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Author Topic: Patella Knee Tendon Rupture Treatment Plan  (Read 10917 times)

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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















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