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Author Topic: Cycling Patella Fracture.  (Read 18667 times)

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Offline MDAL

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Re: Cycling Patella Fracture.
« Reply #45 on: August 05, 2014, 11:32:24 PM »
That TENS looks a like serious piece of machinery... Mine was way cheaper, works with only 2 pads, it doesn't looks so Pro as that, but it still did the job, in spite of some limitations.

Also rented a CPM machine before, different brand but same specs, had it for almost 2 months, since my problems were serious in terms of ROM, after 2 months of immobilization and extra surgeries.

Offline mjeffrey

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Re: Cycling Patella Fracture.
« Reply #46 on: August 06, 2014, 06:08:48 AM »
Hi MDAL

At the risk of hijacking this thread I want to take advantage of you reading it to ask a question :). I've been reading your recent posts and you seem to have expertise in the area so I was hoping for a little advice. I can repost the question in another forum if you want as well.
My story is basically in my signature below, successful MUA after diagnosis of adhesions 3 months ago, patella fracture with ORIF 6 months ago.
I now have full ROM compared with the uninjured side although the quads are slightly tighter (improving gradually). It does not move as freely as the other and there has been a clunk on extension since day 1 after the surgery. The annoying but not painful clunk occurs during walking and particularly after stretching; the OS says it is the wires. My patella tendon feels harder than the other and I am worried about patella baja.
I am having the wires out on Friday and asked the OS if he was going t remove any scar tissue he found. He said the adhesions have gone and there won't be any scar tissue to remove.
Do you have any recommendations for improving the flexibility of the patella tendon? Currently I do a bit of massage/patella mobilisation but it is not very directed or systematic.
Any other suggestions, or things I should point out to the OS on Friday?

thanks
Mark
2014:
20 Feb: Comminuted patella fracture, 4 K-wires, Cercalge, Figure of 8
11 Mar: Staples removed Flex 50
22 Apr: Control Xray, flex 80, progress stalled
09 May: MUA: flex 120, 3 weeks CPM
23 Jun: Slow Running, Flex 135
06 Jul: Flex 140
08 Aug: Hardware removed
10 Sep: full flexion

Offline daihard

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Re: Cycling Patella Fracture.
« Reply #47 on: August 06, 2014, 04:54:12 PM »
Good luck with the hardware removal surgery, Mark!

I don't think you're hijacking the thread. I would personally appreciate any information and advice regarding post-op recovery from a fractured patella. That would help cyclists greatly. :)
2014:
06-21  Fractured right patella
07-02  ORIF - figure 8
07-29  4-week post-op follow-up
07-31  Started PT - 60 ROM
08-07  90 ROM
08-14  115 ROM
08-21  Started bike trainer - 122 ROM
08-28  132 ROM
09-04  135 ROM
09-08  139 ROM

Offline MDAL

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Re: Cycling Patella Fracture.
« Reply #48 on: August 08, 2014, 07:09:49 AM »
Hi MDAL

At the risk of hijacking this thread I want to take advantage of you reading it to ask a question :). I've been reading your recent posts and you seem to have expertise in the area so I was hoping for a little advice. I can repost the question in another forum if you want as well.
My story is basically in my signature below, successful MUA after diagnosis of adhesions 3 months ago, patella fracture with ORIF 6 months ago.
I now have full ROM compared with the uninjured side although the quads are slightly tighter (improving gradually). It does not move as freely as the other and there has been a clunk on extension since day 1 after the surgery. The annoying but not painful clunk occurs during walking and particularly after stretching; the OS says it is the wires. My patella tendon feels harder than the other and I am worried about patella baja.
I am having the wires out on Friday and asked the OS if he was going t remove any scar tissue he found. He said the adhesions have gone and there won't be any scar tissue to remove.
Do you have any recommendations for improving the flexibility of the patella tendon? Currently I do a bit of massage/patella mobilisation but it is not very directed or systematic.
Any other suggestions, or things I should point out to the OS on Friday?

thanks
Mark

mjeffrey:

My personal experience is that things will never be the same again, this is something we need to live with and keep fighting. With all this (we) have scar tissue, both in the infra patella fat pad and above. All our ligaments and tendons and fist got shorten and then stretched back (will never be the same as the original).

If you do have patella baja, you should be able to measure it comparing to the other. However your patella ligament should be shorter now and surrounded by scar below it (fat pad scarring), which happens after long periods of inflammation. This is not necessarily patella baja, it's scar tissue together with shorten ligaments on both sides. This is why is not so mobile as before. If it is actually lower it should be visible.

I wish I had good news for you or a solution. I don't, I have made a long way through several surgeries (3 and probably counting), plus stem cells treatments, 12 shots of PRP, 5 of hyaluronic acid, physiotherapy to death, bought and rented devices I can't even count. I have made a lot of improvement, pulled myself out of disability, but I have the same thing you do, a knee that is not and will never be perfect, and will require maintenance for life.

You mentioned ROM is good for flexion (very few that have went through what you did can claim the same), extension is hard to get back, but can be done, you need to exercise in 2 ways, one for stretching the ligaments in the back of your leg which are shorter, the second is to get the quads strong enough to pull the knee straight. If you still have inflammatory reaction in the knee, means the extension deficit is likely to continue.

Good luck with the hardware removal, I hope this will contribute to further progress.

Offline daihard

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Re: Cycling Patella Fracture.
« Reply #49 on: August 08, 2014, 07:23:54 AM »

mjeffrey:

You mentioned ROM is good for flexion (very few that have went through what you did can claim the same)...

I hope it's not true for people with a fractured patella in general. Both my OS and my therapist have told me most  of those people will get a full ROM back - though it may take longer for some than others. While the therapist says 125-130 degrees should be good enough for me to do everything I want to do, I'm still aiming to regain all my ROM (which should be about 140-150 degrees).
2014:
06-21  Fractured right patella
07-02  ORIF - figure 8
07-29  4-week post-op follow-up
07-31  Started PT - 60 ROM
08-07  90 ROM
08-14  115 ROM
08-21  Started bike trainer - 122 ROM
08-28  132 ROM
09-04  135 ROM
09-08  139 ROM

Offline mjeffrey

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Re: Cycling Patella Fracture.
« Reply #50 on: August 08, 2014, 08:52:11 AM »
Hi daihard

I don't know if there is any research on regaining ROM but in reality every case is different and even if the outcomes don't seem that good , remember that you're part of a select group (kneegurus) who intelligently work hard toward getting better. Most people are pretty passive or don't work at getting better.
My roommate during my initial operation would tend to skew any statistics. He drank alcohol ,smoked and ate the day of his operation. He weighed 48 kg and was my age but looked twice as old. Just before the operation they put him on oxygen since his stats were low, he went out to smoke during this!

it's your outcome that counts not the average.
My extension and flexion are both good (same as the good knee) but I am realistic that I will always have problems with the knee. I just want to do what I can to minimize them.
2014:
20 Feb: Comminuted patella fracture, 4 K-wires, Cercalge, Figure of 8
11 Mar: Staples removed Flex 50
22 Apr: Control Xray, flex 80, progress stalled
09 May: MUA: flex 120, 3 weeks CPM
23 Jun: Slow Running, Flex 135
06 Jul: Flex 140
08 Aug: Hardware removed
10 Sep: full flexion

Offline mjeffrey

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Re: Cycling Patella Fracture.
« Reply #51 on: August 08, 2014, 09:14:29 AM »
Hi MDAL
Thanks for the reply. I'm writing from my bed waiting for the operation now. Will update when it is over, I need to spend the night so will have plenty of time  :)
2014:
20 Feb: Comminuted patella fracture, 4 K-wires, Cercalge, Figure of 8
11 Mar: Staples removed Flex 50
22 Apr: Control Xray, flex 80, progress stalled
09 May: MUA: flex 120, 3 weeks CPM
23 Jun: Slow Running, Flex 135
06 Jul: Flex 140
08 Aug: Hardware removed
10 Sep: full flexion

Offline daihard

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Re: Cycling Patella Fracture.
« Reply #52 on: August 10, 2014, 04:40:35 PM »
Hi daihard

it's your outcome that counts not the average.
My extension and flexion are both good (same as the good knee) but I am realistic that I will always have problems with the knee. I just want to do what I can to minimize them.
That's true. I do hope that I won't have too much issue with my knee once I've healed, but I should be realistic about it. I am making progress, after all.
2014:
06-21  Fractured right patella
07-02  ORIF - figure 8
07-29  4-week post-op follow-up
07-31  Started PT - 60 ROM
08-07  90 ROM
08-14  115 ROM
08-21  Started bike trainer - 122 ROM
08-28  132 ROM
09-04  135 ROM
09-08  139 ROM

Offline mjeffrey

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Re: Cycling Patella Fracture.
« Reply #53 on: August 11, 2014, 06:46:39 AM »
In the beginning my OS told me I should be at 90 after 6 weeks (but I also started PT straight away). You have better ROM than I did at that stage and given you've only just started it seems like good progress to me (60-90 in a little over a week looks pretty good to me).
I was sure the hardware would limit my ROM but it didn't seem to at all.
2014:
20 Feb: Comminuted patella fracture, 4 K-wires, Cercalge, Figure of 8
11 Mar: Staples removed Flex 50
22 Apr: Control Xray, flex 80, progress stalled
09 May: MUA: flex 120, 3 weeks CPM
23 Jun: Slow Running, Flex 135
06 Jul: Flex 140
08 Aug: Hardware removed
10 Sep: full flexion

Offline daihard

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Re: Cycling Patella Fracture.
« Reply #54 on: August 11, 2014, 03:17:28 PM »
In the beginning my OS told me I should be at 90 after 6 weeks (but I also started PT straight away). You have better ROM than I did at that stage and given you've only just started it seems like good progress to me (60-90 in a little over a week looks pretty good to me).
I was sure the hardware would limit my ROM but it didn't seem to at all.

Thanks Mark. That's encouraging. I started wondering whether I would stall as I wasn't making as much progress this past few days compared to last week. I got 90 on Thursday. As of Sunday, I was only getting 95 or so at home. Can I assume that the rate of progress in terms of the angle will slow as I get more ROM back?
2014:
06-21  Fractured right patella
07-02  ORIF - figure 8
07-29  4-week post-op follow-up
07-31  Started PT - 60 ROM
08-07  90 ROM
08-14  115 ROM
08-21  Started bike trainer - 122 ROM
08-28  132 ROM
09-04  135 ROM
09-08  139 ROM

Offline MDAL

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Re: Cycling Patella Fracture.
« Reply #55 on: August 11, 2014, 04:08:06 PM »
Yes Daihard, it tends to slow down, because now you are not just releasing the tightness, now you are actively growing the shorten ligaments and tendons... (they do shorten fast under immobilization).

Yet, gains in the order of 10 degrees (at least) a week are perfectly attainable with enough effort, and that means a lot of it. Sometimes it seems to stall, other times it seems to release. It depends a lot on the inflammatory moods...

The last degrees are always the hardest. I used to call it the "Great journey to the butt"! An epic adventure! You can write a memoir book about it later!

Offline mtb1

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Re: Cycling Patella Fracture.
« Reply #56 on: August 12, 2014, 03:39:40 PM »
"Great journey to the butt"! An epic adventure! - MDAL

Sir, you just made my day.
fractured r patella into 3 pieces 2014/01/23
surgery - k-wires, tension band, screw 2014/01/24
sent home, no cast/brace/immobilizer same day
follow-up with OS 2014/02/04
2nd follow-up 2014/03/11, ROM 90
3rd follow-up 2014/04/08, ROM 130
HW removed-2014/08/06

Offline daihard

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Re: Cycling Patella Fracture.
« Reply #57 on: August 15, 2014, 07:18:39 AM »
It's been 2 weeks since I started PT. I was able to get 115 ROM this afternoon. I still can't do much else, but the therapist told me this is pretty good flexion for someone who is 6 weeks post-op. I will keep on trying. :)
2014:
06-21  Fractured right patella
07-02  ORIF - figure 8
07-29  4-week post-op follow-up
07-31  Started PT - 60 ROM
08-07  90 ROM
08-14  115 ROM
08-21  Started bike trainer - 122 ROM
08-28  132 ROM
09-04  135 ROM
09-08  139 ROM

Offline daihard

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Re: Cycling Patella Fracture.
« Reply #58 on: August 24, 2014, 12:34:24 AM »
Another update. It has now been 7 weeks since the surgery.

I was cleared to start working actively on regaining muscle as of last Thursday. Knowing my passion for cycling, my therapist put me on an indoor bike trainer. I initially wasn't able to bring the right pedal up to the top dead centre. The therapist told me to just lock the pedals back and forth as much as I could, and in a few minutes I was able to spin it. It was painful, but it sure gave me hope.

She also used a TENS machine on me for the first time, in addition to some exercises to wake up my quad muscle.
2014:
06-21  Fractured right patella
07-02  ORIF - figure 8
07-29  4-week post-op follow-up
07-31  Started PT - 60 ROM
08-07  90 ROM
08-14  115 ROM
08-21  Started bike trainer - 122 ROM
08-28  132 ROM
09-04  135 ROM
09-08  139 ROM

Offline charlottekatt

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Re: Cycling Patella Fracture.
« Reply #59 on: August 24, 2014, 03:07:22 AM »
*balancing on one leg and applauding*   ;D 















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