Quad Tendon Revision Repair Failure

[quadder]

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.

[Stuart Rulka]

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!

[quadder]

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

[Stuart Rulka]

Quadder, John is our Mentor on this Forum, but you may have to contact him via one of the Major threads.

[quadder]

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.

[John42]

Hi Quadder

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

JohnK/ Manchester UK

[John42]

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

[quadder]

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.

[quadder]

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.

[quadder]

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 

[bballkingofnba]

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

[vickster]

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

[quadder]

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.

[quadder]

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.

[quadder]

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.