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Author Topic: Ruptured Quadriceps Tendon  (Read 467387 times)

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Offline Stuart Rulka

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Re: Ruptured Quadriceps Tendon
« Reply #870 on: November 19, 2013, 12:30:20 AM »
SE. Forgot to mention I was 10years old at the time. Luck only goes so far!

Fishy - Don't even think of it ! Positive thoughts only! Lol
Stuart Rulka
Complete RQT Aug2 2013
Surgery Aug3 2013
Resumed work Aug6 2013

Offline SE27Eagle

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Re: Ruptured Quadriceps Tendon
« Reply #871 on: November 21, 2013, 09:38:51 PM »
A blow for freedom today - a bath!  This probably breaks a few rules but carefully negotiated entry to it, then ran the bath with leg propped up, in brace, on side.  Some careful placement of shampoo and soap for the largely leant-back bather, but a great relief.  Then emptied it and carefully got up with the remaining leg and used crutches to get out.  Don't try this at home.  At least not if you're going to mention my example to your lawyers or medical team afterwards.
L RQT 2 April 2007
R RQT 22 October 2013
Surgical repair 5 November 2013
First two leg bath 28 November 2013
First standard cycle commute into London 6 March 2014

Offline Stuart Rulka

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Re: Ruptured Quadriceps Tendon
« Reply #872 on: November 21, 2013, 10:39:21 PM »
SE. Hate to sound like a broken record but I had my first shower the day my stitches came out (two weeks ) and my Physio told me to stop wearing the brace whilst at home at 4.weeks. If your dressings are off you should be able to treat yourself to a proper bath. Usual legal disclaimers of course. My Physio shakes his head on hearing how long people are staying immobilized.
  I am personally convinced that as long as the OS's are calling the shots their concern for the success of their procedure overrides  the return to normal for the patient, because you will return to normal eventually. So what if it takes an extre couple of months?
Stuart Rulka
Complete RQT Aug2 2013
Surgery Aug3 2013
Resumed work Aug6 2013

Offline SE27Eagle

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Re: Ruptured Quadriceps Tendon
« Reply #873 on: November 22, 2013, 07:47:34 AM »
I have a copy of your record, Stuart, and am playing it increasingly - I think you've got it right about upside/downside calculations in the conventional protocols.  But in fairness to my OS, he said three weeks was OK for a bath (limit set by the wound) and passive movement is at four weeks rather than six, so he is somewhere in the middle between old practice and new.  The only thing I remember thinking about the last time we discussed this was the extent of the original injury and when I saw him this week he said cheerfully "You completely shredded it".  So the only thing connecting me at the moment is his suturing and some toddler cells forming around it.  I asked about timing and he said "it's a very fine balance between repair and putting enough force through it to stimulate regrowth"

My diagonal reading of the literature echoes what he then said, which is that you need to be pretty careful for the first few weeks simply to lay down some connection, but then have to start work increasing load and strain through the new tissue to make sure it has any tensile strength (the echo being the shift in the healing process between two types of collagen fibre).  So the debate is about a balance between two complementary processes rather than a simple dose-response curve. 

Meanwhile, I look back at 6 and a half years ago wonderingly.  I was in a full leg cast for seven weeks, so the knee much more tightly immobilised (there is always some limited movement in the brace) and so the joint was much more stiff when I started rehab - later, of course.  The cast was very heavy so I didn't really get around very much - but I only had half an aspirin a day.  Whereas this time I am less immobile and got prescribed anticoagulants.  And will get going sooner, of course.
« Last Edit: November 22, 2013, 07:52:39 AM by SE27Eagle »
L RQT 2 April 2007
R RQT 22 October 2013
Surgical repair 5 November 2013
First two leg bath 28 November 2013
First standard cycle commute into London 6 March 2014

Offline SE27Eagle

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Re: Ruptured Quadriceps Tendon
« Reply #874 on: November 22, 2013, 11:56:56 AM »
And here is a randomly culled snippet from the British Medical Journal - piece in 2002 about tendon repair in general.  By implication, this is about self-repair as opposed to the relationship between cells and suturing (see further below in my post):

"The migrated fibroblasts begin to synthesise collagen around day 5. Initially, these collagen fibres are randomly orientated. Tenocytes become the main cell type, and over the next five weeks collagen is continuously synthesised. During the 4th week, a noticeable increase in proliferation of fibroblasts of intrinsic origin, mainly from the endotenon, takes place. These cells take over the main role in the healing process and both synthesise and reabsorb collagen. The newly formed tissue starts to mature, and the collagen fibres are increasingly orientated along the direction of force through the tendon. This phase of repair continues for two months after the initial injury. Final stability is acquired during the remodelling induced by the normal physiological use of the tendon."

Of course, if you haven't got a tendon to repair itself, or there's a great big gap, the situation is a bit different (this from a rather older journal article in Hand Clinics from 1985 (so yes, this is what I found on Google, not the careful perusing of my favourite periodical I can never bear to throw away):

"Somewhere between three and six weeks post-tendon repair, the suture material and technique become secondary to tendon healing as the primary provider of tensile strength to the tendon wound."

So all in all, I can see why there's a range (and this range in particular) of opinions about when to start passive movement and when to start putting force through the new tendon.

You know, this level of sophisticated patient-led insight wasn't my experience last time.  I love what you guys have done to this place.  ;)
L RQT 2 April 2007
R RQT 22 October 2013
Surgical repair 5 November 2013
First two leg bath 28 November 2013
First standard cycle commute into London 6 March 2014

Offline Stuart Rulka

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Re: Ruptured Quadriceps Tendon
« Reply #875 on: November 22, 2013, 05:44:35 PM »
SE. I think one of the significant aspects of your little treatise is that as the fibroblasts synthesize new collagen it starts to be increasingly oriented along the direction of force through the tendon. It follows from this that immobilization at this period would result in a more random orientation of fibres. Once rehab starts these would then not be well positioned to accommodate stress and would have to be reoriented. Slows the process!
Stuart Rulka
Complete RQT Aug2 2013
Surgery Aug3 2013
Resumed work Aug6 2013

Offline SE27Eagle

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Re: Ruptured Quadriceps Tendon
« Reply #876 on: November 22, 2013, 11:07:01 PM »
Stuart - completely agree.  My point in setting out the argument is simply to home in on what the profession is split over, which is when is that tipping point reached between the two types of repair.  Everyone agrees on the deleterious effect of waiting too long - they just disagree on when that is.  And evidently the direction of travel is towards sooner rather than later.  If I had to choose between one of just two options presented by the gods of logic:

(a) Stuart has been treated by irresponsible yahoos who are experimenting on him recklessly by pushing tendon repair to the very limit; and

(b) Stuart's clinical team's approach represents what will increasingly be taken as the norm for post-operative rehab protocols for ruptured knee tendons

then I would have to choose option (b).  However, you can see why the tendency has been to conservatism because the theoretical downside of having to operate a second time greatly outweighs the downside of slightly longer rehab with minimally different results (my left quads tendon has done very well after its ludicrously extended stay in cast in 2007, during which time it presumably amassed enough type 1 collagen to sustain Joan Collins for several years).

In other news: my father-in-law has just delivered his nearly new Nespresso machine.  Life in the cell day room is looking up.




 
L RQT 2 April 2007
R RQT 22 October 2013
Surgical repair 5 November 2013
First two leg bath 28 November 2013
First standard cycle commute into London 6 March 2014

Offline fishy

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Re: Ruptured Quadriceps Tendon
« Reply #877 on: November 24, 2013, 02:50:14 PM »
Fishy here....its Sunday morning, 5 a.m., and my knees told me it was time to get up.  Coffee and this website now occupy my time.  I just love the conversations.... I am now at week 25 and my atrophy is subsiding.  Combinations of PT and just walkin' around have brought me to the conclusion that I just might overcome this "event".  I don't have any brainy insight... I just know that I am tired of the recovery and want to get on with life....but then I remind myself that patience is a virtue that I have cultivated and I need to just stay in the moment.  And it appears that my coffee cup is empty, so I wish all my brothers and sisters taking this journey with me farewell for the time being.  Enjoy the day!
 

Offline SE27Eagle

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Re: Ruptured Quadriceps Tendon
« Reply #878 on: November 27, 2013, 08:04:33 AM »
One theme worth noting is how thoughtful people can be when you're a bird with a broken wing.  I had rehearsal tickets for the opera this afternoon but they were really high - above the tree line and entirely unsuitable for a man carrying a rolled up leg.  I called the box office and explained my dilemma - they came up with three tickets in the stalls circle; one extra for the leg.  So not only has this limb cost some unimaginable amount in medical costs, but it is starting to acquire expensive habits.  Will it be expecting anniversary presents?

Separately I am wondering how you are, Omar.  How has it been?
L RQT 2 April 2007
R RQT 22 October 2013
Surgical repair 5 November 2013
First two leg bath 28 November 2013
First standard cycle commute into London 6 March 2014

Offline mojocpa

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Re: Ruptured Quadriceps Tendon
« Reply #879 on: November 27, 2013, 03:32:48 PM »
I celebrated my 8 week anniversary of the fall yesterday with a PT session. ROM over 140 in both legs and he started me on 3 new exercises. Took a stand-up shower for the first time this morning. We went to a movie on Sunday night and the grocery store for the first time since the incident last night. How do the rest of you handle the crowds? Walking around the store I got paranoid that someone was going to come around the corner and knock me down. The tightness in the knee is going away. I find it easier to go down stairs than to go down the ramps out of buildings. I am very happy with my progress. Thanks for all the help and ideas.

Dave J
Bilateral quadriceps tendon rupture 10/1/13
Surgery 10/2/13

Offline SE27Eagle

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Re: Ruptured Quadriceps Tendon
« Reply #880 on: November 27, 2013, 09:47:56 PM »
Nice work, Dave.  Not sure my ROM was 140 before the fall.  Even more impressed about the shower.  The reason I went for Cresta Run bath entry quite early was and is almost existential terror of the shower - a small slip, the knee forced to close, a ripping sound and the screams of tiny fibroblasts.  But we are at three weeks and one day now, so the next bath will be one without the brace (even if I require it for entrance and exit and will keep the knee weighed down with a life saving training plastic brick, or nearest available equivalent).

I've got to tell you all that a man on crutches feels at home at the Royal Opera House, especially on a rehearsal day.  It's largely an older and less flamboyantly ambulatory crowd.

L RQT 2 April 2007
R RQT 22 October 2013
Surgical repair 5 November 2013
First two leg bath 28 November 2013
First standard cycle commute into London 6 March 2014

Offline mojocpa

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Re: Ruptured Quadriceps Tendon
« Reply #881 on: November 27, 2013, 11:07:05 PM »
I act in plays. When I was forced into early retirement from the last play that just finished up, I figured the least I could do was usher. Was I wrong. The slope of the aisle was impossible to navigate. So my lovely wife ushered in my place.
Bilateral quadriceps tendon rupture 10/1/13
Surgery 10/2/13

Offline Stuart Rulka

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Re: Ruptured Quadriceps Tendon
« Reply #882 on: November 28, 2013, 04:04:57 PM »
Happy Thanksgiving to all our American friends. We do indeed have much to be thankful for ! In my darkest hours immediately post surgery I kept reminding myself that just a couple of generations ago injuries such as our would have meant a lifetime as a cripple. We ,on the other hand can look forward to a complete return to normal, with an improved appreciation of all that means. Let us count our blessings indeed!
Stuart Rulka
Complete RQT Aug2 2013
Surgery Aug3 2013
Resumed work Aug6 2013

Offline santosomar

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    • Quadriceps Tendon Rupture Blog
Re: Ruptured Quadriceps Tendon
« Reply #883 on: November 28, 2013, 11:55:18 PM »
Happy Thanksgiving folks!!!

mojocpa/Dave those are awesome news and great accomplishments. I am not sure that mine before the surgery was at 140 either ;-) (although, I am already 40 years old).

Fishy, 25 weeks is a long time, but hang in there. It sounds that you are doing good, though....

Stuart, thanks for the pointers!!

Well a bit of an update from my side...

Tomorrow will be two weeks after I had my surgery on Nov 15th.

The pain is a lot less now and stopped taking all pain medications. On Monday (Nov 25th), the doctor removed the surgical staples.  The following is a picture of my leg right before the surgical staples were removed.

http://quadtendonrupture.files.wordpress.com/2013/11/leg.jpg

During the first week the pain was very bad (especially during the first 3 days after the surgery). I will say that one of the things that helped the most was the cold therapy machine (Breg polar care cube).

http://www.breg.com/products/cold-therapy/devices/cube-cold-therapy


This is an awesome machine! You only need to fill it with a little bit of water and tons of ice. As I mentioned in earlier, I do a bit of home automation using INSTEON technology for my lights, garage door, and other things around the house. I connected the Polar Cube to an appliance INSTEON switch and created a script to turn it on every 30 minutes. Currently, I just use it for a couple of hours each day (30 minute intervals).

I am still using a brace fully extended (at 0 degrees). To be more precise a Breg T-Scope Premier Post-Op brace. This is the brace: http://www.youtube.com/watch?v=wtQAV3StDvg

Today itís Thanksgiving here in the United States. So Happy Thanksgiving again to all that celebrate it! Thanks to my wife, I was able to enjoy an awesome meal with my kids. However, it was very frustrating when I was not able to help at all around the house. I cannot wait until this torture is over.

I start physical therapy tomorrow. The doctor gave me some exercises to do in the mean time.  The first exercise is to tighten the quadriceps muscles (op of the thighs) by pushing the knee down into surface and holding for 5 seconds. Each set 10 repetitions and 2-3 sessions per day. That I can do, but I can tell you that I am extremely weak and do not feel much strength on my quads.


The other exercises are to lift my leg (with my brace on, of course). However, I cannot lift it at all. This may be normal, but I am a bit concerned. I guess that I will get some answers from the physical therapist tomorrow.

Were you experiencing the same at week 2 or were you able to lift your leg? This is what the doctor instructed me to do:
http://quadtendonrupture.files.wordpress.com/2013/11/e2.png


But I cannot lift it even a mm. :-(

Letís see how the physical therapy goes tomorrow.
Quad tendon rupture accident - Nov 7, 2013
Surgery - Nov 15, 2013
First Physical Therapy Session - Nov 29

Offline Stuart Rulka

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Re: Ruptured Quadriceps Tendon
« Reply #884 on: November 29, 2013, 02:16:37 AM »
Omar. Keep positive, it will improve. A variation of your quad exercise I did was standing against a wall with a (quite soft) 6 inch ball behind my knee an using my quads to push it into the wall. At 2 weeks I still relied on my sling so hang in there. Your polar care cube sounds like the "game ready " machine my PT uses after every session. At home I use a zip lock bag filled with ice frozen round a ( vodka ) bottle in the freezer. Works well, and keeps the vodka cold!
Stuart Rulka
Complete RQT Aug2 2013
Surgery Aug3 2013
Resumed work Aug6 2013