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Author Topic: Patella Knee Tendon Rupture Treatment Plan  (Read 11076 times)

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Offline scammy

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Patella Knee Tendon Rupture Treatment Plan
« on: July 28, 2012, 05:04:45 AM »

Hello,

Glad I found this forum. I live in USA but was in India visiting family. While crossing a road, I missed the curb and my knee bent awkwardly and my entire body weight came down on my left knee. Had numbing pain and noticed that my kneecap was pushed up to my thigh. Luckily I was in Delhi and was near a very modern hospital. I was rushed to the emergency room. They took X-rays and MRI and immediately diagnosed the rupture. They immediately did the surgery the same day on June 27, 2012. A day after, they put my entire leg in a permanent cast and cut a flap over the knee so the staples could be removed in 2 weeks without removing the cast.

The surgeon said the cast will remain for 6 weeks after surgery. Until then, he told me to do toe flexing exercises and to flex the knee down as much as the cast allows. I had the the staples removed about 2 weeks as prescribed. The surgery site looked good with no infection or swelling. I get around with a walker. When the cast was placed after surgery, they bent my knee at a slight angle of about 15 degrees.

I am anxiously waiting for the 6 weeks and my cast to be removed. I am currently planning for cast removal on August 7th. From what I read, I have a long grueling process ahead. I am planning on flying back to USA on September 4 th. I'll have about 4 weeks after cast removal before I travel and I hope that with physical therapy I will be able sit in an airplane seat to get back home.

I would appreciate any feedback such as how far to push myself after cast removal. I don't want to rupture it again. Will I need to be in a brace after the permanent cast is removed?

Thanks in advance for your responses

 :)

Offline Zlou58

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #1 on: July 30, 2012, 11:46:03 AM »
Not a doc but after doing this twice I kind of got a handle. I never had a cast, I was always in a brace. The brace is nice in that it allows you only to bend a certain amount of degrees and as you progress you can move the degree. Im in a donjoy post op brace. I had to leave locked at straight or zero for 8 weeks before movement could begin. Every doc is different. Good luck brother. This is a great site or just email me and I'll answer any and all questions.


Lou

Offline Zlou58

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #2 on: July 30, 2012, 01:53:46 PM »
Forgot!  There is a section just for your surgery in this same section, down from where you posted. Tons of info man!

Offline scammy

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #3 on: July 30, 2012, 02:52:07 PM »
Lou,

Thanks for the post. Wow, 8 Weeks before you could move any degrees. How long did it take befor
you fully recovered?

Offline J.V.

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #4 on: July 31, 2012, 10:16:34 PM »
I'm same level as you scammy, i had a complete tear of my right patella tendon while playing basketball on july 10th 2012, had surgery on july 17th 2012. I was place in a full cast (ankle to just below my groin) its been 2wks getting the staples out this thursday, but my orthopic said he is putting back in a smaller cast for another 3weeks, then i'll goto a post op knee brace for several months. i've came to the realization that my basketball days are all but done, which is cool cuz i'm 37yrs old and have been playing it for 30yrs, but would loe to be able to get back to everyday life. i hope you your recovery is a great one, and i wish you the best of luck. i will keep you posted on my journey.
                                                                                    J.V.

Offline Zlou58

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #5 on: August 02, 2012, 03:01:20 AM »
Scammy,

Well I am still recovering!!!  11 weeks today and at 80 degrees. This is my SECOND go around but did them both at the same time. I rehabbed first one from December to may. Got fully recovered then may 10 I took a Nasty fall and did both!!!!!!!!!  So 11 weeks and I'm plugging away with a double.  It gets better brother.



Lou

Offline scammy

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #6 on: August 04, 2012, 04:15:29 PM »
I guess I'm a little concerned since my doc prescribed the full leg cast for 6 weeks and then said physical therapy. He didn't say anything about a brace but it seems that most orthopedic surgeons prescribe a brace. My cast is due to come off in 5 more days. I'm wondering if I should ask him about the brace. I really don't want to injure something again. My problem is that my surgeon is very far away.

I guess I'll see what happens next week.

Thanks for all the responses.

Offline J.V.

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #7 on: August 14, 2012, 12:32:17 AM »
Hey scammy! Was just wondering how things where once they took your cast off? I get mine off in a week and a half?

Offline scammy

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #8 on: August 14, 2012, 07:32:05 AM »
Well the cast came off 5 days ago and physical therapy began immediately. Initially, I had no movement at all but am working hard thru the pain. I'm currently at about 40 degrees. I was instructed to wall with the full leg brace and a walker. I have considerable swelling and stiffness.

Trying to keep positive. I will keep you updated as time goes on.







Offline J.V.

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #9 on: August 15, 2012, 12:20:51 AM »
@scammy. Cool keep it up and I'll let you know how mine is in 2wks...

Offline The Eejit

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #10 on: August 23, 2012, 04:06:13 PM »
Scammy,

You're doing really well, I started bending mine 3 weeks ago and I am only at 50 on an assisted heel slide. That said I've had no physio as yet, had to do it all myself.

 But I hear you about the stiffness, after exercising and then resting my knee does not want to move at all and I have to force it to bend. I just asked on the other RPT post if this is normal so keep an eye there.

Juls
My friends call me Juls :)
-----------------------------------
6th July 2012 - Ruptured Left Patellar Tendon
Friday the 13th July - Surgery (yes I said my goodbyes lol)

Offline scammy

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #11 on: August 26, 2012, 08:15:47 AM »
Eejit,

Thanks for the info. I am now at 3 weeks after cast removal which is 9 weeks after surgery. The doctor says that I can now bend at about 70 degrees unassisted. My quads are still pretty weak. I fly back to USA in a week so hopefully I can sit in a plane seat by then.

Offline John42

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #12 on: August 28, 2012, 04:24:25 PM »
I would suggest that you arrange a wheel chair at the airport  - at least you would get priority boarding and pampered going through immigration.

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

Complete Ruptured Tendon

Offline scammy

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #13 on: August 28, 2012, 06:54:15 PM »
JohnK,

Yes, I have a wheelchair scheduled. You are right, I need all the help I can get. Thanks for the suggestion.

Offline scammy

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #14 on: October 01, 2012, 11:05:59 PM »
Update:

Well. its been 3 months since surgery. I've been back home in USA. Current movement is 90-100 degrees. Quads are still very weak. Still cannot get full extension to due to weak quads. The knee is always very warm compared to the good knee. I can walk but with a limp and still cannot put too much load. Doctor says I am progressing satisfactorily.

Offline John42

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #15 on: October 02, 2012, 09:27:32 AM »
Hi Scammy

You are just about on track = the next mile stone is 120ROM, which should be reached in the next two months or so, and anything over 120 is a bonus.

Just one tip, the tendon is still very weak, so treat the knee with respect, ;isten to your knee and you will continue to make normal progress.

\keep posting

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

Complete Ruptured Tendon

Offline scammy

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #16 on: October 03, 2012, 12:07:53 AM »
John,

Thanks for the reply. Good to hear that I am on track. Is there a specific reason why I won't get over  120 degrees?

You are right about the weakened tendon. Just today, my knee slipped a little why walking and I felt the pain. The surgeon also said the same thing.

Thanks for the feedback and prompt response.

Offline John42

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #17 on: October 03, 2012, 11:30:40 AM »
Hi   Scammy

The reason why I stated 120Rom is simple - have your good knee measured, which should be in the region of 130/140 ROM - you lose a little in the operation -   I have finished up with 118ROM , but you cannot run after a bus, walking up and downhill is a B.................., and bear in mind, work hard at those stretching exercises, because what you achieve after 12 months is your lot.

Keep posting

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

Complete Ruptured Tendon

Offline scammy

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #18 on: October 24, 2012, 12:25:37 AM »
Just a status update. I am now at 120 degrees ROM. I still cannot straighten my leg all the way.
Hopefully, I can get more range of motion and my quads have a long way to go

Offline John42

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #19 on: December 24, 2012, 09:29:15 AM »
Hi Scammy

A further two months along the long road to recovery, and it`s two months since you have posted.

So, what is the current situation.

With seasons greetings

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

Complete Ruptured Tendon

Offline scammy

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Re: Patella Knee Tendon Rupture Treatment Planua
« Reply #20 on: December 24, 2012, 04:33:52 PM »
JohnK,

Thanks for the post. My current situation is 130 ROM which is very good. Taking steps is still very painful. I still need to strengthen my quads. The exercise bike and elliptical machine is being used but results seem to be very slow.

Thanks,
Sam

Offline scammy

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #21 on: January 12, 2013, 05:35:40 AM »
JohnK,

I was wondering if I could ask a few questions. As stated in my earlier post, I am at 130 ROM but my leg still looks like a noodle. I do physical therapy 3x per week for about an hour each session. This primarily includes bicycling, leg lifts, leg press, elliptical machines. I am almost 23 weeks post injury and I still have pain going up/down stairs. I think this is primarily due to quad muscles being weak. I can walk fine but my progress seems to be very slow. On the leg press, I use only my damaged leg and can do about 90 lbs (no pain). The leg lifts about 15 lbs (painful), hamstring (leg pushes) about 50 lbs (no pain).

Am I on track or am I not doing something right?

Any help will be greatly appreciated.

Thanks,

Offline John42

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #22 on: January 12, 2013, 12:33:02 PM »
130 ROM at six months is very good, but you still have lots of work to do, as my Consultant, used to say,  hard work up to 12 months and then you will not get much more to increase that noodle.

Upstairs, will always be a problem, so much for me, that I sold my beautiful house and bought a flat.  In this way, I have no stairs - but it has made a vast improvement to my life.

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

Complete Ruptured Tendon

Offline Pauljohno

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #23 on: January 31, 2013, 07:27:21 PM »
Hi John and all,

Baring in mind I did the double, my rehab has not really been any different to the singles club.
I can't wrap my head into what ever ROM I end up with after 12 months will be it'.
The limit will be mechanical as in how my knee will go, tendon's and muscles must be able continue to be stretched beyond the 12 months, if I am not wrong?
I taught martial arts in my teens and twenties and remain convinced that anybody can improve their flexiblity with a steady regular stretching routine.
Still at the 5 1/2 month stage I am frustrated how slowly my quads are regaining strength. During the martial arts time I began weight training more and more and ended up kicking the Kung Fu and being a hell for leather weight trainer.
Being lucky to have been around intelligent bodybuilders from the start, I have always stuck by the key to building muscle is to use the max resistance through the max range of a muscles movement, using a set and rep system.
Sort of rationalising the slow re growth of my quad's being linked to me still not being able to work them through their max movement range, though I am not far off, if we are talking using a leg press. However the resistance is still not enough to stimulate growth in my quads. I have not yet got the sore muscle feeling in my quads or anything near the fealing that they are being worked to a level I would like them to be.
'Am I wrong or is it just as I think a question of keeping at it and increasing and increasing to gain the strength and gain the  associated stablity of re built quads should give me. I have cut back on direct hamstring stuff now I have sort of got over in braces and lack of use wastage in this area.

Offline scammy

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #24 on: February 28, 2013, 03:00:55 AM »
Pauljohno,

You describe the exact same thing that is happening to me. I can work out on a bicycle or elliptical machine forever and the quads in my good leg are sore the next day but the quads in my bad leg are NOT sore at all. When I exercise, I try to use my bad leg more but it doesn't help.

My step down exercises don't seem to work either. I cannot slowly bend my knee such that I can control the descent to the lower step. It just seems like I "fall" to the lower step. I think this is all to my weak quads.

Have you had any luck in building quads?

Offline Jedward

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #25 on: March 04, 2013, 06:59:06 PM »
Hi Scammy et al.  I ruptured my patella tendon playing football 7 weeks ago.  Initially in a brace set to 30 degrees, at 6 weeks it increased to 50.  I can get it to 50 but it is very stiff and very swollen.  Also very tender to touch still and there is a part of my knee I cannot feel at all.  During the op they also wired the knee which I was told is likely to snap when I have full movement and will need to come out most probably.  It feels a long process so far and reading your progress it is going to be a long haul.  I was told I would be in the brace for 12 weeks as this is the time you are most at risk of snapping it again, should 90 degrees be exceeded.  However on my last consultation I was also told that once my knee no longer tender and I can get to 90 degrees  they will take it off.  I imagine on my 8 weeks review I will go to 70 in the brace before at 10 or 12 it goes to 90 - will see.  I'm 37 so no more football for me.  Just want to make the best of it, work hard on the physio and play some golf.  Ay tips or advice welcome ... :)

Offline John42

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #26 on: March 04, 2013, 07:36:02 PM »
Hi Jedward

Welcome to the RPT treatment plan - I would suggest that you repost your story on the RPT surgical webpage - lots of buddies out there to help through on your long rehab journey.

    Where do you live?

At six weeks, you should be coming out of the brace and the knee should be about 30/40ROM, so you are not doing bad.

I suggest that you read a set of documents which I have compiled over the years, and don`t forget ASK questions.

Take care - keep in touch
JohnK/ Manchester UK
Ruptured Patella Tendon January 9 2003
Slipped on black ice.  Manchester UK

Complete Ruptured Tendon

Offline Jedward

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #27 on: March 04, 2013, 09:36:20 PM »
Hi Johnk, I'm on the wirral, so not far from you

Thanks for the post, I will read your doc and repost as you suggested.  Cheers, John

Offline TendonTim

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #28 on: March 20, 2013, 09:27:26 PM »
Hi everyone,

I'm very interested in the progress that everyone has been making here. I ruptured my right patella, and medial and lateral patella retinaculum on 2/10/13. I had my surgery on 2/15/13. 2/16 I was set up by my physical therapist with an electronic stimulation machine and a list of other exercises to do. To date (4 weeks 5 days) I have 80 degrees active flexion, and I can do 2-3 sets of 5 straight leg raises without pain. I'll start physical therapy tomorrow with home exercises and progression to 90 degrees flexion by next friday. After that, I have clearance to really go at the bending past 90 degrees. My question to everyone is: what did you all use to gain the natural movement? Right now, I have to warm my knee up before I get to the 80 degrees. Waking up in the morning, I only have about 30-40 degrees flexion.


Just my input on progression of the ROM. I'm a second year med student in the US and I'm studying for my USMLE step 1. I can post the links for some of the literature that I've been reading if anyone would like to know the source of my info. Majority of the studies associate early ROM (30-45 degrees) immediately post op with increase strength of the repaired tendon. This is mainly due to stronger cross linking of microfibrils in the repair. During the 4 week post op, the body begins to lay down Sharpe Fibers that anchor tendon to bone. That process is complete enough by 6 weeks post op to begin vigorous active flexion. The repair is still not adequately strong enough to support heavy lifting until the 3-4 month time period when the type 1 collagen has been completely laid down. After this point, it should be ok to really work the muscles around the joint as the tendon should be strong enough to receive the load. This is more of a general process that will vary from person to person and things are not always like textbooks say so please dont take my word as gospel, but more general information. Also, if anyone sees anything i said as incorrect, please feel free to correct me.

Oh, and I'm not sure I agree with 12 months being the limit on achieving full ROM. The body is capable of some amazing things.

Offline John42

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #29 on: March 20, 2013, 09:55:28 PM »
Hi Tim

Have a look at Ruptured Patella Tendon Surgery, would be wise to post on that webpage

Take care

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

Complete Ruptured Tendon

Offline TendonTim

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #30 on: March 20, 2013, 10:35:24 PM »
Hey John,

Sure. I can post the links there but I'm still curious about what did you all use to gain the natural movement of ROM? I have to warm my knee up before I get to the 80 degrees. Waking up in the morning, I only have about 30-40 degrees flexion. Do you have any insight no this? Thanks for your help.


Tim

Offline carkeltom

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #31 on: August 19, 2013, 02:44:07 AM »
TendonTim, if you read this, could you post the links or if John has them, that would be great.
  Tom
Bilateral patellar tendon rupture 7/19/13

Offline carkeltom

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Re: Patella Knee Tendon Rupture Treatment Plan
« Reply #32 on: August 29, 2013, 12:30:59 AM »
OK, here goes.  Going to try out my typing skills and post my orthopedic surgeons' protocol for MY injury.  From following JohnK's links, it matches, to an extent the Univ of Wisconsin and UMass protocols.  Even though I suffered a bilateral rupture of the patellar tendon (both knees) at the same time, this is what he gave me.  I plan on working with him and the PT to develop something tailored to my situation and experiences, since the protocol is geared to someone who only hurt one tendon and is able to guard with their non-injured knee or use it to brace themselves.  Like JohnK has told me and from what I have found, there are only 5-6 doubles on this board and we all seem to have had different protocols and outcomes.

I.  Immediate Post-Operative Phase (Days 1-7)

Precautions:  Sleeps and walks in a locked brace, full extension for 6 weeks
                      Flexion ROM limits see below

Goal:  Restore full passive knee extension
           Diminish pain and joint swelling
           Restore patellar mobility
           Initiate early controlled motion
           Controlled foces on the repair site

Post-op Days 1-4

Brace:  Drop locked brace locked at 0 degree extension with compression wrap.  Sleep in brace.
Weight bearing:  Toe Touch with WB with two crutches or walker
ROM:  Passive ROM 0-30 degrees
Exercises:  Ankle Pumps 10 times per foot/ankle per hour
                  Quad Sets  3 sets of ten per day,  flex and hold for 5-ten seconds
                  Patellar Mobilization  (moving the kneecap slowly and with slight pressure in each direction
                  Standing Hip Abduction/Adduction
Ice and Elevation:  20 minutes of each hour at elevate

(during this phase, I was in both the surgical hospital and rehab hospital and was using the CPM machine as tolerated 30 minutes per leg every two hours.  I started at 0-30 degrees)

Post OP days 4-7

Continue the use of brace at all times (sleep in locked brace)
Weight bearing:  Locked brace and two crutches or walker, Weight bearing as tolerated (WBAT)
Range of Motion:  Passive 0-45 degrees
                             CPM 0-75 degrees as tolerated (30 min per leg per two hour period, including
                             while sleeping)  I planned it so that I could try to get the whole hour done     
                             consecutively and try to get some sleep and have like one hour off the machine.
Exercises:  Continue all exercises above plus:
                  Initiate gravity eliminated SLR Flexion (assisted)  This consisted of me standing using the             walker or crutches and bringing each of my legs forward one at a time (think of it like              standing on one leg and kicking your toe forward, without flexing your quad.)  3 sets of ten per day.
Continue Ice and elevation

II.  Maximum Protection Phase (Weeks 2 to 6)

Goals:  Control forces on the healing tendon(s)
            Gradually increase passive knee flexion
            Restore full passive knee extension (placing heel on pillow and allowing knee to               extend                 downward
             Restore Patellar mobility (not letting the kneecap get stuck in the tracks and to reduce formation of scar tissue)
             Inhibit muscular atrophy (quad sets only for the flexion motion)

Week 2:

Brace:  Continue use of locked brace for 6 weeks
            Sleep in locked braces 6 weeks
Weight Bearing:  WBAT (usually 50-75% of body weight)
Range of Motion:  Passive ROM (PROM) knee flexion only to 60%
                             Full passive knee extension
                             Patellar mobilization
Exercises:  All previous exercises
                  Electrical muscle stimulation to quads
                  Quad Sets
                  Ankle Pumps
                  Hip abductions/adductions
                  Gravity Eliminated SLR Flexion (my doc and PT did not do this being a double RPT)
Continue Ice and Elevation

WEEK 3: 

Continue above mentioned exercises
Passive ROM 0-75%
Continue the use of walker or two crutches  75%-80% of body weight

WEEK 4:

Continue all exercises listed above
Weight bearing:  Progress to one crutch at 28 days (Not to easy with a double patellar tendon rupture
Passive ROM 0-75%
Exercises:  Initiate Mini-squats (0-45) (also not done with my double)
                  Initiate weight shifts ( I did this while standing at my kitchen counter)
                  Initiate Proprioception Drills (standing at the counter and closing my eyes)  also I used
                  a pillow and stood on it since the body has to adjust to the weight shifts


WEEKS 5 and 6

Discontinue use of crutch at 5 weeks post op
Unlock braces for ambulation at 6 weeks
Passive ROM:  Week 5 0-80 degrees
                        Week 6 0-90 degrees
Exercises:  Initiate pool exercise program
                  Active knee extension 90-30 (sitting on chair and actively flexing knee to 30 degrees)
                  Multi-angle isometrics knee extension (subnex)  ( I have no idea)
                  Continue all above exercises from weeks 1-4
                  Initiate anti-gravity SLR flexion
Continue Ice, compression and elevation as needed

OK, that is my weeks 1-6.  If yours was any different or if the PT or physio added something, let me know and I would like to see if it appropriate or needed for myself.  I know that I am different being a double, but just trying to get back to normal as we all are.

Thanks and best wishes

Tom



Bilateral patellar tendon rupture 7/19/13