Ruptured Quadriceps Tendon

[Stuart Rulka]

Welcome back SE27Eagle. If you haven't caught up with previous posts my PT had me on a bike to test my ROM at 21/2 weeks. Even if I am outside the norm I wouldn't sweat a little movement inside your brace. Listen to your body but don't be afraid to try things.
   Good luck!

[SE27Eagle]

Thanks John and Stuart

So - London, England in answer to your question, John, and intrigued to see you were being encouraged to flex the knee so much after two and a half weeks, Stuart.  I was given a non-negotiable look in the eye by my surgeon and told "you're keeping this straight for four weeks!".  But apparently the plan is to set the brace to 45 degrees at four weeks, which is significantly more exciting than 10-15 degrees after seven weeks last time.  Just had date for follow-up appointment in clinic to check wound and healing for a week today, so all on schedule. 

Things I now recognise/remember which I had forgotten for six and a half years:

- negligent attitude towards crutches for short journeys on the same level of the house
- odd tingling sensation from the knee (fondly imagined to be distinct moments of healing)
- nightly dreams about walking, cycling and running, sometimes with brace/cast and sometimes without
- the usefulness of the humble bathroom flannel
- full nights of sleep (you really do get bored enough to go to bed on time)
- reduced calorific consumption (can't get to the fridge so easily)

[Stuart Rulka]

SE27. There seems to be different attitudes in the UK and Canada. Here our PTs are viewed as
Healthcare Professionals in their own right. The Surgeon looks after the repair and then the Physiotherapist supervises the recovery. My OS told me to refrain from hiking for a year,which to me was completely unrealistic! I was more than willing to trust my PT, who,as I have stated elsewhere,was Chief Therapist for our Vancouver Olympics (Marc Rizzardo - the joys of Google). He had me cycling at 3 weeks and hiking at 6. He habitually works with Athletes, whose livelihoods are on the line, and given North America's propensity for litigation he can't afford to screw up!

[fishy]

Greetings, comrades.  I find myself in a bit of a Groundhog Day moment since I had this injury on the left side six and a half years ago, and then a couple of weeks ago managed to rupture the right.  I well remember this site as a source of great comfort, and in an odd way it's good to be back.  In another way it isn't - after that first injury I thought "That's it - you really need to sort your life out" and started doing more sport.  That was a slow but steady process, but five weeks ago I managed to cycle up Mont Ventoux, easily outpacing every other 110kg cyclist on the mountain that day (I draw this conclusion from not seeing anyone else that big, thus suggesting they'd all been left for dust in Bedoin or didn't in fact exist).  Anyway, here we are again after a completely freak accident on the stairs at home. 

So while of course I am here for tea and sympathy, I am definitely also here to tell anyone else arriving in the ruptured quadriceps tendon thread in the coming weeks and months that you really do get better.  Fully better.  And that you've timed your injury brilliantly, because you're more likely to be in a brace locked to 0 degrees nowadays than the full length cast I was in for seven weeks last time.

One question for people with more recent experience - is the fantasy that the tiny movement of which you are capable within the brace/cast is somehow disturbing the repair a common one?  I don't remember it from last time, but then I think I was more complacent generally back then.  And of course found it implausible there was much movement because there was this huge plaster cast on...


Fishy here:Welcome back to the club....sorry your good leg is now your "bad"....but at least you know what to expect.  I saved all the time of wondering if I would rupture my "other" leg by getting it right the first time...ie, I am a double, left was a full RPT/right torn ligament.  Both legs were in braces for 9 weeks, wobbly walking let alone trying to run.  I felt like someone loaned me their used legs....I was a dedicated runner for twenty five years (amateur, not professional).  I am at week 23 now and I can stand without using assistance, running is not out of the question but my legs tell me "no" for now, pain levels are very low, and I know it will be another 6 months or there abouts until I have most of my recovery...my PT doc says to expect 80% recovery of quad (I lost 4 inches/10 cm in diameter both legs wearing the braces).  At 66 yo I will accept the prognosis but bet my ass that I will beat the 80%.
  Not to worry about rupturing your repaired tendon, just don't try major movements without approval of OS.  PATIENCE is our montra.....so patiently exercise but ask many questions, and if you don't like the answers look to other sources. 
  Welcome back to the club, and keep reading these posts and post a few of your own.  We need your support as much as you need our!

[SE27Eagle]

You're going to beat the 80%, Fishy.  That kind of estimate sounds more like an observation of the behaviour of most people the surgeon's seen and not the long term dose-response to exercise (I went on to do a lot of cycling after the first one and both legs were bigger and more powerful just a few weeks ago).

On the PT point, very interested to read your observations, Stuart - I'd certainly say the PT is the key recovery professional, but on my massive sample of two, it appears to me that that surgeon gets a highly levered point of influence in that first instruction about immobilization.  Of course he or she is the only person who has actually seen the damage and the repair up close, so presumably there is some individual variance based on healing time estimates.  But if I were a betting man, I'd say most of this is custom and practice - in the same way that my first surgeon (eminent but near retirement, and thus of a previous generation) was adamant about six weeks in full cast, and was also rather sniffy when I asked about anti-coagulants and said half an aspirin a day would be fine (needless to say, this time I limped out of the hospital with a bag of needles pre-loaded with Clexane).

Then further on the PT point, I am also very lucky - we live close to the National Sports Centre here in South London so our first resort for PT is in fact the sports injury clinic which has set up there.  They are outstanding and they do seem to understand biomechanics and tissue performance very, very well.  Still, I have fond memories of my first PT, a traditional practitioner, who said shrewdly (and in my case presciently) "People go on about skiing but in my experience, the most dangerous things are baths and stairs."

[Stuart Rulka]

SE27. Think you hit the nail on the head when you said "custom and practice"! This feels to me like the old American Heart Association protocols on pre-medicating patients for a wide variety of issues. Nobody wanted to stick their neck out and be the first to say "No!". This led to widespread overuse of antibiotics, which has now thankfully changed. Going to try to contact my OS and press him for some answers on this.

[SellaVee]

SE27Eagle, I agree with the points you and Stuart have made about surgeons and physiotherapists.  When he gave permission for me to lose the brace and crutches my surgeon told me my leg was stiff because I'd been in the brace too long!  That was his decision.  I took his word as law.  With the information I had then I was very cautious but I'm now drawn to a more 'assertive' approach.  Are you going to the National Sports Centre as a private or an NHS patient?

My consultant discharged me weeks ago.  He wasn't really interested in my rehabilitation.  Going to physiotherapy and doing exercises at home, these are the things that are helping me to progress.  I'm very much being guided by the physiotherapist.

fishy, I'm sure you're going to do better than the norm.  I think some people, certainly in the UK, do very little outside the physiotherapy sessions.  Some folk can't be bothered to exercise and so don't make as good a recovery as they might have done.

Is it just me, or does anyone else think that the mood on the forum is turning towards a more pro active approach to rehabilitation?

[Stuart Rulka]

Sella. My position on this is pretty obvious, but until I can get more particulars on my own surgery I hesitate to recommend my approach to others. My surgery was done on an Emergency basis out of town and my OS's receptionist will not give out his e-mail address. I have given her mine and asked her to have him contact me but he may have other priorities. I do intend to pursue the topic of Protocols with my own PT.

[mojocpa]

I hit the 6 week mark yesterday with another PT session. ROM 120 in left and 116 in right. PT increased my exercises and reps. Feeling good about the progress and that my quads are coming back. I really hate to be a burden on my wife but if this would have happened 15 years ago the standard operating procedure would have been dual casts for 6-7 weeks. That would have been pure hell. I feel keeping a positive attitude and doing everything the doctor and PT tell you to do has benefited my recovery.

[santosomar]

I am very glad that I found this forum and specifically this thread. I am a 40 year old male that fell on a slippery wet hotel floor last week after delivering a presentation at a conference in Cancun. Go figure, the least expected place I would have guessed to have an accident. :-( After, I came back home (Raleigh, NC), I went to the doctor and they have confirmed that I have ruptured my quadriceps tendon and will have surgery this Friday.

To be honest, I am a bit scared. I have never gone through any surgery and this one does not seem to be an easy one. I do not have any health problems, but I am a bit overweight.

I really enjoyed reading the previous posts and experiences. Hopefully, everything goes well on Friday. I will keep you folks posted. Thanks in advance for any guidance before and after surgery.

Thanks again!

[John42]

Hi and welcome to Santosomar

You have found the best website for persons who have RQT/RPT injuries.   You have done well to read previous posts on this thread and will prepare you for your operation on Friday.

Rehab is a long process, so you will have to get used to the idea.

May I suggest that you click onto the undermentioned thread, as this contains quite a number of useful documents which I have put together with KneeGuru.  They will describe your injury and the rehab procedure.  We hope to hear how you get on after Fridays operation.

Take care

JohnK/ Manchester UK
https://www.facebook.com/QuadricepsPatellarTendonRupture

[cfernandez]

This has been a very usefull site.  I ruptured my quad back in August, and had surgery in Sept 4th.  Yesterday I was able to reach 75% passive.  And it feels great!

I do have a question, does your foot supposed to get so swollen?  Mines gets huge though the day.  I am still using scrutches but was given the green light yesterday to put 100% weight on it.

[santosomar]

Thank you John42!!
I just liked and joined the conversation in Facebook, as you suggested. Thanks for putting this together!

Tons of great information!!!

[santosomar]

Quick question. What is the most common anesthesia applied during surgery and what type were you administered?

[Stuart Rulka]

Hi santosomar. I was offered the choice of a spinal block or General anaesthetic and chose the latter!
Cfernandez. I don't like the sound of  your foot being constantly swollen.have it checked by your Physician!