Ruptured Quadriceps Tendon

[D.S.]

David, I hit about 72 ROM today. Surgeon wants 10 degrees a week right now.

Second day on the elliptical. 45 minutes, with less resistance than yesterday, and a slower RPM (35-40). Decided not to use the brace, because the strap that really holds the brace up is the one immediately above the kneecap. So the tendon/quad is being compressed by this strap, and I feel when exercising, that area should be allowed to expand. My elliptical has rails on either side, so I hold onto those, not the moving arms. Again, I can't afford to fall. Without the brace, I noticed the tendon/quad more. Even though I move freely to 65-70 degrees ROM, I could feel a slight pull on each movement of the elliptical that I think was masked by the strap of the brace the day before. Not pain though. But the elliptical doesn't make my knee go past 65 ROM. So it should be okay. I think it is a balanced risk. I am using very little resistance. The entire thigh (quad) feels like it has had a workout, but is not sore. I can't think of a more dynamic way to counter the atrophy and involve all of my leg's muscles/tendons/ligaments without impact. Of course, I can't wait to get on my spin bike. That will tie everything together. I've weight trained for years, using leg sleds etc, but I like the natural muscle building that spinning provides. I never got serious calves until I became a long distance cyclist.

David, it's interesting your trainer has you doing squats to 60 degrees ROM. Just your body weight, I assume.

I thought of a brace over pants, and I'm surprised it is slipping. I am going to parks with my wife and little dog, walking all over and deliberately seeking slight grades to ascend and descend.

I hope everyone is making progress!

[Bearkev]

Well, I am 10 weeks post op and have had my second (of three) Synvisc injections.  Today at therapy I reached 98 degrees.  Very happy to be close to triple digits.  The injections seem to be helping quite a bit.  The pain is much less now than it was prior to starting the injections.  I just wish they didn't use such a big needle.  I have cut down wearing my brace a lot also.  I don't wear it around the house anymore and usually take it off once I get to work.  Knee is feeling stronger every day too.  For those starting out with the physical therapy, don't get discouraged and stay patient.  You will probably reach a point where your ROM is stagnant for a bit.  That won't last forever.  Keep a positive attitude and don't give up.

[D.S.]

Congratulations Bearkev! The injections are to help with your pain, but what kind of pain? Is it pain felt all the time, or pain while trying to increase ROM? Your ROM is excellent. Keep up the good work!

[D.S.]

Well, a week ago I was at 72 degrees ROM, and today I'm at almost 85 degrees of ROM. So progress. I made a mistake the other day. I started stretching on the spin bike (classic Monark). Obviously can't do a full revolution. I just move the pedal as far as 80-85 degrees ROM allows me, getting a gentle stretch. I like it better than heel slides (no friction) because of the bearings. For one second, I went into automatic pilot and started to turn a revolution, forgetting why I was on the bike. Just tuned out for a second. Instantly I hit my limit due to tightness. It all happened so fast. I think I stopped the pedal just in the nick of time and kept from making a revolution. I was clipped in, so couldn't just pull my foot off. Still I think I just stopped the pedal in time. It was all a blur. It was a shock. I felt some pain for 5 minutes when I walked, but at the bottom of my kneecap, rather than at the top where the tendon is newly reattached. Made me fear that I might have done a partial tear? Can anyone tell me, when you get a partial tear, do you know it instantly? Do you feel pain right away? I'm hopeful I did no damage, because for the rest of the day I felt fine, and feel fine today. I see the PT tomorrow. Will get an accurate ROM. Surgeon wants me to permanently remove my brace in 4 days (10 weeks post op). Not sure I want to. Think I want to still wear it in public for a while. Afraid of falling and bending my knee past it's limit (hope to be 90 ROM in 4 days). Hope everyone is well.

edit: (interesting - I just looked at videos of QTR surgery, I thought the patella was drilled just at the top for reattaching the tendon, but it appears the holes go through the top and exit at the bottom - hope the pain I felt near the bottom of the kneecap had nothing to do with the stitching there, or the kneecap itself, or the patellar tendon attachment. Some of my suture thread was absorbable and some was non-absorbable)

[Bearkev]

Congrats on the progress D.S.  13 degree increase in a week is very good.  In regards to feeling pain at the bottom of the kneecap - I've felt that too.  Usually when my therapist is bending me pretty hard.  Once I straighten my leg out I feel the pain at the bottom of the knee cap.  I know where you're coming from though.  I constantly worry about reinjuring it.  Also, about the shots I was getting, they are usually meant to treat arthritis so it helps with the constant pain.  But I think the main reason he wanted me to get them was to lubricate the joint to help with bending.

The good news today at therapy...TRIPLE DIGITS!  101 degrees.  Must have broken through some serious scar tissue though because I heard the loudest pop yet.  Next goal is a full rotation on the bike.  I can get one if I lift my hip up a bit but want one normally.

[amberisma]

Hi folks, sorry for taking so long to check back and reply.  I had my surgery on June 14th, so I am 20 days post-op.  My tendon was 75% torn and my OS said he had never seen anything like my leg before.  Because of the history of my injury he said he is going to treat me as he would treat a patient that completely ruptured their tendon.

As far as my rehab goes...I received a CPM machine 11 days post op and have been using that every day since then.  The first day I used it I could only get it up to 24 degrees.  The next day though, I was able to get to 48 degrees, and since then I was able to increase by 8 degrees a day.  Now I am sitting at the current limit imposed on me by my OS of 90 degrees (most days, except when extra swollen).  I also started PT a week ago and have had two appointments thus far.  The first day I was only able to flex my knee to 40 degrees with gravity, but that increased to 64 degrees at the second appointment (17 days post op).  During that appointment, I also performed my first lying down straight leg raise without my brace.  The only exercises I am doing so far are straight leg raises in four directions:  lying on back, lying on stomach, and lying on each side.  100 of them each way 4 times a day.


As far as how I got injured.  I had a knee scope in December 2008 where another OS performed a lateral release.  13 days post op I fell...and after that it was never the same.  I went from being able to do all my PT exercises to not even being able to extend my leg.  I had to start using my crutches again because I was not able to walk.  I went back to the OS and told him that I fell and that I was not able to do my PT exercises or extend my leg or anything, but he didn't think I did any sort of additional damage to my knee.  I kept following up with him, especially when my muscle never grew back, but he never sent me for an MRI even though I told him something wasn't right. 

It took me four months after I fell to be able to do a leg extension over a fulcrum (a foam roller).  I was in PT for multiple years and was able to get some function back in my leg, but I still fell so many times that I lost count.  My leg always gave out on me.  It got a little bit better recently and I didn't fall as much, but I still had to be careful when walking on wet floors, in gravel parking lots, etc.  Since my OS kept telling me there was nothing wrong, I got myself to start thinking that I just wasn't trying hard enough and doing enough for rehab.  I started back into my usual exercises.  I worked my way back up to running.  It took forever, but I did it.  I ran two half marathons and one full marathon...with a torn QT.  Of course my pace was 2-3 minutes per mile slower than pre-injury.  But even in the two months before my QT repair, running got harder and I had have more rest days in between runs.

It wasn't until I was seeing seeing a sports med doc about another injury (in March 2013) that someone actually acknowledged that something was wrong with my knee.  He saw it and asked why "my muscle was dead" and why there was a huge indent above the lateral portion of my knee.  I told him my history and he sent for an MRI.  After that, I was sent to a new OS and the rest is history.

My OS told me that he couldn't promise perfect results because it had been 4.5 years between injury and surgery, but I still wanted to go through with it.  He thought that he might have to use a cadaver tendon because it was a strong possibility that my tendon was too retracted and fibrotic after so many years without use.  I was lucky though, and my tendon was apparently still usable. 

[D.S.]

Congrats on the progress D.S.  13 degree increase in a week is very good.  In regards to feeling pain at the bottom of the kneecap - I've felt that too.  Usually when my therapist is bending me pretty hard.  Once I straighten my leg out I feel the pain at the bottom of the knee cap.  I know where you're coming from though.  I constantly worry about reinjuring it.  Also, about the shots I was getting, they are usually meant to treat arthritis so it helps with the constant pain.  But I think the main reason he wanted me to get them was to lubricate the joint to help with bending.

The good news today at therapy...TRIPLE DIGITS!  101 degrees.  Must have broken through some serious scar tissue though because I heard the loudest pop yet.  Next goal is a full rotation on the bike.  I can get one if I lift my hip up a bit but want one normally.

Hi Bearkev (and everyone). I've been...well, frequenting another site (epicski) but I am back and sorry I was gone for a while. I was not told I could do this, but I tried my elliptical after 8 weeks (June 24). Felt fine, the ROM required was well within my capabilities (65 ROM or so). My PT was gone that week, but the following week I saw her and told her and she didn't have any objection, other than to avoid striding backwards on the machine (avoid hyperextending the knee). But I'm questioning whether I should continue and worry if it is too aggressive at this point. Other QTR patients have said not to use the elliptical until 4 months and full ROM. Has anyone else done elliptical, and how soon? I examined the movement last night on the elliptical with no resistance and in slow motion, and I felt a twinge (or pain or strain) in my knee near the union of the tendon and patella in an area a few millimetres wide. Never noticed it before. Not sure if it is an injury or just a twinge created by the motion of the elliptical. For the 2 weeks I did elliptical, I felt fine during and after each workout. I didn't notice any strain or pain in the repaired area. So what I felt last night could be from the elliptical, or stretching for ROM. Who knows? I monitored it first thing this morning when I got up and put weight on my knee, not sure if I felt it or something somewhere else in my knee (I have remnants from the past, the odd ache or pain that I have lived with forever). Worst fear is a partial tear, so I'm going to try to see my OS next week. So I'm putting the elliptical on hold. Also, I'm avoiding any leg exercise that has an eccentric phase (or negative). And apparently walking downhill isn't good for the knee at this point.

Today is approximately 10 weeks. I'm concentrating on ROM now, and I'm up to 95 degrees.

Bearkev, I'm so happy to hear how much progress you've made in your ROM. Congratulations!

I wish everyone well!

[D.S.]

amberisma, what a struggle you have been through! How were you able to run? I really admire you. You are doing so well now! Congratulations!

[amberisma]

amberisma, what a struggle you have been through! How were you able to run? I really admire you. You are doing so well now! Congratulations!

Thank you!  I really appreciate it.  Honestly, I have no idea how I was able to run.  My OS has no clue either.  Every time I see him he always says something along the lines of "I have no idea how you were able to be out running about everywhere."  The body is an amazing thing...that's the only thing I can tell myself.  It did take me FOREVER to get back into it though, and my actual "running" pace started out at 4.5 mph, so that's like a 13:20 minute mile.  Before my original injury in 2008 I was running 7:10 minute miles.

A quick update.  I went back to my PT today and told him that I was easily able to do 100 straight leg raises, so he upped me to doing 100 straight leg raises x 4 ways with a 2 lb. ankle weight.  It was a little more work to do those but I still finished them with a lot of energy left.  That had me pretty pumped.

Then he took me back to a different continuous motion-type machine.  It moved my leg constantly, except I was still straight up and my hip did not flex at all while my leg did.  It was almost the exact same positioning as a seated leg curl on a gym machine.  Anyway, my leg dropped to 55 degrees with gravity before it stopped due to tightness in the tendon.  After my leg was strapped into the machine though, I got it up to 75 degrees.  11 degrees in 7 days!  Probably could have gone a bit further too, but we decided to wait.  I go back tomorrow afternoon so he is hoping to get me around 80.  I have another week and a half with this in-home cpm machine so I'm trying to make the best of it.

I am so thankful that I found others going through the same thing that I am.  It really helps reading everyone stories.  I wish everyone the best!  We got this!!

[D.S.]

I'm 100 degrees ROM. PT says I have just a degree or so of "lag".

So I'm aiming for 115 degrees of ROM to be able to do a revolution on my spin bike. I will have to be very careful at that point and go slow and start with no resistance and slowly build up.

When I am at full ROM I will use the elliptical again, I think...

Check out this commentary on ellipticals and tell me what you think:

http://veloreviews.com/blog/2012/06/20/elliptical-machine-friend-or-foe/

I hope everyone is doing okay!

[amberisma]

I'm 100 degrees ROM. PT says I have just a degree or so of "lag".

That is awesome.. congrats!  I am still trying to work on my lag.  It is a very frustrating thing to deal with.

Well, I hit a big milestone today.  27 days post-op and I got to 90 degrees flexion with one of those continuous motion machines.  I didn't start PT until 11 days post-op, so I am really trying to not get myself too excited about the quick progress.  I have a feeling that won't last.

Letting my leg hang over the edge of an exam table with gravity, my knee freely flexed to about 65 degrees.  I am extremely thankful for the CPM machine that my doctor gave me to use at whatever hour of day I please at home.

I hope that being younger, extremely active, and flexible will all play on my side when it comes to trying to heal up this baby.

I hope all is well!

[D.S.]

amberisma, you are doing so well!

[D.S.]

A couple of days ago, my wife and I took the dog and headed off to a forest. The mosquitos kept us moving at a fairly quick pace (just to avoid them). The trail was gentle, and I must say it was the perfect exercise for my knee. Can't say enough about walking. Except for the mosquitos, it was a very relaxing time, getting away from the noise of the city. A little pain at the start (not in the repaired area) and that melted away. I would say we were out for about 90 minutes. It was weird, frogs everywhere, bouncing off our bodies. We will incorporate more walking in our lifestyle, but out of the city, on trails, where there is less impact. Much softer.

[D.S.]

Hooray! for me! I hit 115 degrees of ROM. My PT asked me to slow it down, because last Tuesday, I was only at 100 degrees. I'm making steady progress.

Hope everyone is doing okay!

[Bearkev]

Great progress D.S.!  Congrats!

Update on my progress...saw my doctor on Friday & once again he wasn't happy with my ROM.  I was on my feet a lot that day and the knee was pretty swollen.  I was only bending to about 95 degrees in front of him. He didn't accept it when I told him I was at 104 the day before.  So now he's talking about a possible MUA and possibly even arthroscopically cleaning up the scar tissue.  I see him next a week from Friday.  Flash forward to my first therapy session this week...my therapist thinks my doctor is crazy (and I concur).  Challenge on.  When we measured...109.  5 degree gain.  Went again today and measured in at 114.  Another 5 degree gain.  I have four more therapy sessions before I see my doctor again.  If I can gain 1 to 2 degrees the rest of the way I think I'll change his mind.