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Author Topic: Ruptured Quadriceps Tendon  (Read 467189 times)

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Offline SE27Eagle

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Re: Ruptured Quadriceps Tendon
« Reply #960 on: January 16, 2014, 09:27:39 AM »
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=10975.0 is the closest I could find, Frank, but since it's on the same site I guess you'll have already found it.  I had heard of Rolfing but so vaguely I would have filed it away with primal screaming and EST.  Truly sorry you're in such a frustrating position.  Does the physio have any other suggestions?
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 vince99frc

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Re: Ruptured Quadriceps Tendon
« Reply #961 on: January 19, 2014, 02:15:23 AM »
Hello everyone I have read through probably 1/4th the post out of this 65 page thread.  I am wondering if I am doing ok.  I ruptured my quad tendon in late June and had surgery July 1st.  I am over 6 months and I still having swelling around my knee.  Things don't look much different from 1.5 months out from surgery till now to be honest.  Now don't get me wrong.  My gait is normal.  My ROM is the same as it was pre-injury.  I still have some quad lag.  My joint is stiff at times and numb on the lateral part of the knee.  As you can tell I am still holding some edema.  I take ibuprofen daily and ice it off and on as needed.  When I was given the ok I was not able to do unilateral leg press of 30lbs, but I am now able to push 170lbs unilaterally on the right and easily able to do 330lbs bilaterally for 10 reps on the leg press.  Leg extensions however is disappointing.  Anything over 40lbs and I am hurting.  I can do 30lbs for 15 reps and 40lbs for 10 reps with discomfort.  I am able to jog with a limp.  I can do 3x25 reps of air squats in 15 to 20 minutes with very little discomfort in my right knee, but if I do more it starts to ache.   I can jump up 2 steps at a time.  My doctor told me my right quad tendon rupture was the worst he has ever repaired.  I am 6 foot 7 inches and I weighed 294lbs when I had the injury.  I am down to 273lbs at the moment and still dropping weight.  I read this injury can take up to a year to feel confident, but I don't think my right knee will look like my left.  My next doctors visit is next month.  I don't want to gripe to the doctor if all of what I am going through is normal.  I would like to have zero quad lag by the time I see the doctor, but for some reason that is something difficult for me to get rid of.  Please share your thoughts.

These picture is the day of my quad tendon rupture





This picture is right after the surgery.



Staples came out



1.5 months post surgery



Today--6 months and 17 days.







Offline Stuart Rulka

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Re: Ruptured Quadriceps Tendon
« Reply #962 on: January 19, 2014, 03:29:07 AM »
Vince. To be honest your experience would seem to mirror my own, and I consider myself to be very fortunate. I think we have to accept that recovery is going to take time and take satisfaction from the things we CAN do. The rest will come!
Stuart Rulka
Complete RQT Aug2 2013
Surgery Aug3 2013
Resumed work Aug6 2013

Offline vince99frc

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Re: Ruptured Quadriceps Tendon
« Reply #963 on: January 19, 2014, 03:57:41 AM »
Thanks Stuart for the words of inspiration.  How old are you?  I am 45 years old. 

Offline Stuart Rulka

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Re: Ruptured Quadriceps Tendon
« Reply #964 on: January 19, 2014, 06:06:12 AM »
Vince. 66 in 4 weeks! Reasonably fit though, and resumed my major activities at six weeks post- op. Still have some swelling and discomfort as you describe. As John likes to say "Patience!" I too was told it would take a year.
Stuart Rulka
Complete RQT Aug2 2013
Surgery Aug3 2013
Resumed work Aug6 2013

Offline vince99frc

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Re: Ruptured Quadriceps Tendon
« Reply #965 on: January 20, 2014, 02:39:45 AM »
20 years difference.  If our lifestyles mirror each other then I am in trouble Stuart.  Before my quad tendon rupture I was working out 4 days a week, participating in tough mudder, chasing my 5 year old, and playing basketball once or twice a month.  I have been seriously working out for the past 25 years.  I went from 185lbs at 6 foot 7 to 295lbs and 7% body fat in a 10 year period.  I maintained that size for the next 5 years and then after that my testosterone started slowly dropping and so did my activity, but I never stopped working out. 

My doctor actually said my downfall was NSAIDs.  Over the years I popped them like candy to fight through my workouts.  I did not know they would also decrease nutrients to your joints over time and make you more prone to injury.  Regardless I will bounce back.  I am just surprised its taking me this long, but I will keep fighting to get my strength back....

Offline SE27Eagle

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Re: Ruptured Quadriceps Tendon
« Reply #966 on: January 20, 2014, 07:54:44 AM »
Welcome Vince and thank you for giving us the best illustrated medical history I've seen on this board.  So as Stuart says, patience is the key.  But where Stuart brings clinical training, balanced judgement and relentless rehab energy, I bring corpulence, free-floating optimism and prior experience of the injury.  49 years old, London England.

In any case Stuart's absolutely right - patience is the key.  But I am much more confident than you are having seen your leg now and read your history.  I ruptured my left quads tendon in 2007 on a ski trip when walking ill-advisedly down a bit of "hill" which turned out to be snow covering a hole and carrying two sets of skis - massive torque on the knee and a sudden crisis which involved being hauled up by my friends and left with a good book and a bin liner full of snow on the basis that you always want to use ice and elevation.  It took a couple of weeks to get to a consultant who said "I'm operating on you tomorrow".

At that point I was about 252lb against my 6'0" and cheerfully unfit (skiing was the only thing I did and that was once a year).  Oddly I remember my instant reaction to the injury, which was (a) %[email protected], (b) this is serious and (c) now you are going to have to sort your life out in terms of weight and fitness.  This was all before I was hauled up.

Anyway, rehab was slow because I had a full leg cast on for 7 weeks - 2 weeks and wound inspection and then a fresh cast for the next 5.  Most of the physio work was - looking back - concentrated on recovering the joint and the leg from the effects of 7 weeks total immobilisation.  Lots of swelling, scar tissue and a long fight to ROM recovery.  I had surgery in April and was just about able to make the family holiday in California in August (driving was fine but walking around San Francisco...).  I skied that winter at Christmas and I can't remember being conscious of the injury after that.

I did start getting back to sport and in particular, cycling.  A few of us started to meet Sundays in the local park which has a great circular track for that and for jogging.  We just went round 7-8 times on the flat and had coffee afterwards.  It took us quite a few months to break out of the park (and touchingly, our first instinct was to cycle to another park and just go round that).  But it got better and we got stronger, and started getting in the way of club runs out of South London into Kent and Surrey on 40-60 mile runs.  Then this year a couple of us got onto RideLondon, which is 100 miles on the Olympic road race route on closed roads, and then all of us did London-Paris for charity, and finally I and a couple of other friends went up Mont Ventoux in early October, which is a Tour de France climb and about 10 miles of 10% gradient.  Unfortunately, and for reasons known only to providence and our fridge, my weight remained exactly the same.  Slightly differently distributed, but the same.

Now in all of this time, my left leg of course got stronger, my gait had long since returned to normal and the scar healed nicely.  The muscle bulk on the two legs was changed by the cycling - heavier cyclists tend to be quite powerful sprinters but struggle climbing.  Very heavy cyclists almost have to weightlift themselves up big hills, so my muscle definition got quite pronounced as did my lung capacity (resting heart rate also fell from low 60s to about 50).  The two legs were identical.  But there has always been a little depression just above the knee.

Imagine my surprise and frank irritation, then, when a couple of weeks after the Mont Ventoux trip I was coming down the stairs at home and misplaced my step on the turn at the bottom and wrenched my right knee.  I was pretty sure I knew what had happened immediately so didn't even bother going to the ER and instead went out to the Peter Gabriel concert I was rushing to get ready for except now in a wheelchair space.  I then went to the doctor, asked for a referral letter, went to a consultant and had my diagnosis confirmed subject to MRI, which duly did that but also revealed a small meniscus tear.

This time it's incomparably faster - put in brace not cast, been a bit more irresponsible about just walking around and trying new things out and had the inspiring example of Stuart and his mountaineering exploits while still in the throes of post-operative morphine to keep me going.  I know how the story will end and it's striking how it's therefore progressing faster (note also - same weight, same 2 week interval between rupture and surgery, same post-op home environment).  However, I am now pretty sure the accident was waiting to happen because of degeneration of the tissue.  There is some talk in the literature about cycling and posture/bike setup but there is also a clear relationship between weight and this injury - it's not a requirement but it's disproportionately common.  So after this long story, three tentative conclusions:

-   you're doing really well and you will continue to improve (though a sports physio will be able to give you forensically accurate drills to lose the last of the lag - it's not solely going to be walked and pressed off)
-   if this can happen once it can happen twice (and in my case thrice - more than once I have had the weirdest feeling that the knee I need to be careful of is the left rather than the right it's protecting), so there is a lifestyle message - I only managed to get it half right last time and just became a fitter fat person
-  we need to understand better what improves/sustains vascularisation of the quads tendon - I have put another cross by NSAIDs after reading your account but still want to find out more about diet

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 #967 on: January 20, 2014, 11:19:04 AM »
Vince, it's your bad luck I went straight off to the physio after writing my first post, so here's a second before you've had a chance to wake up in the morning.  But he and I talked a bit about accommodation - how the body adjusts to a deficit or weakness - as we went through my exercises.  The one that occurs to me now thinking about your lag and the fact that you work out is the difference between the two big muscle groups at the front of the thigh - the vastus medialis and the vastus lateralis.  The VM is the one on the inside and the VL to the outside.  Anyway, the chances are that the tendon rupture damaged the connection with one more than the other and the odds on favourite is the VM.  Because you will have plenty of preserved muscle bulk from all that working out over the years, the difference between the two may actually be a bit bigger than for pure civilians.  So when you're doing straight leg raises, try rotating the angle your foot is pointing at by a little bit - perhaps  to 1-2 o'clock - and see whether that exposes the relative weakness between the two when you raise slowly and evenly.  If it does, then you may want to be practising just at this point of weakness (to give the VM a bit of a wake-up call) before the rest of your exercises.  The VM block of muscle is sometimes referred to as the VMO to include the oblique tissues at the bottom (i.e., more to the inside side of the knee itself), and this lower part of the VM is the hardest/last to recover, but critical for holding the chain together tautly when you raise in extension.  Last time this happened to me I was given a lot of reps squeezing a ball between my knees but the counter-argument is that this isn't a separate muscle but just part of the VM complex, and the trick is therefore more to be working the VM and the VL more evenly, not accommodating subtly to make sure that you can get around, jump up stairs, chase 5 year olds, etc. by getting the VL to do most of the work.

Looking at your photos you can see how the VMO on your left thigh makes a nice curve as you go down into the knee, whereas the inside of your right thigh descending to the knee is pretty straight.  That might just be the precise camera and leg angle, and I am no physio, but in any case lots of other people are and I'd really suggest you find a sports physio to work you over and check out each of the muscle groups in the quadriceps complex.  Its history as an injury is basically middle-aged men who are pushing themselves in sports ("weekend warriors") and guys who play pro (American) football, so perhaps find a practice who look after the local college team?  One thing I have learned from having this twice is that it's horses for courses.  If you want someone to do a good and clean job of stitching you up and putting in place the structure for repair, you need an OS.  If you want someone to pilot you back to normal with your new tendon, you need a PT. 

And now I will be quiet for a bit.

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 vince99frc

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Re: Ruptured Quadriceps Tendon
« Reply #968 on: January 20, 2014, 05:31:17 PM »
SE27Eagle that is some great advice and you are very informative.  I say for sure you have changed my whole perspective on this injury.  I see I am whining about nothing when I am actually right on track with my rehab.  I do want to get rid of this quad lag and it has improved compared to what it was months ago.  I will report back on that test you wanted me to perform later this evening.  I think you are on to something for sure....

Thanks for sharing your experience.  I am really doing ok..  :)

Offline Frank550

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Re: Ruptured Quadriceps Tendon
« Reply #969 on: January 20, 2014, 10:24:51 PM »
Welcome Vince, and heres my 2 pennies worth, having had your op in July, its now what 6 1/2 months, and personally I think you're doing brilliantly well, like others have said already, patience patience patience!

I was told that post op swelling can easily take 6 months sometimes, and longer in some cases. I think if you do your exercises, and then rest, ice and elevate and compress if you can, you should get here nicely.

SE...bloody hell, i thought I was at the start of a thesis there!

As for lil ol me, 45 cold, 65 after work out with my physio nazi last week, and today got to 86 on my CPM machine, but it still doesn't feel any better to be honest. Considering paying to see a private ortho surgeon to get another opinion, not that I dont have faith in my surgeon, just would like a fresh pair of eyes looking at it.
Ruptured (complete) quadriceps tendon 14 April 2013
Surgical repair 19 April 2013
Scar tissue surgically released 17 December 2013

Offline SE27Eagle

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Re: Ruptured Quadriceps Tendon
« Reply #970 on: January 21, 2014, 12:32:22 AM »
The thing is, Frank, I AM actually meant to be writing a thesis - except about hard-living soldiers in the American War of Independence and the hard-living life they returned to in London in the 1780s.  Obviously that's a lot less fun than amateur attempts at biomechanics.  If only I could get this excited about drunken antics in the streets of Georgian London...  ;)

Have you had an MRI either/both in the original treatment or for the revision?

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 vince99frc

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Re: Ruptured Quadriceps Tendon
« Reply #971 on: January 21, 2014, 02:37:15 AM »
Ok SE27 I did several test and yes my VMO is significantly weaker.  I will start hammering more VMO exercises on the opposite exercise days in hopes I can get it stronger.  You are correct my right VMO is significantly smaller.  I just thought it was due to my surgeon not putting things back in the same place.  LOL!!

Offline Stuart Rulka

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Re: Ruptured Quadriceps Tendon
« Reply #972 on: January 21, 2014, 03:46:31 AM »
Vince, don't get too hung up on the age thing!

James, at your age I was so invested in my daughters I did not really have time to exercise as I had when I was younger but at 48 decided I had to make a change. As mentioned I started hiking the Grouse Grind before it became one of "THE" things to do in Vancouver. For the last 18 years I  have done it 4 times a week summer and winter, twice a week after work which at this time of year means in the dark, with a headlamp.
 The trail is said to be equivalent to a 10k run and yes Vince I have maintained this regimen since week 6 of rehab so you may not be in that much trouble!
Stuart Rulka
Complete RQT Aug2 2013
Surgery Aug3 2013
Resumed work Aug6 2013

Offline SE27Eagle

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Re: Ruptured Quadriceps Tendon
« Reply #973 on: January 21, 2014, 09:43:17 AM »
Vince, I'm completely with you on the careless surgeon illusion - I spent a couple of weeks quietly convinced my leg wasn't straight any more (I think the rupture was really from one side for me, so the accommodation/compensation to the other side was particularly pronounced).  Then I realised it was straight enough when I was weight-bearing downwards, but not quite so straight when I was lifting it from the horizontal...  In any case, I really would invest half an hour with a sports physio just to run through compensatory exercises - the ones with specific rehab experience know the back door drills to isolate specific muscle groups.

As for you, Stuart, we just need to get you onto a road bike and an Alp or two.  Your long term training regimen means you're ready to become a vets champion climber.  Why confine that power-weight ratio to walking?   
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 Frank550

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Re: Ruptured Quadriceps Tendon
« Reply #974 on: January 21, 2014, 10:11:31 AM »
No SE I didn't have an MRI, just an initial x-ray when I came through A&E then an ultrasound to confirm the rupture the day before I had surgery.

You guys are making me very jealous with all your talk of striding, galloping, even walking.... it takes me something like 20 seconds after standing up to actually being able to take steps. Something somewhere isn't what it should be methinks!

A thesis on the american war of independence, has such a romantic notion, civil war would be more appropriate! I can imagine the life those soldiers came home to was quite a lot different to the "Help The Heroes" we have today. Which brings me on to another observation. I was watching the old goggle box recently and saw a soldier who had his leg amputated above the knee after an IED went off under his vehicle in Afghanistan. It showed him being fitted with a  prosthetic limb and then about 6 weeks after fitting they showed him walking normally, with no visible limp! Which tells me 2 things, the advancement of biomechanics in the UK and The US is really advanced due to the Afghan situation and secondly that having a limb removed would have been preferable to my recovery!! (For those that don't know me that second observation was a joke).

happy rehabbing people
Ruptured (complete) quadriceps tendon 14 April 2013
Surgical repair 19 April 2013
Scar tissue surgically released 17 December 2013















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