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Author Topic: Ruptured Quadriceps Tendon  (Read 473253 times)

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Offline D.S.

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Re: Ruptured Quadriceps Tendon
« Reply #735 on: June 16, 2013, 10:22:51 PM »
My turn. A ruptured quad tendon. It's 7 weeks since surgery. I've had physio twice, and I see the surgeon every few weeks. I have read all 49 pages of this thread. Thankful for this forum and all of the support. I will rely on the PT and surgeon for their advice and recommendations, but I would still appreciate feedback/suggestions from you guys. I have had a rigid splint since the operation (velcro with metal stays). Received the adjustable brace 5 weeks after surgery. The flexion was set to 30 degrees, then PT allowed me to move it to 60 degrees. It was meant to be worn all the time, with the hinge locked.

My issues: The brace, no matter what, will slide down my leg within minutes. Can't be worn in public. It looks like this will happen with most of the braces available. I have huge quads, even with atrophy. Can only do the straps up so tight. My medical practitioners have told me, in that case, to use the splint for most everything, and use the brace only during exercise/physio. That is the compromise. Nothing wrong with having the leg rigid in the splint, being conservative does have it's value. The splint is nicely padded, to protect a fall. It's not clear from all the posts in this thread: Are people allowed to/advised to unlock the hinge at some point, and allowed to walk with the flexion setting at 30 degrees or 60 degrees? If so, not sure what I will do? Maybe I can just keep doing the ROM exercises, and by the time I reach 90 degrees, can walk without a brace? Or maybe at that point I will still walk with the splint, to be on the safe side? I'll wait to see what my physio therapist and surgeon advise, but wasn't sure if and when people were unlocking the hinge on their brace, and walking with the hinge open, but limited to 30 degrees etc? It's too bad I can't wear the brace.

Everything else is progressing well, considering I didn't have surgery for 3 months after the tear (my fault). I feel no real pain, my ROM is about 55 degrees. One other question. I like to do heel slides sitting in my low to the ground love-seat, with the computer in my lap. Does anyone see the need to limit heel slides to being in bed, lying down? I'm very comfortable doing the slides seated, my rear end quite forward on the lower seat cushion, and my back semi-reclined on the rear cushion. It's nice to be in this position surfing on the computer and doing heel slides from time to time, as the day progresses.

My niece is a physiotherapist, so I will consult with her. There is a lot of great advice on this thread. I thank everyone in advance for their help.

(ps: even my splint "walks" downward and bottoms out on the top of my foot, so I have to pull it up from time to time, because it is not overlapping the top of my leg enough, and allows my knee to bend a fair bit. But the brace is shorter overall, and comes right past my knee! I tried taping my brace to my shin with duct tape, but that isn't practical obviously. I could fabricate a "cuff" made from rigid camping foam, to go between the top of my foot and bottom of the brace, to limit it's slide down...but I'll wait until I find out that I have to wear a brace "unlocked". Very frustrating!)

D.S.
« Last Edit: June 16, 2013, 11:08:02 PM by D.S. »

Offline David Down Under

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Re: Ruptured Quadriceps Tendon
« Reply #736 on: June 17, 2013, 08:11:13 AM »
Hey DS, we share the same initials, injury and time post op. Strange, huh ? I too am constantly adjusting the brace. I would think u would be better off using the hinged brace as it will get you walking properly quicker. When using a fixed brace, the quad is not firing.

So I take it you had a partial tear ?

This is my second RQT in 9 years... Lucky me

My second PT is tomorrow.

Surgery was April 27th

Offline D.S.

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Re: Ruptured Quadriceps Tendon
« Reply #737 on: June 17, 2013, 02:43:45 PM »
Hi David. I played with the brace this morning, extending the bottom portion to bottom out on my ankle bone/foot. May be painful and rub in the long run. I can never quite get the pivot to align with the pivot joint of my knee, it's off by an inch or more, I guess because I can't get the brace to sit in the right place. Found a similar brace from the same maker, in the US, that has a provision to eliminate sliding down...stirrups extend down and fit your foot inside your shoe. So I may suck it up and pay $350 and duty and taxes to bring it over the border...my knee must come first.

That said, do surgeons and/or PTs recommend unlocking the brace at some point down the road? Is that standard procedure for rehab? David, surely you aren't using the brace unlocked, this early? They indicated to me that using my fixed splint is fine, and want my leg locked in a fixed position, for a long time to come. I asked them if there would be a time they might want me to walk with the brace unlocked? They said we would all worry about that when the time comes. So, I am assuming the time will come.

I had a full tear, basically. The surgeon said there were "strands" remaining on either side of my knee connecting my tendon to the knee.

I wish you, and everyone else here, the best recovery possible!

I donated to this website yesterday. This forum has offered me so many new ideas and options for improving my rehab. I am very thankful!
« Last Edit: June 17, 2013, 03:09:16 PM by D.S. »

Offline David Down Under

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Re: Ruptured Quadriceps Tendon
« Reply #738 on: June 17, 2013, 09:38:28 PM »
Hey DS, the thing you will notice is that there appears to be no standard protocol re PT and what the OS's allow.

They may be taking extra precaution with you as there was quite a bit of time between injury and repair. My first RQT 9 years ago was reattached in 4 hours ! Pure luck that a surgeon was available shortly after I arrived in the ER. This one was repaired in 20 hours.

But yes, I was FWB with brace locked from week 2. At week 5.5 I was allowed to walk with brace unlocked at 30. After first PT session at week 6, it was unlocked to 45 for walking.

Re Brace, I too thought about buying a better one as for me to change the settings on this one I need a screw driver.

Just on the brace, the hinge MUST align with your knee cap when unlocked.

Cheers

David
« Last Edit: June 17, 2013, 09:40:15 PM by David Down Under »

Offline Flangecrank

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Re: Ruptured Quadriceps Tendon
« Reply #739 on: June 17, 2013, 11:15:09 PM »
Hi - New here and posted on the main forum - They pointed me in this direction in the hope i can find someone with the (rare) injury that i sustained for advice.

I'm a Male - 39 - Was V active - Whilst Jogging just before Christmas 2012 suffered a fall and diagnosed with Fractured Patella and Ruptured Quadricep tendon Two weeks later - Placed in a rigid brace with leg outstretched.

A month and a Half after injury I had an op - Screw in Patella and Quad tendon re-attached and stitched \ drilled into place. Continued with Rigid leg brace.

Placed in a hinged brace a month after surgery

4 months after surgery I have managed (With the help of physio) to obtain 97 deg maximum ROM - The last 5 sessions it just didn't increase and stayed at around 95 - 97 degrees. My knee feels like it physically CANT get past this.

The 'Bending' physio stopped last week and I have started exercises - Squats, Leg raises, Static bike, Cross trainer etc. Physio team however have contacted Orthopaedic team to potentially refer me back.

My concern is that my leg do-sent want to bend any further - Physio say 'i am on track' however progress seems to have stopped - Knee is still really swollen compared to my good knee and the harder i push to increase ROM, the more pain \ swelling i get.

Is there anyone with the same type of injury - As i understand it, fracturing the patella AND a complete rupture of the Quad tendon is quite rare!

I must say, its a horrific injury and can really get you down at times. I have sympathy for anyone in a similar position.

Offline D.S.

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Re: Ruptured Quadriceps Tendon
« Reply #740 on: June 18, 2013, 05:20:21 AM »
FC, feel really bad for you! Sorry you aren't getting any more ROM. I'm really concerned about your swelling, and your ROM. I hope you get this resolved soon. Good luck!

Offline D.S.

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Re: Ruptured Quadriceps Tendon
« Reply #741 on: June 18, 2013, 05:51:13 AM »
@David Down Under, thanks for the details! I assume FWB means full weight bearing.
« Last Edit: June 18, 2013, 05:53:10 AM by D.S. »

Offline David Down Under

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Re: Ruptured Quadriceps Tendon
« Reply #742 on: June 18, 2013, 06:46:37 AM »
Yes mate... Full weight bearing.

The consensus seems to be the sooner the surgery the better. So they may take things a little slower with you.

But as mentioned in previous post, there are so many different recovery regimes out there. I have read of many guys starting PT twice a week from week 2. These guys are at 90 degrees at week 5 & 6. And have also heard of guys staying in a brace locked at zero to week 14.

I came across a great PDF on a recommended RQT recovery plan. Will dig it up and post it as an attachment

Offline D.S.

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Re: Ruptured Quadriceps Tendon
« Reply #743 on: June 18, 2013, 02:49:50 PM »
Thanks!

Is there any consensus as to whether one should get ultrasound fairly early on (or at all?) to minimize scar tissue in the affected area?

Offline D.S.

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Re: Ruptured Quadriceps Tendon
« Reply #744 on: June 18, 2013, 10:36:31 PM »
I saw my physiotherapist today. I asked her about ultrasound for scar tissue. She felt the skin all along my knee, and pointed out that the skin was moving freely relative to the tendon/muscle tissue beneath, and therefore, did not require ultrasound. She gave me a detailed explanation about the healing site and how scar tissue was a good thing in that particular area. I was very satisfied with her explanation. She's well recognized in her field, and is a lecturer/instructor at the university. She allowed me to unlock my brace (but keeping the ROM limited to only 30 degrees of movement on the brace adjustment) and it felt good to walk with more movement in my knee. She measured my ROM at 60 degrees. I'm at 55 days post-op now, so almost 8 weeks. I'm supercharging my nutrition now with all the supplements I used to take when weightlifting. I'm looking at my elliptical and spin bike right now...they will come in handy when rehab gets more advanced. That said, I am being very careful when I walk, and I am being mindful of patience. It will be a long road back.

Offline Bearkev

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Re: Ruptured Quadriceps Tendon
« Reply #745 on: June 20, 2013, 01:39:57 AM »
Has anyone had Synvisc injections?  I am 9 weeks post op and received my first of 3 injections today.  Curious about what to expect.  The good news is that I finally reached my first goal yesterday at therapy - 90 degrees. 

Also, a note to those starting out.  Once you're weigh-bearing...tread carefully on the stairs.  The other day I was walking out into the garage.  There are two steps going down.  I completely spaced out and went down with the good leg first.  When my good leg landed, my bad one was bent beyond my normal.  The pain was terrible.  Luckily I was fine after a couple minutes and only had minor swelling. 

Offline David Down Under

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Re: Ruptured Quadriceps Tendon
« Reply #746 on: June 20, 2013, 03:37:28 AM »
Hi Guys, you might find the following of interest

http://www.uwhealth.org/files/uwhealth/docs/pdf6/sm_pat_tendon_quad.pdf


Offline D.S.

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Re: Ruptured Quadriceps Tendon
« Reply #747 on: June 20, 2013, 04:03:49 PM »
Thanks for the link!

Offline D.S.

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Re: Ruptured Quadriceps Tendon
« Reply #748 on: June 23, 2013, 10:39:13 PM »
Saw the Surgeon on Friday. He's allowed me to open my brace to 90 degrees for doing my exercises for ROM. He was very encouraged by my progress. My ROM is 65 now. He indicated to me and my physiotherapist that I should be trying for a rate of increase in ROM of 10 degrees a week. I think he wanted me to remove the brace as of July 4. I may be up to 90 degrees by then. But I told him I want to stay conservative, and keep the brace on, past July 4, limited to 90 degrees, in case I fall. (I walk with it limited to 70 degrees right now). He said he didn't think the brace would save my knee if I fell at that point, but I disagree. If I can only get ROM of 90 degrees by July 4, I am not going out without a brace! I will have it limited to 90 degrees. A fall could take my knee past 90 degrees and undo the surgery. (The brace can be totally unlocked, but adjustable limits only go to 90 degrees, so when ROM is past 90 degrees, I will still limit it to 90 degrees when out walking). I am willing to take other risks though. I got on my elliptical today. It has an adjustable length of stride. I was careful to check how far it bends my knee, and it didn't take me past about 60-65 degrees. I kept the resistance very low, stayed on for 30 minutes, felt no pain anywhere. I feel great now, and feel that I got a nice light workout. Heart rate was at 115 to 120 bpm, so I was in a nice fat burning zone. No one told me I could do this yet, but they'll allow me to walk anywhere outside, up and down hills, stairs, etc, so what's the difference? I think as long as resistance is kept very low in the beginning, it's a win/win situation for strengthening all the leg muscles (hip too) and increasing my overall health. I'm eating very carefully, and supplementing with vitamins and minerals. I'm at 8 weeks post-op and feel great. I'll need much more ROM to use my spin bike. I'll see what the PT recommends for weights later on, but I think I will avoid any weight training for a long time. I'd rather build up gradually with the elliptical and then add the bike when possible. I'm listening to my body and feel no pain. But bottom line, I am planning to wear my brace for a long time, especially when out and about in the city. I can't get over how much better I feel, hours after using the elliptical! My beta endorphins are "high" and it feels so good knowing that I am slowly on my way back to some kind of normal, whatever that may be. I am under no illusion that I may never get my original ROM back, and perhaps there will be other limitations. One thing is clear. Working out hard all my life (weights and long distance cycling) has allowed me to be in an excellent position to heal. I do not feel 55 years old. I am lucky in that regard.
« Last Edit: June 23, 2013, 10:40:47 PM by D.S. »

Offline David Down Under

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Re: Ruptured Quadriceps Tendon
« Reply #749 on: June 24, 2013, 12:06:47 PM »
Hey Mate,

Sounds like you are making great progress. I will definitely give the cross trainer a go this weekend. Did you wear the brace when on the machine ?

I think I am nudging 75 ROM and have 4th PT tomorrow morning. He has me doing squats to 60 ROM, and some other very basic strengthening exercises. I managed to walk 1.2kms on Sunday. Still have a limp. Did a day in the office today. The brace doesn't seem to work well over long pants. Constantly slipping down. I come home feeling exhausted, like its a Friday. Man this injury sux ass.

Keep on truckin !















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