movement back, with a possibility that the wire may have to be 'divided' if not, but this is usually not necessary. 

Issue is I have had 90 degree for the last 3 weeks now and attempting to get more is not happening due to the wire, which is not naturally snapping no matter how much I am exercising or how much ROM exercises I am doing (i am really putting the work in with home exercise sessions twice a day and going to the gym once a day on treadmill, elliptical, leg press and swimming pool).  Upto the 90 degree mark I was consistently gaining 10 degree a week.

It is a different type of pain once I get to 90 degree, rather than a stretching quad tendon pain which I have had when regaining ROM up to 90, it is around the kneecap and in the shin where the wire is situated, and pushing it feels like I may do more damage as the wire is tensing around this area.

This is impeding my recovery and physio as cannot get past 90 degrees which is required for bike etc.  Very demoralising and frustrating as I feel I could be progressing better but restricted by the wire.  The surgeon wanted to see me on 13th feb to check I was getting ROM back but I have moved my appt forward to 23rd jan in order to discuss this, as I honestly cannot see this wire snapping allowing me more ROM and I am concerned about leaving it later.

Other than this i also struggle with doing active extensions, these are painful round the kneecap with grinding/clicking.  I am doing these with a theraband to assist hopefully this will get better as quad control and strength improves. Anyone else have this?

Cheers

Bri

[Invincible17]

Over 2 years since I ruptured my patella tendon. Have had numerous injuries playing rugby over the years but this one is definitely the worst. However now back doing pretty much everything in the gym I was doing before and run/walk/mountain bike most days. Wake up every morning with an ache in my knee, seems like that’s never going away. So anyone who’s new to this, stick to the rehab and you will make near enough a full recovery.