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Author Topic: TTO for Patella Alta following patella tendon rupture and fractured patella.  (Read 6854 times)

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Offline Heidi S

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Hi Randoknee,
Sorry to reply here in your diary thread - I got your PM and so appreciated it. I'm unable to reply back privately as I'm under 20 posts, apparently (I get an error message)...  But wanted to thank you for the great info.  I'd been following your diary posts and other posts, of course noting you were a fellow washingtonian :)  and 12 I assume - gohawks! -  but wow you have been through a living hell from what it sounds like.   My situation seems like a picnic in comparison, although i know it's not a competition! 
I'm really glad things are feeling like they are improving for you after your fall.  I'll be interested to see how the cold turkey plan goes for you.  I have gradually been trying to back off my OTC stuff also, so again, you are someone I'll be following up on to see how things progress on that front.  I recently read a very interesting article (on FB) about people with chronic back pain - but apparently the top clinic for this issue somewhere back east holds with that same approach.  Upon admittance, ALL pain meds are discontinued immediately or asap.  If I can dig up the article I'll pass along the link - it was quite interesting about the body-mind connection around perception of pain etc..
Anyway, please know how appreciated by me (and I'm sure many others!) all your very detailed posts are, I'd say you could practically be an OS yourself (and a competent one!) judging by the level of medical expertise you have...!   I have no doubt it has helped a lot of people on this site.  And when I get to the required level of posting here I'll be following up with a return message to your PM, until then, thank you again, so very much!! Best wishes to you as you continue to heal and recover!  My best,  Heidi
12/2/14:  Fractured L. Patella, tore P. Tendon
12/9/14:  ORIF Surgery + repair p. tendon
12/23/14: PWB on crutches
1/5/15:  ROM 65
1/14/15: ROM 70
1/23/15: ROM 90
2/3/15: ROM 105; stationary bike
2/11/15: ROM 114; first steps!
3/3/15: ROM 121
3/24/15: ROM 132

Offline randoknee

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Hey Heidi,  thanks much for your nice reply.  I'll IM you with my email address if you have any question or you want to message off the board.   It may be symptomatic of some sort of knee psychosis but I've found it helpful to learn as much as I can about my condition(s) as I can so I can advocate for myself.  My OS describes me as a bit unusual compared to his typical patient.  Even though his office is 3 states away I have better contact and access to him than I've had with the two local surgeons who did my ORIFs for my ruptured tendon and Fx patella.  I grew up around medicine as my dad was an OBGYN and grand after was the first dean at the UW med school so I'm not intimidated by docs and learned to ask questions at an early age. 

And yes... Go Hawks!  This having bad knees and recovering from surgery would suck that much more if the Hawks were a lousy  football team.  But I plan on watching the game on Saturday for the duration on the seat of my bike on a trainer in my living room.  Hopefully They'll do well and provide a few more rehab opportunities.  All the best,  Randoknee
12/08 L patellar tendon rupture (mush) -ORIF  -  8/10  fx of L patella  - 8/10 ORIF L Patella 9/10  dx patella alta  - 2/11 dx "delayed union" - 6/11  L knee scope / HW remvd.- 6/13  R Knee Scope - 11/13 R knee PFA - 6/14 Left knee PFA - 10/14 L Knee TTO- 11/16 L patellar tendon repair & augment

Offline John42

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  • Complete Ruptered Patella Tendon 9 Jan 2003
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Hi RPT/RQT patients

Have a look at the undermentioned thread - contains a collection of documents which I have put together with KneeGuru - explains your injury and rehab process.

Also look at ruptured patella tendon/surgery - lots of fellow RPT patients whi share their experiences with you.

https://www.facebook.com/QuadricepsPatellarTendonRupture

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

Complete Ruptured Tendon

Offline randoknee

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Hi John, 
That's a great list of articles on the possible complications of delayed repair of quad /patellar repair.  Before I found this board, I had found and read many of the same. If I known you then, I'd have saved a lot of time. Alas, I suspect the ER doctor that originally diagnosed my total rupture as a simple sprain did not read any of these.

I view my journey through my particular maze of knee issues as a learning opportunity for others as well.  Maybe some of my issues are applicable to others maybe not. 

I ask myself the "what if" questions like:  What if, due to my original delay in the repair of my ruptured tendon, my Dr ordered periodic XRays to assess whether the tunnels used to reattach the tendon properly healed up or whether my patella was properly positioned?    I am certainly not a rocket scientist or engineer of any sort but I find it ridiculous that I was the one who observed from viewing my post surgical XRays following my subsequent patella fracture that my patella was now grossly out of position.  It seems like that one should have been picked up by one of the medical professionals (2 ortho surgeons and who knows how many radiologists reviewed my XRays) involved in my case earlier on. 

I was amazed at the simple brilliance of the Dr I saw for my third opinion to order XRays of both my knees, and not just the injured leg to properly assess my patella alta.  I refer to that as "sesame street medicine"... One of these things is not like the other... Feel free to sing along if you know the tune.

When I consulted with my fourth opinion Dr, (who is my current OS) I was struck by the nuance and detail in his physical manipulation during my initial assessment visit and his request that I try to clearly describe the nuanced quality of the knee pain that I was experiencing... Perhaps the most refreshing thing was after that exam, he said "I don't know yet what to recommend for reconstruction.  I don't have enough information YET.  I suspect there's something else going on in there, but here's what I recommend to get that information..."    That's when I figured out what a PF specialist was.

All the best.


12/08 L patellar tendon rupture (mush) -ORIF  -  8/10  fx of L patella  - 8/10 ORIF L Patella 9/10  dx patella alta  - 2/11 dx "delayed union" - 6/11  L knee scope / HW remvd.- 6/13  R Knee Scope - 11/13 R knee PFA - 6/14 Left knee PFA - 10/14 L Knee TTO- 11/16 L patellar tendon repair & augment

Offline John42

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  • Complete Ruptered Patella Tendon 9 Jan 2003
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Hi Randoknee

It is 12 years tomorrow since I ruptured my Patella Tendon - this thread did not exsist at that time, but has been built up on RPT experience.  One must understand that a RPT/RQT is a very rare injury- maybe 50 a years, mostly a sports injury, basketball, volleyball etc and the majority of PT`s and OS have never dealt with this type of injury.

I try and direct patients to the main RPT thread " Ruptured Patella Tendon/Surgery", in this we can all share our journey to normality.

I sincerely hope that you have learnt something from the KneeGuru threads on this unique injury.

Best

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

Complete Ruptured Tendon

Offline randoknee

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So true John!

You just prompted a flashback ...  When I was on my first round of PT for my RPT, my regular therapist was not at an appointment due to a sick kid.  The "fill in" wanted to manipulate my leg in a manner that was contrary to my understanding of my doctors orders.   I refused and asked her if she'd ever rehabbed a RPT.   Nope...  totally clueless!  I shudder to think what could have happened.   Like surgeons, not all therapists are created equal.
12/08 L patellar tendon rupture (mush) -ORIF  -  8/10  fx of L patella  - 8/10 ORIF L Patella 9/10  dx patella alta  - 2/11 dx "delayed union" - 6/11  L knee scope / HW remvd.- 6/13  R Knee Scope - 11/13 R knee PFA - 6/14 Left knee PFA - 10/14 L Knee TTO- 11/16 L patellar tendon repair & augment

Offline randoknee

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It's now 11 weeks since I had my TTO surgery.  It's almost 2 weeks since I strained my knee on New Year's Day.  It's been a full week now since I've taken any pain meds At all!  No naproxen, ibuprofen, or acetaminophen.  That's the longest. Without pain meds that I've gone since my original tendon rupture back in 2008!  I hope I don't jinx this by putting it into print, but today has been the first, in a long time, that I have no ringing in my ears! No tinnitus!   Wahoo!    That doesn't mean my hearing is completely normal though. I suspect  I still have a case of, selective spousal hearing disorder.  What dear?...

Dusting the meds, has resulted in un-masking some other aches and pains.  I've been working on upping the mileage of my daily walks to between 2 and 3 miles.  I concentrate on trying to maintain a normal gait and pace.  After about 2 1/2 miles, my surgical knee starts to hurt and things start swelling up.  It then takes some kicking back and elevating the leg to get things more back to... normal-ish. 

Overall things seem to be improving.  This last week, I took the crank shortener off my bike, so I now have normal crank lengths and can easily turn my pedals through a full pedal revolution with no stress on the repair.   I've been working with my bike on an indoor trainer for a minimum of a 1/2 hour at a session (much longer during Seahawks games).  while it's good exercise, it's not like getting outside and hitting the road. 

Today it wasn't raining, the fog finally lifted and the roads dried up a bit.  So I grabbed a helmet and took the bike outside.  Oh baby, oh baby!  8) Sunny, blue skies, quiet country roads and a clean bike.  I kept the ride relatively short (8.5 miles) pretty flat (less than 250 feet of elevation gain for the ride) and slow (mostly between 10 a 15 mph).  I still saw a couple of bald eagles,  red-tailed Hawks, four camels and the usual cows, horses, dogs and cats.    When I finished the ride, I took my dog out for a two mile walk.  That may have been a tad much...  I'll probably be feeling the fruits of my excess tomorrow.  The rain is suppose to move back in over the next couple of days so I can recover then.

« Last Edit: January 14, 2015, 07:42:03 AM by randoknee, Reason: Clean up »
12/08 L patellar tendon rupture (mush) -ORIF  -  8/10  fx of L patella  - 8/10 ORIF L Patella 9/10  dx patella alta  - 2/11 dx "delayed union" - 6/11  L knee scope / HW remvd.- 6/13  R Knee Scope - 11/13 R knee PFA - 6/14 Left knee PFA - 10/14 L Knee TTO- 11/16 L patellar tendon repair & augment

Offline randoknee

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Since my last post I found that the daily grind of Pt along with walking a couple of miles and the occasional stumbles and trips that seem to be a common experience with muscles and prioreception that is just off a bit, my general aches and pains caused me to take a couple of days off.  It was really nice to just relax and let things calm down.  So maybe it was one step backward, but today I took two steps forward.  A beautiful sunny day with no rain and temps pushing 60 degrees F, I took the bike out on the road.  8)  Took it easy with a comfortable 12-15 mph on the flats...slower on up hills and faster on downhills.  31 miles (50km) later I rolled back into my driveway just before dark after a lovely afternoon of bald eagles along the river and gorgeous views of Mt Baker and the BC costal range.  So much nicer than the tedium of the PT grind.  I've got some tired muscles but not anything painful.  I spent an hour in the hot tub this evening for a little hydrotherapy.
12/08 L patellar tendon rupture (mush) -ORIF  -  8/10  fx of L patella  - 8/10 ORIF L Patella 9/10  dx patella alta  - 2/11 dx "delayed union" - 6/11  L knee scope / HW remvd.- 6/13  R Knee Scope - 11/13 R knee PFA - 6/14 Left knee PFA - 10/14 L Knee TTO- 11/16 L patellar tendon repair & augment

Offline randoknee

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So I'm 15 weeks post surgery now.    I'm making good progress and have much less pain in my surgical leg and with the ability to use that leg for more of the daily work, the other leg is getting the rest it needs so it isn't hurting as much either. 

This last weekend I got out on my bike and rode a bit over 100km (65miles) in the rain on Saturday and another 50+km (35 miles) on Sunday.  It was great.  I didn't experience any substantive knee pain at all.   My muscles sure felt it but I felt surprisingly good on the Sunday recovery ride.  The only area in my range of motion that is causing me any pain is when I'm weight bearing and between 0 and 15 degrees of flex.  My patella is still riding a tad too high on the leg and until the patella becomes fully engaged in the femoral groove, it's a rough and a tad painful.   Once I get past that 15 degrees of flex, it engages smoothly and it works like butter.   So the key for me is to set my bike up so at the bottom of my pedal stroke, I still maintain a slight bend in the knee.  It'd be nice if I could ride my bike where ever I needed to go and didn't have to walk...

So in summary so far,  The repositioning of my tubercle down the leg 11mm and rotating it medially 5mm is a help.  I suspect moving it slightly more distal possibly could have helped my 0-15 degree flex issue, but It likely could have caused more problems and complicated a complicated surgery even further.  Pedaling from a standing position puts that leg into a straighter position and thus causes me more pain, so I'm sticking with sitting and spinning.     I don't perceive any lateral deflection of my patella in my left leg at all, even with the leg in full extension.   I still have a bit of numbness on my lower leg from the surgical incision.  It's funny that with the number of times my left knee has been cracked open for surgery since 2009, I don't have the skin numbness in the knee area at all.  I guess the nerves right around the upper part of the incision area have done their work around and made their adjustments.   This last surgery incision ended up another 3 inches or so lower on the leg so those surface nerves haven't figured it out and made their repairs yet.   As an interesting side note, I added up all of the incisions in my left leg from my procedures and the total exceeds my inseam length of 31 inches.

Over the next couple of months, I plan on increasing my cycling mileage and getting my muscles trained up again to be able to do sustained effort.  My other main plan is to get serious about shedding the excess pounds and taking pressure off of the knees and the whole bod in general.   

The improvement I'm seeing in my left leg is now bringing my right leg into a more prominent area of discomfort.  When I had my PFA on that leg, a lateral release was done to access the back side of the patella for the plastic button to be attached.  I do have a very pronounced lateral deflection of the patella as my leg approaches full extension causing some pain.  The medial rotation of my tubercle during the TTO took care of that issue for me in my left leg.   I suspect an MPFL procedure may be necessary in my right knee at some point in the future, but right now I'm going play with Kinesio Tape to help with the full extension positioning of my patella.

« Last Edit: February 11, 2015, 04:14:57 AM by randoknee, Reason: simple correction »
12/08 L patellar tendon rupture (mush) -ORIF  -  8/10  fx of L patella  - 8/10 ORIF L Patella 9/10  dx patella alta  - 2/11 dx "delayed union" - 6/11  L knee scope / HW remvd.- 6/13  R Knee Scope - 11/13 R knee PFA - 6/14 Left knee PFA - 10/14 L Knee TTO- 11/16 L patellar tendon repair & augment

Offline Chin

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Dear randoknee,

Thank you for sharing. I can only imagine what you are going through. Personally for myself, my 12 year old son broke his patella (in 4 pieces), tore the patella tendon and also a dislocated patella two weeks ago.

He is a sporty boy having just managed to get onto the black runs on the ski slopes last year and was looking forward to another ski trip this year. Unfortunately he suffered the injuries whilst doing high jump in school.

Naturally, my wife and myself are quite upset and concerned (understatement) over his injuries. But reading how yourself and many others are coping with your injuries and overcoming it has inspired me to recollect myself and to do what it takes to help my son on the long road to recovery.

I look forward to reading your updates and I sincerely wish you all the best.

Best Rgds


Offline randoknee

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It's been a couple of weeks since I've posted to my diary.  I'm making some good progress in my TTO recovery but this post will be a bit of a catharsis...sorry but,  out comes some of the laundry.

The knee with the TTO is coming along fine.  The swelling is down but I've come to the realization, that it will never look normal.   Aside from the big old scar down the front of the leg, my patella still sits a bit high on the leg and my external knee appearance is more of a 'big o'l thing' than a cute little patella.  Maybe someday the swelling will completely subside and it will look normal... but I doubt it.   The important thing is that it is working better.  I can walk with a normal gait and even walk down a slope without feeling like a runaway train. I have been able to bike without any pain in my left knee at all.  So far this week I've gotten in a couple of 43 mile rides and I'm hoping to get in a couple of 60 plus mile rides before the weekend is over.  I'm not pushing too hard yet and gradually working on training the muscles to do the sustained work.

When I'm cycling, I'm actually experiencing more pain in my right knee.  When I had my PFA on that knee a lateral release was done so my patella could be inverted to slice off the back and fit me with my plastic button.  Now, when my right leg approaches full extension, my patella tends to track laterally, causing pain.  I'm using Kinesio tape to try to keep the patella in the groove as best as I can but I suspect somewhere down the road, I I'll need an MPFL repair on the right leg, but sure as hell, not anytime soon.

Other stuff...   

When I went down to Park City for my TTO surgery late last fall, I made the ambitious decision to have trigger finger surgery on my right hand on the friday before I had major surgery on my left knee the following monday. 
Perhaps this wasn't the smartest idea in the world.  The necessity to use crutches, I'm sure delayed my recovery from the trigger finger release surgery.  But that's all better now and my hand is working properly and pain free finally...  no biggie

Biggie...    So when I was having my post trigger finger release tibial tubercle osteotomy done on that monday in Utah, my wife was having a post mammogram biopsy back home.   The result of that was confirmed a bummer and has resulted in surgery and now chemo.  Aggressive disease so aggressive approach to treatment.    Lots to learn, and lot's of time in Dr's offices, clinics and hospitals.    So my little knee issues pale in comparison to the major $#iT-storm my wife is working through...   I'll take a bad knee or two any day.   So when life hands you a bunch of lemons...  at least it isn't boring.

On the bright side...
I didn't buy a season pass for a snowless ski area.   I don't live on the icEast coast,  and with the near forecast of blue skies and temps pushing 60 for the weekend, I'm looking forward to a nice long bike ride on my upcoming birthday.

Cheers! 8)
12/08 L patellar tendon rupture (mush) -ORIF  -  8/10  fx of L patella  - 8/10 ORIF L Patella 9/10  dx patella alta  - 2/11 dx "delayed union" - 6/11  L knee scope / HW remvd.- 6/13  R Knee Scope - 11/13 R knee PFA - 6/14 Left knee PFA - 10/14 L Knee TTO- 11/16 L patellar tendon repair & augment

Offline randoknee

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Not a lot of change since my last post.   

I've had some nice bike rides and have managed 5-6 hours of nearly continuous bike riding at a whack without any significant knee pain.  When I do ride, I'm still using Kinesio Tape to help keep down swelling around my knees and to help nudge them (primarily my R patella)  into the right position to stay in groove.    The weather has taken a turn back to wet and rainy as of late, so I haven't been out for any long rides in the past couple of weeks.  As the weather improves, hopefully my saddle time will increase as well.

I find I can even stand and pedal for brief periods without too much pain.   When I stand and pedal the pain that I feel has a very deep quality that I think is more related to my PFA implants  into the femoral groove and not related to anything to do with the TTO surgery.  Other than some surface numbness on my TTO leg from the typical nerve abuse of slicing down the front of the knee, I don't have any residual pain from the TTO procedure at all. My doc countersunk the screws so I don't feel them at all.

I'm working hard on shedding the excess weight I'm carrying by logging my food and activity.   I figure this is probably the most important thing I can do do make significant improvements in how my knees feel.  Last week  I picked up a Fit Bit Surge to help with the effort.  It's like having a fitness coach sitting on my wrist 24/7 helping me watch what I eat and to remind me to get off my backside.     I'm now walking around 5 miles a day at a brisk pace with a normal gait, so this is an improvement. 

Cheers
12/08 L patellar tendon rupture (mush) -ORIF  -  8/10  fx of L patella  - 8/10 ORIF L Patella 9/10  dx patella alta  - 2/11 dx "delayed union" - 6/11  L knee scope / HW remvd.- 6/13  R Knee Scope - 11/13 R knee PFA - 6/14 Left knee PFA - 10/14 L Knee TTO- 11/16 L patellar tendon repair & augment

Offline randoknee

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I keep making steady progress post osteotomy.  While the leg isn't perfect, it's so much better than before my TTO, I happy with it.    I'm regularly walking 5-7 miles a day and as the weather cooperates, I'm getting my cycling miles up too.   The last three days I've ridden 42, 34 and 55 miles respectively.  I haven't yet attempted any big climbs, but will give that a go sometime in the next couple of weeks.  I'll also try to work up to 100 miles plus over the next couple of weeks.   I am to the point where I can now for brief periods of time get out of the saddle and stand on the pedals without much pain.   I still think about it before I do it and am still limited to doing it for usually less than a minute at a whack.   Part of it, it think is getting the appropriate muscles rebuilt.   The pain that I feel has more to do with my PFA implants in the femoral groove and the point loading with the 100% weight transfer when standing an mashing the cranks.   It still helps to take a couple of extra strength tylenol after a major effort.

I'll periodically continue this diary as I experience any major gains or setbacks, but basically plan on plodding on with my progress.  8)

12/08 L patellar tendon rupture (mush) -ORIF  -  8/10  fx of L patella  - 8/10 ORIF L Patella 9/10  dx patella alta  - 2/11 dx "delayed union" - 6/11  L knee scope / HW remvd.- 6/13  R Knee Scope - 11/13 R knee PFA - 6/14 Left knee PFA - 10/14 L Knee TTO- 11/16 L patellar tendon repair & augment

Offline Beeps

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Dan,

I have to thank you sincerely for your posts in this forum. Six days ago, I was diagnosed with delayed union almost 5 months into my recovery. Your story is one of few I've been able to find since, and it gives me hope that maybe I can have a normal life someday.

I wish you the very best in your recovery, and I'll be on the lookout for any new posts you make.

Thanks again!
11/4/15 - car wreck, fx left patella
11/9 - saw OS, dx nondisplaced comminuted fx, no surgery
12/18 - WBAT, still on crutches
12/28 - started PT, ROM of 40
2/8/16 - can finally do SLL! ROM 75
3/17 - recent CT scan revealed no healing, dx delayed healing. ROM 96