Ruptured Quadriceps Tendon

[Eboh]

You've really had your patience stretched, TurboCoder, and I do feel sorry for you! 
I'll cross fingers for you on Thursday!
Remember that compared to a life time, a few months or years isn't really that long.   

I'm completely unable to get anywhere on my own - although taxi is an option for appointments at the hospital or physio - hence I'm seriously grateful that my husband takes me out from time to time. Even if he only can make the time for it at weekends, he does understand the need to get out of the house occasionally. After 8-9 years where mine and our life have been seriously limited by my handicaps for long periods of time, I guess I'm lucky that he's still with me. 

BUT, I have good news!
As soon as the cast was removed today, both straight leg rise and bending the knee was easy-peasy! 
Barrjoe: No noticeable stiffness here at all - I'm very surprised!

I've been complaining a lot about the braces I've had earlier, and the technician has actually listened to me: he had ordered in a different type. He dismantled it completely, sawed off some parts and switched others, and I am now the proud owner of an adjustable brace made just for me! It feels comfortable, airy and not too heavy.

The OS didn't even examine the knee and we hardly spoke at all, but there's no doubt that it looks really good for now. I even think I may be able to try to drive pretty soon.

[TurboCoder3000]

You've really had your patience stretched, TurboCoder, and I do feel sorry for you! 
I'll cross fingers for you on Thursday!
Remember that compared to a life time, a few months or years isn't really that long.   

I'm completely unable to get anywhere on my own - although taxi is an option for appointments at the hospital or physio - hence I'm seriously grateful that my husband takes me out from time to time. Even if he only can make the time for it at weekends, he does understand the need to get out of the house occasionally. After 8-9 years where mine and our life have been seriously limited by my handicaps for long periods of time, I guess I'm lucky that he's still with me. 

BUT, I have good news!
As soon as the cast was removed today, both straight leg rise and bending the knee was easy-peasy! 
Barrjoe: No noticeable stiffness here at all - I'm very surprised!

I've been complaining a lot about the braces I've had earlier, and the technician has actually listened to me: he had ordered in a different type. He dismantled it completely, sawed off some parts and switched others, and I am now the proud owner of an adjustable brace made just for me! It feels comfortable, airy and not too heavy.

The OS didn't even examine the knee and we hardly spoke at all, but there's no doubt that it looks really good for now. I even think I may be able to try to drive pretty soon.

That is great news on the bending of your knee and the straight leg raises!!!! Took me a few months to finally do a straight leg raise from a horizontal position. And I just started the bending 2/5.

Great news: as of today: NO MORE FREAKING WOUND CARE!! My wound is fully healed. Four months to the day that I started wound care almost (11/22).

And finally: as of yesterday, I have experienced an 8-degree improvement in the bending of my knee.

It's been a great week all-around! Except for work. My FMLA has run out and I will need to go back. I am in no condition to walk great distances and will likely still be going to work in a brace, using crutches and a wheel chair.

Stupid wound.

Sigh. Oh, well. I can be happy my wound is finally healed and I can take an actual shower. At last!

[Barrjoe]

Got my fears confirmed today. Rt Quad is partially torn. 3rd time in 5 months. Ortho doc was flabbergasted for lack of a better word. We discussed what to do and for now we're going to continue rehab and try to strengthen the remaining attached muscles.  I don't have a clue when I could have torn it again. And I'm not in any pain to speak of. Only thing I can't do is a leg lift and stairs, which I believe is mental as much as physical.

Right now, my emotions are doing a roller coaster between anger and self pity. I cannot do another surgery right now mentally. Especially one that will probably fail. I may wind up going to the Mayo clinic or somewhere else.  Short of some radical surgery that I'm not sure  exists, life is going to be different

[Eboh]

Barrjoe, I'm at a loss of words.   

I hope you don't mind me asking, considering my own issues: Have you been examined for autoimmune or vascular diseases? Diabetes? Do you smoke or use any other nicotine products?

Concerning my own re-rupture, these issues have been brought up:
 
I smoke. (It's a result of "if I can't do anything of what I want to do, I insist on having at least that." I am well aware how problematic it is and that I should be ashamed of it, but I'm rather stubborn about it...)
However, I've also "some kind of not quite defined auto-immune problems" related to my arthritis.
I have relatively severe neuropathy/lack of and weakening of reflexes/impaired sense of touch to both legs (due to my back injury), and some of the medications I've been on for years can also contribute to tendinosis and weakening of the tendons.
AND, due to my phrenicus paresis my O2 sats are chronically low, which may give poor oxygenation to the limbs - although I've never had any symptoms of poor circulation; my feet are always warm, wounds usually heal fast etc. (Pulmonar function and capacity are excellent, so please don't haste to conclusions about my smoking!  )

Hence the poor prognosis after the last surgery: 30-50 % risk of re-rupture.

This is not to complain, just to show that there may be more to a tendon rupture (or re-ruptures ) than trauma from mechanical force.

I feel so terribly sorry for you now!

[Barrjoe]

Guess to answer your question is i smoke a pack every 2-3 days. Been doing that probably for 40 years. Been on a variety of arthritis meds for 5 or so years. Mostly knee pain. Physically before I got hurt I was a very solid 6'1  220 lbs.  Biked, walked, hiked or snowshoed at least an hour a day almost every day. Also have a fairly physical job that I've been doing for 38 years too. Also haven't drank or used rec drugs for over 10  years. I asked the Doc about underlying issues and he laughed but gave the. "Other than smoking....... " spiel.

Been a rough week! Had to put my beloved Boxer down Thurs  morn. She was 13 1/2 so it was her time. Yesterday was the icing on the cake. I suppose I should accept my fate but accepting this in my mind is accepting defeat. I refuse to do that at this time! Don't have a clue what to do next however......

[Chiropractor2001]

Hi barrjoe
Sorry for the news... have they set up an mri to see how much of it you.have re ruptured. It could be only few percentage .. and it won't affect your recovery...
Best of luck... and don't forget that things could be always worse.. you will gain your motion/ mobility and most activities ..

[Eboh]

You gotta be kidding me, Barrjoe. 

This one (wonder if the picture will show?) had to be put down three weeks ago (excactly!) when I came home on a temporary leave from hospital. She was 11 years old.
Freaky that we're both Boxer owners, with all our other similarities. Sorry: were Boxer owners. 
(She was my second and last one.)

Guess I should just sit down quietly and wait for my third rupture...
I'm very sorry for your loss! 

In my experience it's not what happens to you that define what your life will be like, it's the way you react to what happens to you. As I have a tendency towards depression, I can't allow myself to feel sorry for myself - so I've decided to be happy whatever comes my way. Often I succeed, and sometimes I don't and become overwhelmed.
Things will get better, in one way or another.
 

[Barrjoe]

No MRI Chiro. The doc knows it torn as do I.  He asked if I wanted one but what's the point I guess till I know what I'm gonna do.

Beautiful dog Eboh. My Wanda was a brindle too. I also have had 3 other males at various times. But Wanda was in charge and not afraid to let them know it

[TurboCoder3000]

Got my fears confirmed today. Rt Quad is partially torn. 3rd time in 5 months. Ortho doc was flabbergasted for lack of a better word. We discussed what to do and for now we're going to continue rehab and try to strengthen the remaining attached muscles.  I don't have a clue when I could have torn it again. And I'm not in any pain to speak of. Only thing I can't do is a leg lift and stairs, which I believe is mental as much as physical.

Right now, my emotions are doing a roller coaster between anger and self pity. I cannot do another surgery right now mentally. Especially one that will probably fail. I may wind up going to the Mayo clinic or somewhere else.  Short of some radical surgery that I'm not sure  exists, life is going to be different

Geeeeeeze, barrjoe - I am so sorry to hear!!! I feel sorry for you that you have to go through the tear again. I couldn't do another surgery after everything I've been through for the past six months either.

Keep your chin up (so much easier said than done, I know) and keep fighting.

[davkt]

Well managed to crutch hop to the local shop and back today! All of about 500m to get there and back with about 25m elevation difference between shop and home but getting mobile again has to start somewhere.

Had lost the the site since this but found it again so time for an update. Yesterday was 2 calender months since my accident and 8 weeks from the knee surgery. Ended up having surgery to put my ankle back together and hold it in place with a plate and 7 screws 2 weeks after the knee op as the cast they put on then didn't keep the butterfly fragment of the fracture in place. The upshot of that was I've been none weight bearing on my injured leg until yesterday when the 4th cast I've had for this (2 between ops and 2 post ankle op) came off and the ankle surgeon was happy to leave it with no support as he was happy with the healing and felt it would interfere with the knee brace which is more important at this stage. Which also meant I got to wash my trashed leg properly for the first time in two months last night, never had a bath that felt so good before!
The knee brace was first unlocked at 4 weeks to 30º and then another 30º each fornight so yesterday I went from none weight bearing and 60º to partial weight bearing and 90º. Had got pretty good on the crutches, a mile no problem (pb mile time 31min!) and 2 ok with a stop for coffee and cake somewhere between 1 and 1.5! I have been trying to get out for a crutch hop of those sort of distances every day the weather has been OK since the first unlock meant I could keep my foot out of the way with the first unlock
Now I'm having to learn partial weight bearing walking and can certainly feel the big lump of metal in my ankle. My knee is feeling OK and with every release it has gone as far as the brace allows as soon as the unlock has changed.
Now I'm out of the cast and have a reasonable amount of flex the knee rehab can start as can the work to rebuild my rather very atrophied leg! Though I am giving myself regular strict talking to to make I don't try and push things too far too fast
Thanks to work health insurance I'll be going private to a top sports injury clinic (one I have chosen as I know the head knee surgeon) as I've already had a bit of a falling out with the NHS physios who seem to think all they need do for someone my age (52) is get me so I can hobble to the shops on a zimmer frame whereas my intention (which the sports injury clinic says is perfectly possible with hard work) is I will only loose this winter just finishing of skiing/boarding and the coming spring/summer of cycling, running and sailing.

[davkt]

Keep your chin up (so much easier said than done, I know) and keep fighting.

THIS!!!!! I've been talking to various folks, professionals like surgeons, Occ Therapy and Physios, and friends and acquaintances from couch potatoes to a professional athlete who've been injured and they all say having the right attitude is half the battle!

[Barrjoe]

Decided to take matters in my own hands and seek a second opinion. Have had everyone up here telling me that a 3 time quad rupture is unusual, so , after quite a bit of internet research, I found a doctor at the Mayo clinic who specializes in tendon grafts. I wrote him a letter today and I hope he answers. Mayo's is about 400 miles from where I live so while logistically difficult, it's not impossible.

Crossing my fingers and hoping for the best......

[TJA]

I ruptured mine in a trampoline park trying to dunk a basketball (37 years old)

Update for everyone wondering how things progress over time: I will say, I'm a physical therapist assistant, and have never treated anyone with this injury, so it was definitely a learning adventure for me. My PT I went for my treatment had only seen a few. I asked my surgeon and he said they come in spurts. He did 4 quad tendon repairs the same week as mine, but only done 2 since then (4 months ago).

I'm 16 weeks out, my MD released me this week, return in a year. I was locked in extension for 2 weeks, then told to improve ROM 15 degrees every week until full ROM, but kept the brace locked in full extension while walking till about 8 weeks out, unlocked while sitting. I reached full ROM at 12 weeks-ish but still very tight due to swelling. Getting the motion back was very tough, but I did lots of patella mobilizations and tissue massage before and during stretching. Wall slides helped the most, supporting with my other leg and slowly lowering. I started the bike at around 8 weeks, just rocking then full ROM. Once I got around 90-100 and could do full revolutions, my motion came along very quickly. I quit using ice about 12-13 weeks, but it still gets tired and swells a bit.

I came out of the brace at 10 weeks completely and was terrified, especially walking down small inclines and avoided hills. Walking up or down any hills was extremely tough and i didn't really start alternating up/down stairs till 12ish weeks out. I still go slow down stairs, use a rail and I am just now starting to "use" my leg to lower me down rather than just letting it buckle quickly, didn't want lots of eccentric load for a while, but ok to start now.

I started doing light leg press work at the gym, probably around  8-10 weeks, small ROM, still feels very weak when I isolate it and weak in deep bending leg press or squats. I don't do knee extensions, the MD said too much strain and not really functional other than kicking a ball, so no reason. I disagree, try getting in your car and using your R leg to reach the gas/brake pedal without kicking your leg out. For about a month after driving I would have to pick my leg up and move it forward to the pedals, but driving was no issue. Now, I can put it up there no problem.

I started hiking with my brace and hiking pole around 10-12 weeks, hills sucked, but now I can do nearly most hills, except steep downhills and rock hopping now.

The surgeon said it would be mid summer before I could mountain bike, I just started about 3 months before he thought I'd be able to. I rode my bike on a greenway last week, then after seeing it was ok, I went trail riding for the first time for a couple hours the other day, again 16 weeks out, did about 5 miles of mountain biking. Climbing is still a bit weak, no pain. I tried standing up on the bike to climb a steep hill, no dice, I plopped back down to the seat, not strong enough.

They said 6 months on running/jogging. I have tried jogging but I think its still not strong enough to take all my weight with that quick load, I kind of gallop like a horse LOL. I have gone maybe 1/4 mile jog, then it gets achy, so I resume walking. I started plyometrics and step downs this week, small squat jumps and lunges, and working on deep squats from a stool about 12 inches off the ground, still feels weak.

One of the best things I did, though, was get in the pool at my gym once my incision healed, maybe around 6 weeks or so. Walking was very hard, just made sure not to kick my leg against the resistance, but starting with walking, forward, backward, sideways, working on standing on one leg for balance, even did squats in the pool and lunges weeks before being able to on land. I started doing jump squats and running in the pool around 12 weeks, which felt amazing. if you're hesitant, go to PT somewhere where they have aquatic PT.

I asked my MD a few questions, not sure if others have this.  My patella sits approx 1/4 to 1/2 inch lower than my "good" leg and the MD said that's normal due to the patella tendon scarring. Said that if it was enough force to tear the quad tendon, the patella tendon probably had some trauma and scarred down, pulling patella down. I thought, if anything, the patella would sit higher due to the shortened quad, quess i was wrong.

It also seems strange, but when i sit with my knee bent, i can feel the knot of the sutures in the bottom, under the patella in the tendon and at the top, where the quad tendon repair is, it kind of sticks out, kind of like it was reattached a little more forward than where it naturally should be. Seems like where my patella was round, like on my other leg, it kind of got flattened out, a knot at the top and bottom. Hard to explain. I also tore my vastus lateralis, so I have a large knot of scar tissue there, where it basically exploded and couldn't be repaired.

Since the patella sits lower, I have a lot of crepitus, or grinding/shearing in my patella now, especially with stairs. Also, the back of my knee, my hamstring pops all the damn time, doc said maybe a cyst in the joint, but its definitely hamstring, so I need to massage and stretch it more.

I frequently get down, thinking "ill never be able to do XXXX again" or "ill never be normal", but every week I limp a little less, get up stairs easier, have more confidence on hills.  I don't know if I ever will be normal, but I am forever thankful that they were able to repair it and I can at least get outdoors. I remember my first "hike" on the greenway at about 6 weeks out. I started balling my eyes out I was so happy. Its funny the things we take for granted...I hate to hear about you that have had re-ruptures and I'm terrified of that happening. The surgeon says this one is now stronger than the other one due to the sutures in there and that scar tissue is stronger than the tendon tissue, just not pliable. So basically, don't do anything "crazy" but I hear of some of you simply going down stairs and it tearing. I don't know if that fear will ever go away...

Sorry for being wordy, wanted to give you all some hope and info on timelines that are fresh out. Some progress faster, some progress slower, but above all else, do your exercises, get your ROM back and don't overload the tendon too early with strengthening. Let it heal, then you can strengthen it. Good luck

[Barrjoe]

Wish I was your age again TJ! I'm hoping to just  road ride starting next week. Therapist is afraid I'm gonna completely tear it, but my attitude right now is f it. If it tears it tears. My body is screaming for me to get active again after 5 months of doing nothing

[Scott53]

Hi Everyone,

I had right leg quad tendon surgery on Jan 26(full rupture from a fall after cycling), waited 25 days after the injury in order to get my MRI, choose my OS and get my living assistance situation in order. First 8 weeks in an immobilizer brace 24/7, followed by light PT(leg raises, heel slides and flexing). At 10 weeks we are working on the squat sled, biodex balancing machine and some thera bands rapped around my foot, calf and quad to help me relearn to walk normally without a hitch. I am a long distance cyclist who also lifts fairly heavy weights for the upper body. I am finally able to ride the stationary bike at my normal 85-95 rpms but if I add resistance my knee catches fire. I am at about 95 degrees ROM, hoping for 100+ soon. Trying to be patient, as I am sure all of us are. I wish everyone the very best in there recovery.

Scott53