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Author Topic: Quad Tendon Revision Repair Failure  (Read 15082 times)

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Offline quadder

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Quad Tendon Revision Repair Failure
« on: January 26, 2014, 10:01:39 PM »
Hi guys,

On the 14/06/2012, I shared with you my experience of a failed repair to a ruptured quad tendon of my right leg. As a consequence a revision repair was carried out in May 2013 using a LARS ligament. Unfortunately the repair has also failed.
I have a consultation with my OS and one of his colleagues at a complex case clinic in 2 weeks time at which time they will have the results of the latest MRI scan and will  discuss this second repair failure and advise me what, if anything, can be done to carry out an effective repair. At my last consultation prior to the scan, my OS did say that depending on the scan results the present condition of my leg could be the best that it will get.
I have since found an article on the net reporting on a relatively new technique which appears to fit the bill for my situation however I am unsure if it is approved in the UK, the link is :- http://orthojournal.org/2011/08/21/revision-quadriceps-tendon/

To conclude, as I am the eternal pessimist, if anyone has had a similar experience to myself or are aware of any other repair techniques out there or any other help or info which I could benefit from, it would be great to know about and also add some fodder to discuss at the planned consultation with the OS.

     Cheers,
          Quadder.

Offline Frank550

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Re: Quad Tendon Revision Repair Failure
« Reply #1 on: January 27, 2014, 08:52:33 PM »
Thats a very interesting article and one that I may well be showing to my prof in case he isnt aware of it.

Whether thats approved over here in the UK, who knows, but it reads like there may be light at the end of the tunnel. I can see similarities in my own situation although quite different, I like the case study, have atrophy of the quad muscle and adhesions also, now whether the repair would be suitable for my situation Im unsure, but it sounds like you would be the perfect candidate.

Let us know what your OS thinks.

Good luck
Ruptured (complete) quadriceps tendon 14 April 2013
Surgical repair 19 April 2013
Scar tissue surgically released 17 December 2013

Offline quadder

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Re: Quad Tendon Revision Repair Failure
« Reply #2 on: January 28, 2014, 11:17:34 AM »
Thanks Frank, I have my consultation on the 10/02/2014. I will keep you posted.

Offline quadder

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Re: Quad Tendon Revision Repair Failure
« Reply #3 on: February 11, 2014, 11:14:06 PM »
Update for those interested :-

Well, I had the consultation at the complex case clinic yesterday with my OS together with two of his colleagues and three junior doctors. After thorough examinations and numerous questions from them all, the MRI scans where perused over and the decision made to carry out a second revision  operation using more of the LARS ligament technique to reinforce the repair. The knee will then be braced in the extended position with any movement only being introduced after six weeks, as opposed to two weeks as the previous ops, to allow the surgery to heal and strengthen. The OS did explain that I could loose some bend in the joint however he thought that it be unlikely. Out of curiosity, I asked about the repair which I posted the link to in my initial post. My OS explained that he had performed the procedure a number of times albeit on younger patients than myself. He explained that as I am 65 years of age it is considered that I need the hamstrings/ligaments to remain where they are to maintain the strength etc in my legs but was still young enough for the planned procedure to be effective.
 I was advised that he would hope to carry out the surgery within six weeks and was asked to return to the hospital later to attend a pre-op assessment.
 For those interested, I will keep you posted.

     Quadder.       

Offline fishy

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Re: Quad Tendon Revision Repair Failure
« Reply #4 on: February 12, 2014, 04:42:27 AM »
Hey Quadder, I am a 67 yo with double RPT, 39 weeks post operation.  There are members of our "club" 77 years old.  I will follow your posting and look forward to your continued progress thru this.  Our  rule one is "patience", our second rule is "see first rule".  I really understand your situation and I want you to heal.  Stay positive, get grumpy, be testy, then remember rule one...... Bob

Offline Frank550

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Re: Quad Tendon Revision Repair Failure
« Reply #5 on: February 12, 2014, 01:07:03 PM »
Hi Quadder, thanks for the update.

6 weeks braced, wow, personally that wouldn't work for me as I now have found out I am prone to scar tissue build up and inactivity makes this worse, my new OS likes his patients to have movement very early but no load bearing initially until the repair can hold, then introduce the load work then.

In any case I wish you all the good fortune I can send and please do keep us updated as to progress etc

Frank
Ruptured (complete) quadriceps tendon 14 April 2013
Surgical repair 19 April 2013
Scar tissue surgically released 17 December 2013

Offline quadder

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Re: Quad Tendon Revision Repair Failure
« Reply #6 on: February 12, 2014, 11:45:48 PM »
Thanks for the interest guys, I will keep you posted.

Quadder,

Offline quadder

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Re: Quad Tendon Revision Repair Failure
« Reply #7 on: April 27, 2014, 10:09:18 PM »
Hello again to those interested.

Well needless to say and thanks to our wonderful NHS system, I didn't make surgery within the said six weeks as the surgeons planned. Little wonder there is wastage of resources, with pre-op assessments being carried out and admissions not arranging a slot. Anyway the surgery is now confirmed for the 9th May 2014. 
Here's hoping that it's third time lucky, I will let you know.

Offline carkeltom

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Re: Quad Tendon Revision Repair Failure
« Reply #8 on: May 09, 2014, 02:15:40 AM »
quadder, good luck on the surgery tomorrow.  Sorry about the wait for surgery.  Keep us updated or post on the RQT thread during your rehab.  Keep strong.
Bilateral patellar tendon rupture 7/19/13

Offline Stuart Rulka

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Re: Quad Tendon Revision Repair Failure
« Reply #9 on: May 09, 2014, 03:18:49 AM »
Quadder, I echo Tom's sentiments re Surgery and updates. All of us on this site are cheering for you!
Stuart Rulka
Complete RQT Aug2 2013
Surgery Aug3 2013
Resumed work Aug6 2013

Offline quadder

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Re: Quad Tendon Revision Repair Failure
« Reply #10 on: May 12, 2014, 02:51:05 PM »
Hi guys,

Well the op went ahead as planned and the consultant gave me the thumbs up and said that it's "sorted".
I'm now in a fixed cricket brace for 4 weeks as opposed to 6 as originally suggested. The staples are to be removed in 2 weeks and I see the consultant again in 4 weeks. Meanwhile I have been instructed via the physio that touch weight bearing only is allowed on the affected leg for the 4 week period. This is easier said than done. As a big guy, 6ft 2inch and over 17 stone (weight gained through relative inactivity) I'm finding it extremely difficult and tedious getting about with this restriction using the forearm crutches supplied. So, I was wondering if underarm crutches would be more suitable. I would welcome comments from past and present crutch users.

    Thanks, Quadder.

Offline bballkingofnba

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Re: Quad Tendon Revision Repair Failure
« Reply #11 on: May 19, 2014, 01:51:00 AM »
I definitely prefer underarm crutches. I am 6'2 as well and I find them a lot easier to balance and you could cushion the tops of the crutches so you don't get too much pressure in the under arm area. My 2 cents since I can relate to being tall and went through this injury.

Offline quadder

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Re: Quad Tendon Revision Repair Failure
« Reply #12 on: June 18, 2014, 02:04:53 PM »
Hi guys,
Well I'm 2 days short of 6 weeks post op, 4 weeks of which were touch weight bearing managing with the forearm crutches. I developed a small Infection in the wound following the removal of the clips which with a course of antibiotics cleared after just over 2 weeks. The leg is still in extension which I hope will be released a little tomorrow when I see the consultant. I'm getting around better now full weight bearing and only use one crutch when I venture out otherwise I get around without in the house. I can't comment on the strength of the repair just yet because I haven't been allowed to bend it, I may judge better after tomorrow.

Offline quadder

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Re: Quad Tendon Revision Repair Failure
« Reply #13 on: November 06, 2014, 07:34:01 PM »
Hi guys,

Sorry it's been so long since my last update.
I saw the OS on the 19th June 2014 as planned where he explained that he repaired the tendon this time using the method shown in the link which I mentioned on the 26th January 2014.
He asked could I walk without the brace and could I bend my knee. I replied that I hadn't tried because I was told not to remove the brace. He then removed the brace and asked me to raise my leg from the examination table. This I tried but as the leg was showing an amount of lag I couldn't fully staighten it. He then told me to walk across the room and back. He seemed happy with the result and  told me to ease myself off the crutches in my own time and that he would see me again in a further six weeks.
This has been the reason for not updating sooner as after twenty weeks of waiting and two emails to the OS I finally had a follow up appointment today. He apologised for the delay saying it was due to administration procedures and asked how the leg was. I explained that I reported in my first email five weeks ago that the lag was still evident in my leg. He examined me and asked me to walk across the room a couple off times while he observed.
He then explained that this is probably the best it is going to get and that because I am type 2 diabetic, my tendon tissue is not supporting the repair.
He asked if I would prefer a second opinion, I agreed and he confirmed that he would arrange it with one of his senior colleagues.
I am at the moment pretty devastated at the prospect of living with this and I am more than a little sceptical about a second opinion from the same camp, so to speak. I will however take the second opinion and if, as I expect, my OS's opinion is supported by his senior colleague, I will consider paying for a private consultation.
I would welcome any comments/opinions that anyone may offer.

   Thanks,
      Quadder.     

Offline Stuart Rulka

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Re: Quad Tendon Revision Repair Failure
« Reply #14 on: November 07, 2014, 08:11:57 PM »
Quadder. First of all, condolences on your predicament. That being said ,I have seen no references to your having received Physiotherapy ( PT  if you prefer).  OSs  deal in physical repair of tissue, (I have heard them referred to as a hammer looking for a nail to hit) but the rehabilitation following the repair should be guided by the PT. My Surgeon was excellent in his performance of the physical repair but completely at odds with the PT. Fortunately for me the PT is someone I have known for 20 years, and was also Chief Therapist for the Vancouver Olympics. Under his guidance I was back to my normal, relatively strenuous, activities in 6 weeks. Find a good PT before you give up hope.
  Good Luck!
Stuart Rulka
Complete RQT Aug2 2013
Surgery Aug3 2013
Resumed work Aug6 2013

Offline quadder

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Re: Quad Tendon Revision Repair Failure
« Reply #15 on: November 11, 2014, 02:06:11 PM »
Hi Stuart,
I have been having physio since around 10 weeks post op. My PT is very good however we are resigned to working with minimal equipment at the gym which I am presently assigned to. It is the opinion of my PT that the lars ligament graft used in the repair is slightly too long thus not allowing the quads to pull enough to straighten my leg. 
I put this to the OS however he dismissed it and instead suggested that it was my own tendon tissue that had degenerated and stretched because of my type 2 diabetic condition, age and lack of blood supply to the tendon. I replied that I was not a raging diabetic. Also between the second op and the third there was a period of some 16-17 months that the quad tendon was unattached and obviously at risk of deterioration.
There was a lot of things that I wanted to say however with his comments/summing up, I had had the wind blown out of my sails so to speak.
I am on minimal meds for diabetes, I am not insulin dependant, I don't and have not suffered with hypo's or hyper's, I am generally a very good tissue healer and relatively fit for 65 years.
The main thing that bothers me though is the suggestion that the tendon has stretched when at the instance that the brace was removed the joint was in a "lag" state after not having bent it or weight borne for 6 weeks.
My PT has in the past suggested that I be referred to a gym with more modern equipment, I will take this up with him at my next session this Friday.
I am also arranging an appointment with my GP to discuss my concerns and to explore a second  unbiased opinion elsewhere other with my own Health Authority. If this doesn't come to fruition I will go private.
I hope that this puts you more in the picture as I obviously didn't put all this in my initial rant.

quadder.

Offline Stuart Rulka

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Re: Quad Tendon Revision Repair Failure
« Reply #16 on: November 16, 2014, 02:50:00 AM »
Quadder. I would think a second, unbiased opinion is essential. I confess to being shocked at the thought of the quad tendon being unattached for 16 weeks. At our age ( I am 66 ) it seems like a recipe for disaster. Not sure a better gym is the answer, my PT has a very basic set-up, nothing much more than a bike and a leg extension apparatus, combined with walking lunges and wall flexes with a ball behind the knee, and squats against a wall. Simple but effective! As I keep reiterating I was fortunate to start Physio at two weeks  and was cycling at 3 weeks.
  Good Luck and keep us posted. Maybe John has some advice!
Stuart Rulka
Complete RQT Aug2 2013
Surgery Aug3 2013
Resumed work Aug6 2013

Offline quadder

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Re: Quad Tendon Revision Repair Failure
« Reply #17 on: November 16, 2014, 05:19:08 PM »
Hi again Stuart, thanks for taking an interest. I don't know if you miss read my earlier post but it was nearly 16 months from when the first re-rupture occurred to the first revision surgery not 16 weeks.
I saw my PT last Friday and he has referred me to a council run gym where I will be set a personal program to concentrate on building up the muscles which are still intact ie. the Vastus Lateralis,  and the Vastus Medialis, this I hope will build up the strength to enable me to control my leg whilst coming down steps and such.
You refer to a person by the name of John. Has he had a similar problem or is he more in the know, so to speak

Offline Stuart Rulka

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Re: Quad Tendon Revision Repair Failure
« Reply #18 on: November 26, 2014, 03:54:16 AM »
Quadder, John is our Mentor on this Forum, but you may have to contact him via one of the Major threads.
Stuart Rulka
Complete RQT Aug2 2013
Surgery Aug3 2013
Resumed work Aug6 2013

Offline quadder

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Re: Quad Tendon Revision Repair Failure
« Reply #19 on: November 26, 2014, 01:58:29 PM »
Just an update for interested parties.
I saw my GP last week and he advised me to take the second opinion with my OS's senior colleague first and if I am still unhappy he will refer me for an unbiased opinion with a OS from a neighbouring health authority.
Incidentally, I had a phone call about an hour ago and as a result I have an appointment with my OS's senior colleague next Wednesday morning.
I will let you know what happened.
Also for info, I had my induction with the local council's run gym yesterday where I went through a programme  to improve my overall fitness but with particular emphasis to strenghten my quads and hamstrings.

Offline John42

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Re: Quad Tendon Revision Repair Failure
« Reply #20 on: November 27, 2014, 05:30:01 PM »
Hi Quadder

I can give you more comprehensive response if you repost on Ruptured Patella - Quadricep Tendon Surgery

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

Complete Ruptured Tendon

Offline John42

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Re: Quad Tendon Revision Repair Failure
« Reply #21 on: November 27, 2014, 05:34:28 PM »
Hi Stuart Rulka

Must admit, I missed some newbies because they had not found the right thread.

Ruptures Quadricep or Patella tendons should be directed to

Ruptured Patella - Quadricep tendon surgery.

Thanks again for helpig these posters

JohnK/ Manchester UK

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

Complete Ruptured Tendon

Offline quadder

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Re: Quad Tendon Revision Repair Failure
« Reply #22 on: November 28, 2014, 10:55:35 AM »
John,

Thanks for your reply albeit, with respect, you haven't really advised me to do anything more than I have already done.

What I really need is advice from similarly affected people who have gone through the same procedure of a second opinion which I am facing next Wednesday 3/12/2014 ie. how to present my case to a colleague of the surgeon who carried out the operation, whilst in the back of my mind, knowing there is a possibility of closing ranks, so to speak.

Thanks,
  Quadder.


Offline quadder

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Re: Quad Tendon Revision Repair Failure
« Reply #23 on: December 09, 2014, 08:46:14 PM »
Well I've had my second opinion with my surgeon's senior colleague which as I expected backed up my surgeons opinion.
Needless to say, I am not really happy about the whole situation as I feel that this is the strongest my leg has been since before the original injury as, this is the only occasion that the repair has stayed in tact for 7 month post surgery, albeit with 15-20 lag.
So I am now awaiting his opinion/explanation in writing which he has promised to send to me then I will return to my GP and take up his offer of a referral to a surgeon in a neighboring health authority for an unbiased opinion.
Forgot to mention that the senior colleague has referred me back to my PT for Electro Muscle Stimulation as he said this would greatly help in my present condition as it would, in time build up the strength in the quads which may pull back some of the lag.
I welcome  your comments.

     Quadder.
« Last Edit: December 09, 2014, 08:52:33 PM by quadder, Reason: Missed out some info. »

Offline quadder

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Re: Quad Tendon Revision Repair Failure
« Reply #24 on: January 04, 2015, 09:59:10 PM »
Hi guys,

Now that Christmas is out of the way I am now considering my next move. As I've said in my last post I am going to take up an unbiased second opinion.
My own Health Authority is Wrightington, Wigan and Leigh. My GP has suggested either Manchester or Liverpool as these two are neighboring health authorities.

Does anyone on the board have any opinions, based on their own experiences, as to who they consider to be the best orthopedic surgeon in either Manchester or Liverpool or indeed another health authority close to where I am.

Thanks,
   Quadder 

Offline bballkingofnba

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Re: Quad Tendon Revision Repair Failure
« Reply #25 on: January 07, 2015, 02:28:08 AM »
Hi Quadder,

I would recommend taking a trip to the US and seeing someone at Hospital for Special Surgery. They have vast experience with failed surgeries.

Regards

Offline Vickster

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Re: Quad Tendon Revision Repair Failure
« Reply #26 on: January 07, 2015, 07:19:51 AM »
Or you could try the Orthopaedic hospital in Oswestry which is presumably rather closer to home (and won't cost you $$$$ for travel and treatment as an NHS hospital)  :)

http://www.rjah.nhs.uk/

You can filter the Consultant list by knee (although, unless going private, not sure if you can request to see a specific surgeon, goes for any NHS referral)

http://www.rjah.nhs.uk/Our-Services/Consultants.aspx
« Last Edit: January 07, 2015, 07:22:46 AM by Vickster »
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Offline quadder

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Re: Quad Tendon Revision Repair Failure
« Reply #27 on: January 29, 2015, 10:20:14 PM »
Thanks bballkingofnba but as Vickster has suggested, I am initially looking nearer to home.

I have contacted Oswestry via an on line enquiry form to establish the procedure for referral to a suitable surgeon with expertise in my particular situation.
I have subsequentley received a reply from their PALS team which has left me with another dilemma.
The surgeon who has been recommended for my GP to refer me to is an ex associate of my present consultant which, being the eternal pessimist, puts me in a similar situation with the second opinion I have already had from my consultant's senior colleague.

What would your thoughts be regarding this.

   Quadder.

Offline quadder

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Re: Quad Tendon Revision Repair Failure
« Reply #28 on: January 30, 2015, 11:02:42 PM »
Update.

I had a phone call this morning quite unexpected from the RJAH  hospital in Oswestry offering a second opinion from another consultant.
I have, this afternoon, asked my GP to formally refer me to him.

I will update when I know something.

Offline quadder

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Re: Quad Tendon Revision Repair Failure
« Reply #29 on: April 12, 2015, 02:27:35 PM »
Hi guys,

For anyone who is interested or have shown passed interest in this thread I have an appointment with a specialist experienced in my kind of problem, on Friday 17th April 2015 at the Robert Jones and Agnes Hunt Orthopedic Hospital at Oswestry.
I will update how I got on. 

Offline Stuart Rulka

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Re: Quad Tendon Revision Repair Failure
« Reply #30 on: April 16, 2015, 11:02:51 PM »
Quadder, good luck tomorrow. Keep us posted!
« Last Edit: April 17, 2015, 04:00:01 AM by Stuart Rulka »
Stuart Rulka
Complete RQT Aug2 2013
Surgery Aug3 2013
Resumed work Aug6 2013

Offline quadder

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Re: Quad Tendon Revision Repair Failure
« Reply #31 on: April 25, 2015, 10:59:32 AM »
Hi Stuart,

Well, the consultation went very well, I saw his registrar first who went through the time line of the history of all three previous ops/rehab etc. He then consulted with with his boss after which he came into the room.
More or less the conversation/examination was repeated with the specialist who, incidentally, didn't put the emphasis on my type 2 diabetic condition. He explained the risks of another op and asked was I willing to have another op to which I agreed. He said that he needed to view the last op notes and do an ultrasound scan to verify what condition the tendon is currently in before he would commit to another op however he said that if anything could be done he would do it.
I am now waiting for an appointment for the scan.
 

Offline quadder

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Re: Quad Tendon Revision Repair Failure
« Reply #32 on: July 11, 2015, 12:41:12 PM »
Hi,
I have since had the ultrasound scan on the 13th June 2015 and received an appointment to see the consultant on Monday 13th July 2015 however, this morning I have received a letter from the consultant explaining that although the tendon repair appears to be intact, there is extensive myositis ossificans in the lower part of the quad muscle. he goes on to explain that he believes that this makes any repair to my extensor mechanism extremely difficult and prone to stretch/failure.
The appointment on Monday is to discuss any future surgery as he feels that the odds for success are extremely low.
Any thoughts or experiences with this situation would be appreciated.