Ruptured Quadriceps Tendon

[Barrjoe]

Just got cast off and all I got to say is "does this f###in hurt". No lie, nearly as much as when I hurt it the first time. Had a real good talk with the Surgeon tho, and I told him I honestly think the reason it retore was the ill fitting braces. He said it was entirely possible.

Oh well, pt starts Monday so here we go again.....

[Chiropractor2001]

Best of luck... just start easy...
It sounds great to start pt on Monday.  Long way however before you know it, you are back to regular life..

[TurboCoder3000]

I am two appointments into my physical therapy. Just started week before last week. Latest appointment was Wednesday. I achieved 46 degrees ROM already!! I am elated.

I am doing wound care at the same time as physical therapy, since I am at the last 10% of healing of my wound. It's insane. Monday I improved on wound care from a 1.0cm small tunnel under the skin at 12 o'clock to 0.8cm at 12 o'clock. Then, I have a 0.4cm tunnel at 4 o'clock. Thursday's wound care appointment yielded no improvement. This sucks. My wound has decided to be super stubborn (it's down to a super small hole right now) but it seems to want to do one week with improvement, next week no improvement. Improve. EVERY TIME dammit! Anyway.......

My brace broke 2/05, exactly the day I started physical therapy. It broke at 5:00 am. The top velcro strap became unglued from the plastic structure of the brace. This made tension nonexistent and I was unable to use my brace much at all.

So, I had to get a new brace and finally got to do so this past Wednesday 2/15. The brace guy (poor guy who had to deal with me) wanted to adjust my brace while I was standing but I am so used to my brace I became an emotional wreck as soon as he said he was going to take off my brace while I was standing. Dammit - I can't DO THAT YET!!!! Laying down with full support of my back on the bed, yes. But dammit don't take it off. I was a whimpering emotional idiot at the brace guy's office. I'm sure they'll be talking about me as the "crazy emotional, whimpering idiot who couldn't handle having his brace taken off while standing" for awhile to come yet.

Siiiiiiiiiiiiiigh.

But: I achieved 45 degrees ROM already!!!! Yippeeeeeeeeeee! Some good developments this week at least.

[Roadrider0529]

Hi All,
Very happy to have found this site. Good to know that I'm not alone especially the way I ruptured my left tendon almost 10 years ago. BOWLING!! And after looking through the posts I come find I wasn't alone.  That surgery took about three years before I felt normal. Even after being an avid long distance bike rider. 
Onward to present day and I'm crossing the street here in Boston and car decides to run into me and destroy my right knee. Same injury! So I was taken to hospital ER where they do the X-rays and determine I have ruptured my right quad tendon. Not looking forward to the work I'm going to have to put in to get back active and the bikes. So, accident last Tuesday, surgery last Friday. Dr provided a great prognosis as we got it back together so quickly. In a splint with compression socks to just below the knee on both legs. Very uncomfortable!
So the question I have today is, How long do I have to wear the socks and how long each day?

Great to know your stories, glad to be a part of it.

[Barrjoe]

Oh man, I feel bad for you roadrider. I really didn't get any where near recovered when I re tore mine. Only 7 weeks for me between hurting it the first time and re tearing it in my case.

Walking like Herman Munster right now, but at least I'm walking. Also confined to the first floor of our house. Was going to take a Sauna  yesterday  to get rid of the dead skin from the cast, but saner heads prevailed (aka my wife), since it's in the basement she thought stairs probably weren't a great idea. God I hate it when she's right !!

Like I said earlier, the first few hours post dr.  visit were horrible. Things got better as the day went on tho

Good luck to all my fellow quad tear pals!  You have no idea how much help you been the last 6 weeks. PT starts Monday so  I'll keep everyone posted

[TurboCoder3000]

Hi All,
Very happy to have found this site. Good to know that I'm not alone especially the way I ruptured my left tendon almost 10 years ago. BOWLING!! And after looking through the posts I come find I wasn't alone.  That surgery took about three years before I felt normal. Even after being an avid long distance bike rider. 
Onward to present day and I'm crossing the street here in Boston and car decides to run into me and destroy my right knee. Same injury! So I was taken to hospital ER where they do the X-rays and determine I have ruptured my right quad tendon. Not looking forward to the work I'm going to have to put in to get back active and the bikes. So, accident last Tuesday, surgery last Friday. Dr provided a great prognosis as we got it back together so quickly. In a splint with compression socks to just below the knee on both legs. Very uncomfortable!
So the question I have today is, How long do I have to wear the socks and how long each day?

Great to know your stories, glad to be a part of it.

Another one who ruptured theirs bowling! Finally!!! I thought I was the only one to have suffered such an injury while bowling hahaha.

[Barrjoe]

Question for Roadrider. I'm a semi-serious rider myself. Probably 100 to 150 miles a week on average from May thru October. In fact , put my bike away 2 days before I got hurt the first time (11/6). We're you able to ride fairly quick after your first injury? I hiked and snowshoed as well . Obviously, those are both probably out of the question for this winter. But I'm hoping to be able to bike within a couple months. Do you think that's a reasonable goal?   Thanks

[SE27Eagle]

Greetings, riders of the road - so long since I have been here that I've forgotten the posting widget and don't know whether this will turn up in the right place or not!  But I am just reacting to Barrjoe's question about recovery time for the bike, since between you, Roadrider's two ruptures separated by most of a decade and Barrjoe being keen to get back on the road pretty much sums me up. 

The answer is dependent on usual disclaimers - age, recovery, whether you are a good physiotherapy patient (I score high on trying to move around early but low on exercise discipline) - but I can date the major events.  Second (RQT) injury was in October 2013.  Had come home from Canada in the morning and was a bit woozy coming down the stairs in London that evening as we were getting ready to see Peter Gabriel at the O2.  Actually because this had happened before, and after a prolonged exchange of heated words with the universe, we just rang the venue and asked for a wheelchair space.  For as you know, followers of the tendon rupture thread, once you've torn it, it doesn't really hurt any more, just as it doesn't really work.

Surgery was at the start of November and I think I first went out with my friends very carefully shortly after I had ROM to complete a full pedal movement (perhaps 110 degrees?).  That would have been the first week of March, but it was a good 50km.  I got back up to enough fitness and stamina to do RideLondon 100 in August 2014 (100 mile circuit on the London Olympics road race route with closed roads and truthfully only three real hills).  Incidentally in July we had been to Japan and climbed Mount Fuji, but while the ascent was fine, the descent was grim (7km of volcanic dust on a 10% gradient).   As you'll have found out from all of us, going downhill is a much bigger deal than going uphill because you need the antagonistic pair of the quads to recover as well as the agonist pair. 

I am a bit sketchy on this, but my sense is that the front agonist pair are the ones which you develop first when you get back on the bike.  If you are using cleats or even a cage, you're probably likely to be using a bit more of the other pair as you bring the pedals back up, but it's not going to be the same amount of training.  So my fully worked answer:

- you can cycle when you've got 110 degrees ROM
- you'll build up the front pair pretty fast, despite looking a bit asymmetric for a bit!
- oddly, your issue may be to make sure you supplement your favourite exercise with something which works on the antagonistic set (the downhill two of the four).  Generally accepted that muscle block balance is better generally for preventing injury

In any case, good luck and remember that even if some days are agonisingly slow, the weeks and months actually go pretty fast.

[TurboCoder3000]

Some major milestones hit this week, with three pieces of great news, and one bad news to report:

1. I hit 60 degrees ROM bending my right knee in physical therapy.

2. For the first time since I completely tore my quad tendon August 28th 2016, I was able to stand on one foot with my right leg - without the aid of my left. It has been a hell of a mental block for me to get my left foot to get OFF the ground when walking. When I injured my right knee I fell three times, and that sensation is forever etched in my brain. So, all I want to do when I try and walk with two feet with my crutches is keep my left foot on the ground. Anyway...I was able to hold the position for a good solid minute before putting my left foot back down.

3. For the first time since right before my injury on August 28th, on Monday 2/20 I was able to do leg raises from a full horizontal position. And, I did them five times. On Wednesday 2/22 I did them ten times.

The bad news:  my surgery wound continues to remain at the last 5%, and it has decided to take the stubborn approach, with improvement one week and no improvement the next week. Argh. I still have a 0.4cm tunnel under the skin at 12 o'clock, and a 1.0cm tunnel under the skin at 4 o'clock.

But, alas, I am proud of my improvement with physical therapy. I can't wait to regain my mobility and go back to my normal life.

[Barrjoe]

One week post cast removal here , so here's a quick update.

Started pt Monday , 2/20, and had 3 sessions last week. Went from 65 degrees rom to  85 degrees this week. Can go a little farther, maybe 95, but knee is tight. Most of the constant pain is gone. By that I mean the dull ache that I had  ever since the second surgery on 1/6. Like I said earlier, the day they cut the cast off was very bad. But that got significantly better in 2 to 3 days.

I originally ruptured right quad on 11/4 and had surgery 2 days later. Started pt  late December  and had 5 or 6 sessions. Thought I was doing ok , but re ruptured my quad on 12/30 going up stairs. Anyway, the pt therapist thinks my knee is responding a lot better than the first time. In retrospect, they knew something wasn't right, but couldn't pinpoint it. I guess I had no idea how it was supposed to feel, pain level , ect. This time it feels an lot different. Mostly it feels a lot more stable.

Anyway, I'm optimistic about a good recovery. I hope for a full recovery but I've been warned that might not happen. I also may be going back to work within a week. Also am optimistic about biking by May. So optimistic that I brought both my bikes to the shop yesterday in a snowstorm (I live in Upper Michigan).

Will give an update again next week. Thanks again everyone!

[TurboCoder3000]

Nothing TOO major to report this week:

1. I am finally healing again per wound care. I resumed 2 tablets of vitamin D because I was known for having a vitamin D deficiency when I began surgery. I had scaled back on the vitamin D because I figured I was fine in that regard. Anyway...I resumed 2 tablets per day. Yesterday at wound care my wound has improved at last --the tiny stubborn hole is still there, but the 1.0cm tunnel under the skin at 4 o'clock is now 0.7cm, and the 0.5cm tunnel at 12 o'clock is now 0.2cm. Halle-freaking-lujah!! That cm is the depth, BTW.

2. PT is more of the same this week. Still at 60 degrees ROM, but I have been improving in other metrics. I was only required to do 2 fully straight leg raises, but I was able to do 15 fully straight  leg raises. This is from a horizontal position. I was also able to stand with 100% weight on both legs for 1min 30secs, a 30 second improvement over last week's measurements.

Results are coming slowly but surely. I've been having a hard time keeping up with my at-home bending only because they haven't shown me how to work the brace yet. I was shown how to work the brace today. Now I can finally regularly perform my at-home exercises.

[Eboh]

Hi, I'm a woman and new here, although I've been lurching for the past few months.
As English isn't my mother tongue, I hope you'll excuse misspellings and lack of vocabulary! 

I've suffered from severe back problems since I was a child (spondylolisthesis), and had surgery for that in 2009 with laminectomy and fixation L4-S1. That didn't work for long, and I have a central nerve stimulator which helps a lot with the neuropathic pain in my legs.
After the back surgery I started having breathing problems, and it turned out that my right diaphragm had stopped working due to paresis of the phrenicus nerve. Nobody knows why, but it's not a major problem when I'm up, and a bipap machine helps my 02 sat not falling too low at night.
I also have a sero-negative arthritis and in addition, arthrosis in particularly my finger joints. I'm not an athlete, to put it mildly. 
So...I thought I had enough, really.

I suffered a complete rupture of my right quad 22. October, a week after my 50th birthday. My patella luxated when I fell in a steep slope while walking my dog.
Although I got it "back in place", I was completely unable to get back on my feet afterwards. As I can't have an MRI due to my central nerve stimulator, the injury was written off as "just a patella luxation", and I was sent home from hospital the day after without any restrictions, and without having an ultrasound. The knee was extremely unstable.
The next day I fell again at home when I for a few seconds put full weight on the injured leg (as I'd been told I could do), worse this time.
Long story short: I had surgery 2,5 weeks later for full rupture. Had a donjoy brace after that starting at 30 degrees, full weight bearing from day 1.
Started physio 21 December, and was doing very well until last week, with ROM a little over 100. I had even started working on walking stairs properly - which is a GOOD thing since my house has 6 semi levels and the knee injury has taken a hard toll on my already severely malfunctioning back.

Last Monday (February 27) I had a new complete rupture. It happened when my knee slipped just slightly, and I really can't fathom that this could do so much harm.
I had surgery Thursday March 2.
This time they made two extra sutures through the patella, in addition to the three that were already there. I know there was severe tendinosis in the quad, and guess that's the reason why it has felt so hard and stiff.
I'm in a cast for three weeks. I've been told that the recovery will be even slower this time, that I can't expect full recovery, and that the risk of re-rupture is 30-50% .

It feels rather hopeless, I have to admit. At least I have no pain since the surgery, probably thanks to the cast.
Can somebody please encourage me? 
With such a high risk of re-rupture, I really need to find the motivation to start working hard with rehabilitation again, and I don't know how to find the patience.
I was just starting to feel independent again, not needing help with anything.

Please tell me that someone here have had two complete ruptures and have recovered completely!
Although it may not seem like it from what I've written, I have a predominantly positive outlook on life, which have helped me through a lot. I just need a little help to find back to my usual, optimistic me. 

(I've seen Barrjoe's posts, and will get back and read them properly later. Seems our stories and timing are somewhat similar.)

[John42]

Hi Eboh

WElcome to KneeGuru - my goodness you have sustained a very serious injury with a very long recovery process.

Suggest you look at Ruptured Patella Tendon/Surgery webpage - you will find many answers to your questions.

Where do you live?    Essential that you ask questions - remember PATIENCE is required for this serious injury

JohnK/ Manchester UK

[Eboh]

Thank you for your answer, John42, I live in Norway.

I've done a lot of reading here since November. Searching out the re-ruptures among you, looking for success stories in all the 84 pages is demanding!

I believe all I need is to hear of someone with complete rupture and complete re-rupture, whose quad was in a miserable condition, and who's fully recovered without any fall backs. It might be too much to ask for. 

I certainly would like to hear about the best route towards success, too! I guess patience will be what's needed the most.

I've seen my physiotherapist twice a week since 6 weeks post first surgery. Obviously I've had to pause that for now, but I've made an appointment to see him the day after the cast and stitches are removed
I've been conscientious about excercising between visits, and like I said: I was doing really well.
Since the first surgery in November I've taken vitamin D and zinc tablets - I eat relatively healthy, anyways. Now I've added vitamin E, and would like to add L-arginin as well, those are supposed to have a positive influence on the quality of the tendon.

I forgot to mention I wore a knee-brace up until about Christmas. (Almost 3 weeks 30 degrees, 2 weeks 60 degrees, then 90 degrees, then I weaned off it)
I've understood I'll start a somewhat slower regime when the cast is taken off.

[Barrjoe]

Eboh,
I'm a long way from recovery, but here's an update on my progress so far.  Original tear was  early November. Was in 3 different braces  and crutches until 12/20 when I started PT the first time. I had 3 braces because I never could get one to fit right. Anyway, started PT 12/20  and had 5-6 session until my knee buckled going up stairs the morning of 12/30 , ironically enough on my way to PT.  Had surgery on 1/5 . I guess it was a total re-rupture.

Post surgery timeline is pretty much as follows. Was place in a long leg splint for about 10 days when they took the staples out. Then they put me in a cylinder cast but that became so loose after 5 days that that had to be changed too. The last 5 weeks or so I was in a hip to toe long leg cast , while cumbersome and hard to get around in , was fairly comfortable and I had very little pain with the re tear itself.

Had the cast removed 2/17 and have been going to pt 3 times a week since. By about  10 days post cast, I have almost all my rom back. Maybe only 5 degrees difference between legs. Been riding exercise bike 10 to 15 minutes before pt starts with no problems.  Been working on strength right now and that's been slow. Cannot do a leg lift right now if my life depended on it. Therapist thinks that's because of the amount of scar tissue. I am also deathly afraid of stairs right now. Both times I got hurt were on stairs so that's probably understandable.  Probably as much a mental thing as a physical thing right now.
 
Anyway, good luck Eboh, wish I had more to tell you or had some miraculous words to tell you but I don't right now. I will follow your progress and comment if you wish. My impression of this board is we all kind of learn from each other.