Middle of Patellar Tendon Tear

[TPQ_RI]

From the US.  Suffered a jagged tear in the middle of the tendon rather than either at the top or bottom.  Surgery occurred 5 days later.  Post-op the surgeon indicated that this type of tear is more serious and occurs in only 5% of injuries.  I am anticipating that rehab will be longer and more difficult.  Anyone with any stories to share on this type of injury?  Any and all feedback welcome.

[TPQ_RI]

Post Op + 10 day update:  saw the surgeon for a follow-up appointment.  Everything is in a "so far, so good" mode.  He suggested some ways in which to manipulate the injured knee to inhibit scar tissue development and recommended "walking" with with crutches in a manner that splits the weight distribution equally between the injured leg and the crutch.  Back to see him at Post Op + 1 month.  If things progress along by that point we may (hopefully) commence ROM PT then.  Glad to be through the first week post op which was very challenging (initially phyiscally, then psychologically).  Will provide periodic updates.  Hope they are helpful to those who may read them.

[TPQ_RI]

Post Op + 1 Month Update:  Second follow-up appointment with the surgeon was today.  Good riddance to the steri strips covering the incision.  X-rays reveal that the knee cap remains where it should be - that is good.  I was cleared to start physical therapy, which will begin in 3 days.  Rebuilding range of motion in the knee seems to be key.  Given more home exercises to slowy but surely bend the knee.  Surgeon wants me to keep the brace in a locked position while up and about, but to start walking without the crutches.  That will be interesting (I will probably look like a pirate).  Regarding whether or not the surgery  "took":  we will know if it hasn't because it will re-reputure.  God willing, that will  not happen.  I will provide an update following my initial PT session.  Again, I hope this is helpful for those reading these posts.  It is somewhat therapeutic to put this down in writing.

[TPQ_RI]

First PT Appointment Today:  Not bad.  The focus was on gently beding the injured knee (goal is to get it to 90 degrees, 36 degrees today) and strengthening the leg.  I was provided with some home exercises, that I will try to adhere to with some diligence.  I am now getting around fairly well with the leg locked in the brace, but without crutches.  It is a bit awkward, but not overly so.  The leg will be locked in a straight position for another month.  Estimate at this point is that PT will continue for 5 months from this point.  A long road lies ahead.  However, I can see small amounts of progress along the way.

[TPQ_RI]

Wow.  Huge improvement in ROM from PT appointment # 1 to # 2.  Went from 36 degree to 70 degree bend.  At home repetition (consistent reps, not trying to be a hero) of the in-session PT exercises seems to be important.  Hoping this means that I am gaining some traction in the recovery phase.

[TPQ_RI_2]

Post-Op + 2 Months Appointment Today - Freedom!  Welll, partial freedom.  After a month of PT and struggling to get my knee to bend to 90 degrees I saw the surgeon.  He felt that things were progressing along nicely.  The tendon itself fees fairly solid to the touch and (after draining 20 ccs of fluid) my knee achieved the necessary 90 degree bend to allow for a partial unlock (40 degrees) of the brace.  PT will continue to focus on ROM exercises but will now also move into strengthening the quad.  This includes a slight squatting exercise, without the brace.  My wife will not like watching that one.  Given my height (6' 4") this means that I was able to ride in the front seat of our car (and not strewn horizontally across the back seat) for the first time in 2 months.  It felt suprisingly liberating.  Again, I hope this form of online rehab diary is somewhat helpful to those reading it.

[YogaSkier]

Wow.  Huge improvement in ROM from PT appointment # 1 to # 2.  Went from 36 degree to 70 degree bend.  At home repetition (consistent reps, not trying to be a hero) of the in-session PT exercises seems to be important.  Hoping this means that I am gaining some traction in the recovery phase.

Wow, that's an awesome increase! What was the time frame between appt #1 and 2? Nice job! 

[TPQ_RI_2]

@YogaSkier - 3 days in between PT appointment # 1 and # 2.  In retrospect I think I may have been coddling the injured knee a bit in the first session, which probably accounted for some of that increase.  I am now about 5 weeks into rehab, and just hit 100 degrees range of motion with some pain (95 degrees with relative ease).  I am still in a brace, but it is now unlocked to 70 degrees ROM.  That makes walking around in it easier.  My trainer now has me doing some exercises without the brace (balancing on the bad leg, squats, etc.) to get quad muscle development jump started.  Next appointment with the surgeon not for another 4 weeks or so.

[YogaSkier]

That's still awesome!  I've found that finding that balance of relaxing/not anticipating pain and also, not allowing too much stretch so as not to stress the integrity of the repair is one of the hardest things. I'm 6 wks post-op and at about 90 degrees so you're doing better than me!

[TPQ_RI_2]

Post op + 2 Months (and a couple of days) Update:  Now walking without the brace during PT and around the house (have to keep it on in public and on uneven ground).  During the same PT session I also made a full revolution on a stationary bike (which means ROM is probably 105 to 110 at this point) for the first time.  Two good milestones that happened on the same day.  I will take it.

[TPQ_RI_2]

Post-Op + 10 Weeks - Farewell Mr. DonJoy - the brace is off.  During PT session this morning the therapist indicated that I had sufficient quad control of the leg to get around without it (both inside and outside of the house).  Rule at this point is to use common sense.  ROM is at approximately 110 to 115.  Use of stationary bike is fairly easy.  Now on to strengthening that quad, which has wasted away to nothing.

[TPQ_RI_2]

Post Op + 3 Month Update:  Surgeon is very pleased with progress to date.  ROM is 120 degrees (easily obtained) and quad control is good (i.e. able to raise the leg without any lag).  The issue now is strengthening the quad muscle, which wasted away to an astonishing degree while the injured leg was immobilized.  Although I am walking fairly comfortably at this point without the brace, progressing normally up stairs remains a challenge.  PT is now focusing on some light weight training, plyometrics, stationary bike and elliptical.  From time to time I will supplement this with some swimming.  All in all I am ahead of where I feared I might be by this point.  While I know that I still have miles of PT ahead of me, I am looking forward to it to continue this forward progress.

[TPQ_RI_2]

Best Birthday Present:  Being able to walk up and down a flight of stairs (almost) normally for the first time in nearly 4 months.  Post-op + 14 weeks.  I will raise a glass (or two) to celebrate this for sure.

[ImJenD]

Dear TPQ_RI_2,

I hope you have the time to answer my questions. You seem to be the only on on this board with a similar injury and I have some specific questions.

I too tore my patellar tendon in the middle of the tendon and not off the bone. I also tore my MCL and LCL (tendons on either side of my knee). My OS told me this was a very rare injury. From your posts (which have given me hope and depressed me all in the same vein b/c I'm not even close to the progress you have made) it looks like you have made tremendous progress.

I'm at 3 weeks post op and my OS has told me no weight baring on the injured leg for another 1.5 weeks. Because this type of injury is even more rare, does it mean a longer recovery?

I'm terrified of PT b/c my surgeon has said scar tissue will be an issue and I'll have to break through it with some tough workouts. Were you able to take any sort of pain killer/ibuprophen prior to PT sessions?


I'm a busy mother of 2 with my youngest being 2 years old. I have a full time job and I'm the bread winner in the family. My family and career count on me getting back in the saddle as soon as possible. I'm feeling tremendous pressure to achieve more and get back to my routine at home and work. When did you get back to daily activities and how was the process? Did you do a few hours at first and build up or did you throw yourself back in the mix full force?

Any advice is greatly appreciated.
Jenny

[TPQ_RI_2]

Jenny,

My apologies for not responding sooner.  I just checked back this evening and saw your post.  It sounds like your injury is more severe than mine, given the additional MCL and LCL damage.  You have my sympathy and best wishes for a speedy recovery. 

To help inhibit scar tissue development my surgeon had me reach underneath the injured knee and gently lift it up (sets of 20 or so, several times a day). Until they clear you for PT there is just a lot of sitting around - which is frustrating, but necessary.  Once I was cleared for PT I went at it hard and then tried to recreate the sessions at home on the off days.  For the first month of PT they will be working on ROM with you and that is not fun.  Ibuprofen and ice after each session is a must.

In terms returns to normalcy:  I have a sedentary job that allowed me to telecommute, so getting back into work came fairly quickly.  In terms of the other day to day stuff (helping out with the kids, chores around the house, etc.)  - that took some time.  It really wasn't until they opened the brace to 90 degrees ROM at around post-op + 2 months that that really was truly feasible.

This is a nasty injury.  My advice is to rest up for the first month or so post-op.  Once they clear you for PT, work at the sessions hard and do your homework.  I think the biggest thing that helped both with the ROM and starting to restrengthen the leg was access to a stationary bike.  Using that on a daily basis (once you have ROM to make a full revolution peddaling) really seemed to help.

Hope that helps.  Best of luck.

- Tom Q.