Ruptured Quadriceps Tendon

[Ron-on-Exmoor]

Hi John,

I'm new to this forum - would it be possible to send me the three docs you mention about the rehab procedure?

Many thanks,

Ron

Hi Jeff

Welcome to the RQT club - regardless of what advice you have received so far, you will require a lot more physio and PATIENCE.....

I have sent you three documents, from which you can learn a great deal of the rehab procedure...

It`s going to take quite some months to get near 100% mobility.

Please continue to ask questions

Take care

JohnK/ Manchester UK

[John42]

Hi Ron ,  of course I will send you the  3  documents, but I need your e-mail address.

How did you sustain  your injury?

Keep posting on this thread - patience and read as many previous posts as possible.

Take care

JohnK/ Manchester UK
[email protected]

[Ron-on-Exmoor]

Thanks, John - I've sent you a separate email - but this is my story.

I live on the edge of Exmoor National Park. On June 4th I was taking the dog for a walk out on the moor. I was coming down a very steep, stony path and a stone rolled under my foot and I was over. I tried to get up (twice) but immediately fell over again. I was on a path I know well, but is very rarely used by anybody, and in an area without any mobile phone reception -  so it was down the hill on my bum (it seemed like forever, but was probably only about 15 minutes), to where I knew somebody would come along eventually -  which they did after about an hour. They went for help and I was half-carried/hobbled for about 10 minutes to a wider track, still a mile off any proper road, but where a 4WD could at least pick me up and take me to the waiting ambulance. Also, because I was in an inaccessible place, the helicopter air ambulance was sent - however, it could only land in the field beside the road next to the other ambulance, so I didn't get a ride in a helicopter!

I was taken to Minehead hospital which only has a minor injuries unit; I only began to realise it was something serious after the doctor looked at the x-rays, and before coming back to talk to me, phoned the orthopaedic department at Musgrove Park Hospital in Taunton, 45 minutes away by road. So it was another ambulance ride, eventually arriving there at about 7:30 pm. At 10:00 they were still deciding whether to operate that night, but as the surgeon was dealing with a serious spinal injury, it was left till Saturday morning. I spent three nights in hospital, and now have a knee brace, currently set at 70 degrees, and getting round OK indoors, but using crutches when I go out.

As I said to my own GP, I was out walking as part of his suggested regime of losing weight and getting fitter!

Hi Ron ,  of course I will send you the  3  documents, but I need your e-mail address.

How did you sustain  your injury?

Keep posting on this thread - patience and read as many previous posts as possible.

Take care

JohnK/ Manchester UK
[email protected]

[ruddski1]

Jeff and John, welcome to the club. Just want to relate to you that my Dr(very respected in NY) went into great detail with me about the first 1 1/2 to 2 months is very critical to not re-tearing any of the repair. I wore a straight brace first 1 1/2 months and a hinge brace at 30 degrees next 2 weeks. He said that if any of the repair is torn it will reduce how well you can recover in the long run. Just want you to be aware of what I was told and if you read my earlier posts we have had discussions about how differently this injury is treated in different regions.

[ds2812]

Hi all, fantastic site.
I ruptured my left Quad after slipping down some stairs on the 19th of june. I was operated on on the 20th and back home the next day. I was put in a full leg cast with a hinge, set at 0 to 30 degrees, i returned to the hospital today where they wanted to put me in another cast with the same flexion, 0 to 30 degrees for another 4 weeks. i asked if i could be put in a brace and they agreed, as the cast is just a nightmare, especially as the weather has been so hot.
I am 43 years old and was a former professional rugby player, i ruptured my achillles tendon on the same leg 5 years ago so i know all the pitfalls on the road to recovery.
Having read nearly all the posts on here i am totally amazed at the different ways that this injury is treated and I have learnt more from this site than from the doctors!
After many years and many serious injuries as a serious sportsman I can safely say this is by far and away the most debilitating injury I have ever suffered.
I can safely bear weight on the leg and walk very tentatively in the brace. I wont rush things as that is always the kiss of death, but equally i think everyone knows there own body and should listen to what it tells them.
I would appreciate any advice on rehab and time scales from any of you guys.
Many thanks, Dave

[John42]

Hi Dave

Welcome to the RQT club - KneeGuru is the best webste worldwide, and you have taken the correct steps to read previous posts on this thread.

I have three documents which would enable to read all about the rehab process - just let me have your e-mail address.

Where do you live?

Take care

JohnK/ Manchester UK
[email protected]

[Fibro-quad]

Hi all.

Just found this thread and am working my way through the years of posts.  From what I have read so far, I must be the poster child for what can go wrong when you suffer this *&^%%$ injury.

A brief synopsis:

* Christmas eve 2009, hiking in Zion National Park along a narrow icy trail, right after I said "Let's go back", one foot slipped and one foot didn't.  Nothing dramatic.  My butt barely touched the red rock and my clothes didn't even get dirty, but, on the way down, I heard a sickening POP.  I thought I had finally broken my first bone.  When I tried to stand up with my left leg bent it induced just-short-of-puke pain.  After a short while I realized I could stand to bear weight on my leg if I kept it straight, so no broken bone.  But if I bent the knee even a few degrees, there was incredible pain and no control of the joint.  With the help of my son and a Ranger, I managed to hobble/peg-leg my way back to the car and proceeded to the ER at our local hospital.

* Xrays showed no broken bones and I suspect the on call OS didn't want to come into the hospital in his Santa suit so he diagnosed a sprained knee.  I was sent home in a knee immobilizer and told to make an appointment after the holidays.

* Five days later (earliest appointment available) I went to the office of the OS who was on call that night.  I only got to see his Physician's Assistant.  He moved my leg and confirmed that the ligaments all seemed to be OK.  He said the knee was too swollen to determine much more.  I asked for an MRI but he said it would just show so much noise that it would probably be misleading.  I was told to wait 2 weeks and come back for a follow up.  As I was about to leave, he asked me to lift my leg off the table.  I told him that was going to be pretty hard, but after three deep breaths I gave it my all and got my heel about half an inch off the table.  He felt directly above my patella and said that he could feel the tendon, so all was OK. This was a critical misdiagnosis.  I don't know what he felt, but it wasn't my tendon.

* Dissatisfied with this line of treatment, I made and appointment with another OS, a sports med guy.  Of course, I went to the back of the line at his office and it was another week and a half before I got to see him.  He ordered an MRI that afternoon and, of course, it showed my quadriceps tendon dangling up there above my patella.  He scheduled surgery a couple of days later, Feb 17 2010. 

*Post op, he told me good news/bad news... Good news was he was able to do a primary repair, just fishing out the end of the tendon and drilling the patella etc.  Bad news was that he encountered more fibrosis and scar tissue than he ever expected.  Apparently, my body had decided that if nobody was going to repair this torn tendon, then it would just grow a fake knee by anchoring muscles and tendon to whatever it could find including the femur. 

* My OS being a sports medicine guy, I was started on PT rather quickly.  I went through hell week like everyone else posting on here and after week 2, we started PT.  All was going OK, except for ROM which sort of stuck at 30*.  After several weeks of little or no progress, we decided it was necessary to perform a MUA.

* Manipulation Under Anesthesia is a procedure to break loose scar tissue by forcefully bending the leg beyond the point where pain would prevent you from going if conscious.  It is a 20 minute procedure.  May 5 2010 we performed the MUA with the additional wrinkle that the OS also performed an arthroscopic lysis of the scar tissue before doing the MUA.  This was intended to release as much of the scar tissue as possible.  After the lysis was completed, they bent my leg and watched on the arthroscope as MY TENDON TORE AGAIN!!   

* Now they had to fillet my leg again and this time perform a much more extensive tendon repair, a VY quadricepsplasty.  They also installed a tissue graft jacket, a sort of tissue scaffold that strengthens and reinforces the tendon.  All very nice, but I am now back beyond square one. 

* I am now just about 8 weeks post op #2 and about ready to begin PT again in earnest.  We are all hoping that the tendon and graft jacket have healed and are ready to begin the slow, careful stretching that will allow me to eventually get my life back. 

I am willing to do whatever it takes, but for the first time in my life, I'm feeling physically and mentally drained.  My left leg looks like a twig stuck through a grapefruit.  It's hard at this point to NOT harbor some thoughts that it might never come back.  That's why I'm grateful for this forum.  I envy you guys who are touching your butts already and even running for crying out loud.  I don't want to be satisfied with 90* just so I can sit at a restaurant table.  I want more than that and I guess this is one of the big lessons from this injury:  Patience Grasshopper...

Nothing like a good whinge to lift some of the load.  Thanks you guys for listening.

Colin 

[John42]

Hi Colin

Welcome to the RQT club - you have found the best information website for your serious and rare injury.   It is essential that you read up as many of the previous posts on this thread - ask questions - lots of buddies out here to help you.

PATIENCE is quired - it`s going to take you a while to recover, with lots of PT.

I have sent you three documents, which will give you an idea of the rehab procedure - hard work, but the rewards are worth it.

Where do you live?

Best wishes

JohnK/ Manchester UK

[ds2812]

Hi all.
I have noticed reading all the posts that doctors in the uk seem to go for a more conservative approach to RQT and appear to imobilize for a far longer period of time before attempting PT, yet every post i have read from the US the docs seem to vary in there treatments, from ultra conservative to very aggressive early movement and therapy and there seems to be no standard treatment.
However the one thread that runs through all the posts is danger or post-op re-tear. Can anybody tell me why the treatment of this injury is so varied and why so many people report mis diagnosis? I knew instantly what the injury was and had no bones telling the A&E registrar he was wrong when he tried to send me home to wait for the swelling to go down and i insisted i see an OS.

[John42]

Hi Dave

I would agree that the OS/PT take a much more agressive approach to rehab for ruptured tendons.

They never seem to mention the word PATIENCE and that`s what it is albout - there has to be a given period for the tend to heal ( 8/12 weeks, before PT and then it is a case of stretch and more stretching that tendon. 

Compare the tendon to a piece of elastic, which has shrunk.

Keep asking questions, and I am sending you the three documents to study.

Take care

JohnK/ Manchester UK

[Ron-on-Exmoor]

Just to add my three-pennorth (I know the Americans won't know what that means!) to the debate re rehab times, the timetable I've been given since my accident on June 4th is:

-  Total immobilisation for 12 days
-  Brace set at 30⁰ for 14 days - which took me to last Wednesday
-  Brace then set at 70⁰ for the next 14 days (where I am now), and told to do do knee bending and stretching exercises four times daily
-  Brace then to be set at 90⁰ for another 14 days, with the promise of more exercises for that period
-  Brace then to be removed, and start strengthening exercises

When I asked just after the accident about what was likely to happen, I was told that I might be able to drive after about 8 weeks (it's my left knee, and a manual gearbox), would be able to walk almost normally after about 3 months, and it would continue to improve slowly for about a year, though the consultant did say that it would never be quite the same knee again - I could always be liable to pain and/or stiffness and/or numbness.

Currently, I get around fine at home without crutches, and have even managed to tie shoelaces. However, I always use crutches outside the house, even in the garden - my fear is falling over.

[John42]

Hi Ron

Dont venture to drive until you have full control of the pedals, otherwise you could invalidate your insurance.   Consider to apply for a disable badge - very useful in the first year, if interested - contact me and I will give you further help in that direction.

You will need to place your car seat right back, to make yourself more comfortable.

Take care

JohnK/Manchester UK

[ds2812]

Hi.
I have just read Rons Re hab program and it differs massively to what i have been told. My first 2 weeks in a cast with a 30 degree knee joint, went to the hospital and my consultants registrar told me i would be put in a new cast set at 30 degrees again for another 4 weeks!!
I refused the cast as it would mean my foot and ankle and calf would have no movement whatsoever for 6 weeks, so I insisted on a brace which he agreed to.
From the majority of posts I have read the amount of flexion at 6 weeks varies from 40 degrees to 90 in some cases, and i notice that Ron has moved to 70 degrees 26 days post op.
I have been given no rehab program or exercises. All i have been told is that the leg will stay at 30 degrees for 6 weeks.
I understand patience as i have had a total rupture of the left achilles a total rupture of the right hamstring and a shoulder stabilisation operation due to recurrent dislocations in the last 10 years! so i am no stranger to the pain and boredom of rehab. But what is really frustrating is the lack of information I have been given and the amount of differing approaches to this injury.

[subail]

Fibroquad

I feel your pain. My misdiagnoses (yes, read plural) took 10 months to overcome...accident in December 06, reconstruction finally, Oct of 07......

Sorry to hear that you had a restart...just a warning shot to anyone who thinks that a repaired tendon can be pushed....PATIENCE, everyone!!

Sue

[Ron-on-Exmoor]

Hi John,

A neighbour mentioned that I might be eligible for a blue badge - do you know what the procedure is?

When they told me that I might be able to drive after about 8 weeks I felt as though that I would surely have made sufficient progress by then - but as of today, it's just over 3 weeks till then, and that does seem very optimistic; I'd be interested if other people could tell me how long it was before they were confident enough or able to drive.

  My only real fear is falling - I've watched a lot of the world cup (my wife couldn't really complain!), and I've winced each time a player has fallen over.  However, on a positive note, I ventured out alone for the first time this morning for 10 minutes, around the block on my crutches with a dog.