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Author Topic: Ruptured Quadriceps Tendon  (Read 467385 times)

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Offline SE27Eagle

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Re: Ruptured Quadriceps Tendon
« Reply #1050 on: March 24, 2014, 11:05:36 AM »
Went for my PT appointment today to discover that's kind of it - signed off from there with some last eccentric exercises to get the whole quads set working more and not just relying on the lateral (in other words, our old and missing friend, the VMO, needs to do more of its bit as well).  Current and future readers of this thread in the South London area - contact me for details of one of the nicest professionals I've ever had the pleasure to work with. 

Yesterday's Sunday morning cycle was a thoughtfully hill-free 48km outing to Richmond Park and from there to Hampton Court (home of an excellent cafe for the thirsty and hungry cyclist), and then back through Wimbledon via an implausibly quick route.  Still walked like a cowboy for a couple of hours afterwards, though.
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 #1051 on: March 28, 2014, 03:42:48 PM »
Apologies for a lack of posting updates, but have been a tad otherwise occupied!

Yesterday I managed to get into the front drivers seat and drive to the local shops and back, no ill effects or discomfort - 347 days of waiting! It felt so good, but thank god for automatic transmission, I would have struggled with a manual gearbox and clutch!

Im still around the 90 degree or so mark, but what a landmark number that 90 is, it certainly allows more freedom... roll on 100!!

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

Offline John42

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Re: Ruptured Quadriceps Tendon
« Reply #1052 on: March 28, 2014, 04:24:14 PM »
Hi Frank

Have you placed the drivers seat as far back as it will  go?

I also changed to an automatic - thank goodness - made life a lot easier

JohnK/ Manchester UK 
Ruptured Patella Tendon January 9 2003
Slipped on black ice.  Manchester UK

Complete Ruptured Tendon

Offline Frank550

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Re: Ruptured Quadriceps Tendon
« Reply #1053 on: March 31, 2014, 02:52:20 PM »
Absolutely John, I need to anyway as Im quite tall, things would be a lot easier without the protruding belly though!!!!
Ruptured (complete) quadriceps tendon 14 April 2013
Surgical repair 19 April 2013
Scar tissue surgically released 17 December 2013

Offline John42

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Re: Ruptured Quadriceps Tendon
« Reply #1054 on: March 31, 2014, 04:18:11 PM »
Hi Frank

No suggestions to reduce a protruding belly - unless you go on a drastic diet!!!!!!
Ruptured Patella Tendon January 9 2003
Slipped on black ice.  Manchester UK

Complete Ruptured Tendon

Offline Frank550

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Re: Ruptured Quadriceps Tendon
« Reply #1055 on: March 31, 2014, 04:29:18 PM »
Steady on John....thats a nasty word...drastic!!!
Ruptured (complete) quadriceps tendon 14 April 2013
Surgical repair 19 April 2013
Scar tissue surgically released 17 December 2013

Offline Stuart Rulka

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Re: Ruptured Quadriceps Tendon
« Reply #1056 on: March 31, 2014, 05:17:49 PM »
Frank. Diet  on it's own is bad enough!
Have to celebrate your upcoming Anniversary .
Stuart Rulka
Complete RQT Aug2 2013
Surgery Aug3 2013
Resumed work Aug6 2013

Offline mojocpa

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Re: Ruptured Quadriceps Tendon
« Reply #1057 on: April 01, 2014, 03:38:18 PM »
6 months ago today I did the double trying to fly down stairs. Stairs are getting better, I still have problem when I have something in my hands, though. I am not conscious of my knees as much with every step I take as it was previous. I  hardly have any of the buckling feeling when walking now. Things are going much better than what I or the surgeon thought at the beginning. Thanks all for your advice and support. Dave J
Bilateral quadriceps tendon rupture 10/1/13
Surgery 10/2/13

Offline SE27Eagle

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Re: Ruptured Quadriceps Tendon
« Reply #1058 on: April 02, 2014, 04:36:22 PM »
Great stuff, Dave.  Stairs are the acid test throughout recovery.  I am at the same point post-op as I was seven years ago when I was on a family holiday in San Francisco.  It's one thing to read about the stairs up and down Telegraph Hill and another to find yourself navigating them.  So imagine my surprise to realise that Edinburgh, where we are at the moment, can rival it...

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 #1059 on: April 02, 2014, 09:24:36 PM »
Good exercise for your Quads James!
Today marks 8 months since my accident. Yesterday evening I took my son in  law ( a marathoner, visiting from England ) up the Grind. Naturally he had to push  the "Old Man", and I must confess to still feeling some discomfort pushing off  my right, injured, leg. There is still some swelling but as so many have said : " one must count one's blessings!"
 Keep up the Good Fight everyone.
« Last Edit: April 02, 2014, 10:55:34 PM by Stuart Rulka, Reason: Poor math »
Stuart Rulka
Complete RQT Aug2 2013
Surgery Aug3 2013
Resumed work Aug6 2013

Offline melynnm

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Re: Ruptured Quadriceps Tendon
« Reply #1060 on: April 06, 2014, 02:25:59 AM »
Hello everyone. Looking for some input from all the RQT members....here's my story. I'm a 46 yr old, non very active female who had a RQT repair on 1/10/14.  Started PT on 3/14 per my OS. Started with 45degrees ROM, RIGHT NOW IM AT 73 assisted & 64 unassisted.   How's my delium....had follow-up appt the other day with my OS, able to take off brace except when out & about. He said its healing well, he alo asked what exercises where being done at PT.  He was not happy when I told him PT does assist with some ROM exercises. OS stated he does not want PT forcing any bending or ROM because it could re-ruptue tendon at this time.  OS wants gentle ROM & strengthening at this point.  Now I'm confused i thought is was more important to achieve ROM at this point.  Wondering your thoughts on the matter.  Thanks so much.

Offline Stuart Rulka

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Re: Ruptured Quadriceps Tendon
« Reply #1061 on: April 06, 2014, 03:37:00 AM »
Melynnm.  There is a general acceptance of the view that because OSs are experts in surgery they are also experts in rehabilitation.  I may be alone in taking the view that they are SURGEONS and probably have little experience with rehab. I placed my trust in a proven PT and people express surprise at how rapidly I progressed. Having the word Doctor in front of your name does not make you an expert in all fields. Let the professional in rehabilitation do his/her thing.
 I realise I am not being politically correct and may be offending some people but for 6 months now  I have been reading posts of people who have suffered because of an adherence to antiquated rehab protocols. My own surgeon admitted , after the fact, that rehab protocols have not kept pace with modern techniques and materials.
 One of the purposes of this forum should be to stimulate discussion!
Stuart Rulka
Complete RQT Aug2 2013
Surgery Aug3 2013
Resumed work Aug6 2013

Offline SE27Eagle

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Re: Ruptured Quadriceps Tendon
« Reply #1062 on: April 09, 2014, 04:53:44 PM »
Hi Melynnm - welcome to our world of flexion and extension!

As is invariably the case, I agree with Stuart.  But I also have an additional if vanishingly small source of authority in this matter and that is being my own control group - I had the injury on my left side 7 years ago and the right side late last year.  This time the rehab has been much quicker and in any case, I was in a brace this time (which allowed a little movement from the get go) rather than having 7 weeks in a full leg cast.  So I can confirm the virtuous circle of a faster approach.  I got to 143 degrees ROM in about 3 months this time, which I think is about 5-6 weeks ahead of where I was in 2007.  Not that ROM is so important on its own - if you don't have the strength to use it, you're still walking down the stairs one at a time for a long time to come.

Here is my current mental model of what goes on with a RQT repair:

Rule 1 - from everything I have seen it takes a good 12 weeks for the tendon fully to repair.  That's cell repair process, not a matter of attitude, moral superiority or diet.  If you fall unprotected during this period, you are relatively likely to re-rupture the tendon.  Similarly, you shouldn't put full force through the tendon until the end of this period (certainly not descending stairs normally with the injured leg, which involves full eccentric force going through the quads and thus the tendon).  That's conventionally why PT usually starts with passive movement (the PT massages the swelling and helps you gently increase the ROM while you are lying down, but you don't do exercises on stairs, or even wall slides).  What you are describing with the PT sounds like passive, not active, work.  In any case, they are not yanking it to get those few extra degrees - they are easing it out.  And that is what happens throughout the rehab period with ROM anyway.

Rule 2 - during the period of healing, you are laying down new fibres in the tendon.  Some of these fibroblasts are aligned (top to bottom like a closely packed bag of fresh spaghetti) and some of them are all over the place (imagine a bag of fresh spaghetti that's fallen randomly onto the counter top).  The more they are aligned, crudely speaking, the greater the tensile strength, the better the glide and the faster the eventual return of your full range of movement.  If you are completely immobile until the end of that period, the more they are likely to be all over the place - lots of tissue, therefore, but less strength and glide.  So moving frequently but gently really is good after the first 4-5 weeks, not just to generate ROM but actively to influence the composition of the tendon and to accelerate it returning to being like the full bag of fresh pasta.

Rule 3 - the longer the period of inactivity, the greater the atrophy of the quadriceps muscles and their neighbours.  That will limit your functional capacity but also the protection that the leg itself provides to the healing/vulnerable knee (the reason your knee doesn't collapse all the time is the strength of the musculature above and around it).

My general observation is that surgeons are very conscious of Rule 1, but only tacitly aware of Rules 2 and 3.  And the net effect of this is that the rehab protocols have lent always to being too conservative, for the entirely laudable objective of preventing re-rupture.  But from what I can see, the baseline frequency of re-rupture post-surgery is pretty low, whereas the frequency of delayed or problematic rehab is relatively high.

Net net, your PT has seen the injury before and is every bit as motivated as the OS that you don't traumatise your new tendon.  Plus you are coming up to the end of the main healing period, so the danger of re-rupture is declining rapidly.  Even so, my only pushback is about wearing the brace - if your ROM is only at 60-80 degrees, I would still be keeping it on most of the time.   My OS is young and progressive and has encouraged me to go for it generally - his one area of caution was about coming off the brace too early.  Having said that, the day he said I could start weaning off, I took it off and didn't put it back on again...



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 SellaVee

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Re: Ruptured Quadriceps Tendon
« Reply #1063 on: April 10, 2014, 05:27:35 PM »
Hi melynnm and welcome.  I'm also a not very active female and I suffered a ruptured patellar tendon when I fell over last year.

I think SE27Eagle has given an excellent summary of the rehab situation.  It's important to keep your knee moving, but in the first 12 weeks you don't want to be forcing it or risking falling over.

It's 9 months since my surgery and when I'm stretching out after exercising I can stand on one leg and touch my bottom with my heel when I reach behind and grab my toes and that's been the case for a while.  Initially though my ROM came back very slowly but I never forced it.  I used to sit on a chair with my foot on a skateboard and use my other foot to move the board back and forwards so that my knee was bent.  In bed I'd lie on my back and put a silky nightgown under my foot to make knee slides easier.  You can also sit on a Swiss ball and move back and forwards gently increasing the bend in your knee - that's great for posture too and you can do it while watching TV.  Later I progressed to a floor pedaller and now I regularly use an exercise bike.

Provided you keep moving, and walking is good, the ROM will come back.  The big thing for me has been strengthening my quads.  I had to wait 31/2 weeks for surgery and suffered terribly from muscle atrophy.  If I don't keep exercising my quads the weakness comes back.  So I do squats and lunges and wall slides and funny things with Therabands.  I also do Pilates for core strength (which I did do before) and stationary biking.

On the plus side I'm sure all this is doing wonders for my heart and I know my blood pressure and lung capacity have both improved.  Keep smiling and think positive.

Sella
Ruptured patellar tendon (avulsion fracture) 11 June 2013
Surgical repair with wire 5 July 2013
Wire removed 28 January 2015

Offline Juny

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Re: Ruptured Quadriceps Tendon
« Reply #1064 on: April 15, 2014, 06:34:18 AM »
Hello to everyone unfortunate to be in this club.

I'm the newest recruit for QTR. March 17th while at the park in sunny Florida with the family my 8 year old daughter wanted to race me and against my better judgment I said ok. Not even 10 yards into the race I felt a small pop in my left leg followed by a large pop in my right leg and down I went like a sack of potatoes full of pain. (Sadly, I wasn't even going to win the race.) 17 days later surgery for QTR in my right leg. My OS got me a hinged brace locked at 0 degrees. I'm post op now 10 days and just had the 27 staples removed from today. He gave me what I thought was good news that in another 2 weeks they would start to give me some ROM from 0 degrees. I thought that meant PT but now I think that's not the case since when I asked him what my ROM at surgery was and he said the sutures ripped when he tested them in the OR. I guess he's going to take a somewhat conservative approach.

Anyway this is where I'm at now on crutches with the hinged brace at 0 degrees. I have some pain mainly to the inside of the knee left of the incision and am starting to get some hip pain the only thing I take is Tylenol. I have to say I really appreciate all the information that I've been getting from all of you who have blazed this unfortunate trail. I can't believe how long this thread has been going. It's great to be able to get inspiration from you all. This injury can be downright depressing like many of you I've always been a very active 46 year old particularly in the last year where I've been doing a lot of weight training and martial arts. In July 2012 I had rotator cuff and biceps tendon repair and I thought that was bad but this is way worse.

I look forward to learning more from all of you and I already figured out that it is best to look ahead a week at a time. So far though I've learned from you all that I need to load up with tons of patience especially during the nights which suck. I tried the pillow between my legs last night but I found that it's a little tough getting the leg into position and I was a little worried of the added weight of my good leg on the bad leg. Another thing does anyone know what ROM is needed to able to drive also is there really that much strength lost in the quad that even though you have the ROM you may not have the strength just to press down on the brake and gas? Sorry for the long post. I wish everyone a re rupture free and speedy recovery.

VIC















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