Recovery From Ruptured Patella Tendon

[BustedWheel]

This is just from my own personal experience as a "middle of the road" patient.  Lots of good information on this site, but lots of conflicting information out there.  Very disheartening to read posts about people out of work for weeks and months.  Talking to my doc, and from my own experience, this is definitely not the norm so long as you are relatively healthy and you have a clean rupture, i.e., tendon off bone, no avulsion fractures, no other significant damage.  Basically, there are three rehab methods.  If you are a college or pro athlete, you might start right away.  If you are aged or have other health problems, they may lay you up in a cast for 6 weeks or so with no movement.  However, my understanding of the "run of the mill" treatment for a healthy relatively in shape adult is: (1) surgery; (2) weight bearing as tolerated after surgery, but pretty much being out of work and confined to your couch, etc. for 2 weeks; (3) can go back to work after 2 weeks but it won't be easy or comfortable; (4) can get out of using cane/crutches after 3-4 weeks if tolerated; (5) you have to remain braced pretty much for at least 6 weeks.  You can go to the gym and work out upper body as tolerated.  After 6 weeks or so you can go to formal rehab--your informal rehab for the first 6 weeks just trying to carry out normal life activities.  The modern view is that the repair is made to reattach the tendon and then a protective or "relaxing stitch" is added around the top/sides of the patella; this protects the repair by taking the strain in the first instance--if you have an oops moment or push it too much you will feel the tug in the protective or "relaxing" stitch above your knee.  Bending your knee or doing leg raises are the two "anathema" activities you should avoid as much as possible for the first 6 weeks, as this is what puts tension on the repair (not walking on it--you should be able to walk and weight bear as tolerated pretty much right after the operation, with crutches at first, then with a cane, then without anything). Granted, people heal differently, but the most annoying thing on the internet is reading about all the people for whom months and months have passed without them being able to walk, drive or get off the couch--this is definitely not the norm, for 2 weeks it sucks big time, after 2 weeks it sucks but you are able to adapt to get your life back a little (and every week after that it gets better), at 6 months you should be able to jog outside.  Even with a complete rupture, if it was a clean rupture, and you're relatively healthy--if after 6 weeks or so you're still out of work, confined indoors, and a basket case on your couch you should re-evaluate.  For those of the rest of us who suffered from this and are under the "bell curve"--not super athletes on the quick recovery end but not ultra slow to recover--you can get back to a tolerably normal life fairly quickly, meaning getting up, getting showered, getting to work, going out to eat, etc.  All the other stuff will come in time.     

[John42]

Hi BustedWheel

I have read your interesting experiences - before giving you my opinion, could you inform us where you live, what was your hospital experience? and how did you sustain this serious injury.

Best

JohnK/ Manchester UK

[Stuart Rulka]

BustedWheel , the Bell curve holds true for large populations  but individuals will always find their own level. Hate to throw a wrench in your theory but as a 66 year old I should have fallen in group3 but my PT had confidence in me and not knowing any better I was back at work ( primarily seated I admit) in 4 days, and  hiking at 6 weeks.
 I suspect that all too often  conventional wisdom ( this is the way it's always been done ) is restraining people from fulfilling their capabilities, and the greater the delay the longer the road to recovery!

[BustedWheel]

46 year old former military officer and current lawyer.  Lifelong gym rat.  Thought I was stepping off a last step but there was one more until the landing.  Came down hard on right foot, fell, strained my quad and completely ruptured patella tendon.  Knee cap shot up into my thigh, couldn't get up, they loaded me into the meat wagon and took me to hospital.  Got operated on one week later after swelling went down (you need to have surgery no later than 14 days after injury under accepted treatment protocols, otherwise your recovery is harder and will not be 100%, odds are; but they have to wait for swelling to go down before they operate, so they usually wait 5-10 days after injury).  I'm in a major Northeast U.S. city with hospitals, doctors and medical schools galore (lots of sports injuries here because of tons of high schools, colleges and also professional teams).  Doc that operated on me is professor of ortho surgery at a local medical school as well as having a private practice.  Characterized it as a clean injury, no fractures, bone chips or other damage other than strained quad. Protocol was repair with protective/relaxing stitch, no removable wire, pins, plates, screws, etc., just sutures.  Walked out of hospital next day on crutches.  This is not a weight bearing injury like a fracture, so you can put weight on it as tolerated.  I was given "conservative" post operative treatment, meaning 2 weeks laying on couch, then going back to normal day to day activity in locked brace, no real physical therapy or knee/leg exercises until 6 week mark.  The goal is to get you up and back to some semblance of normal life after 2 weeks if possible, studies have shown that the two factors that negatively affect recovery are delay in surgery more than 14 days after injury and prolonged post surgery inactivity (tendons have to have some movement and stress to heal better, thus early mobility is better).  The trick is not to do too much, discipline is key--but prolonged immobility is not good, the tendon ends up structurally weaker when it heals if there is no movement or loading.  Of course!again, my injury was just tendon off of bone insertion, which is best case.  If you have a fracture or avulsion it won't be as"easy." 




 

[BustedWheel]

Stuart, 4 days and back at work is impressive...I think I might have attempted my first shower on Day 4.  I don't usually post on the internet, but when I searched for info on rehab and recovery I found mostly the horror stories.  Good to see somebody else had an easier rehab---not that its easy, but not as bad as many posters seem to say.  Glad I had the benefit of a top doc in a major US city, who is using the latest treatment protocols.  Some of the stuff I read on the internet, even though posted recently,  were treatment protocols and post op rehab that went out in the 80s or 90s.  Remind me not to fall down steps in England.

[John42]

Hi BustedWheel

Thank you for your interesting posts on this thread - very encouraging to read such progress after sustaining such a very rare injury - perhaps you might like to inform us the time sequence since sustaining your RPT injury - what is you ROM (range of movement today in how many months.

Would you like to inform us where you live as this is a good reference point as the majority of RPT patients sustain a RPT injury following baseball, volley ball i e a sports injury and this is very popular in the States, but not on this side of the pond.

Very rare to find OS and PT with such skilled knowledge.

Would like to refer you to the thread " Ruptured Patella Tendon Surgery", where the greater majority of RPT posts are to be found.

Best

JohnK/ Manchester UK

[BustedWheel]

Philadelphia, PA.  Operated on at Hahnemann Hospital, which is Drexel University's Medical School, I believe.  Think  Jefferson is also a good ortho place.  6 weeks out of surgery, 7 weeks since injury.  My quads, if they deactivated, pretty much back online.  Rehab is not forcing range of motion, I'm probably at 45 degrees with no discomfort, because the protective/relaxing stitch is still holding, this suture is designed to dissolve or break over time, naturally freeing up motion.  I'm not obsessing over degrees, etc.  After playing sports such as baseball, football and rugby , being in military, trying to lift weights and do cardio a couple times a week,I'm in tune with my body, injury, pain, etc.  I am in no way near where I was., and I'm not sure if I will get back to where I was, especially with my intensive lifting/ cardio routines I used to do, but my moderate short term goals, such as mobility and getting to work and some social activities have been met.  My longterm goal is to run my typical jogging route in the same time as preinjury at surgery plus 6 months.  In between, I'll take what improvement I get.  You should feel better every day, if not, somethings wrong.  So far, every day for me has been better.  The treatment/rehab used is designed to get patient on their feet and back at work, school, driving as soon as possible.  As far as athletic activities, etc., that can wait and will come in time.  The docs and pts can measure what they measure, what's important to me is how I feel and what I can accomplish.  Not to knock docs and pts, but theirs is an inexact science, and they will be first to tell you to listen to your body and practice moderation.  The reality is in America if your out of work more than 30 days you get fired or go on disability, so the post surgery rehab is geared to getting you up and back on track as soon as possible from these injuries.

[John42]

Hi BustedWheel

45deg ROM is quite normal at 6/8 weeks - your efforts and the help of the PT is to commence stretching that tendon over the coming weeks, the next mile stone is 90 deg at 12/14 weeks and anything over 120 deg is a bonus.    The good leg should be in the region of 135/145 deg ROM.

I suggest that you click onto the undermentioned link, which will show you a set of documents which I put together with KneeGuru.   Documents will cover understanding your injury and the suggested rehab procedure.

You should also post on the RPT thread   " Ruptured Patella Tendon/surgery "   every bit of advice is favourable and please ask questions.   

Best
JohnK/ Manchester UK 

https://www.facebook.com/QuadricepsPatellarTendonRupture

[madvillain]

double post sorry

[madvillain]

Stuart you were  66 when it happened!  Man, you are a badass we need to meetup sometime when I get these braces off for a beer if you are still around the PNW.

what a great thread.  Frankly when I first started load bearing at day 4 without crutches or any pain or anything I thought "SOMETHING IS WRONG" after I read of all the "I was off my feet for 6 weeks" stuff that you can find online.   And I had extreme anxiety that I had seriously harmed myself.

I was able to visibly observe my thighs had shrunk from just 4 days off my feet.  Atrophy is real. You gotta stop that atrophy ASAP imo and that means doing your iso sets and getting on your feet some and doing just basic stuff like sit ups even helps keep the quads engaged some.  Trust me I never knew the quad had anything to do with a situp until now. 

3 weeks later I'm doing better every day (can almost walk with a normal gait with braces set to 20 degrees) and I made it a very specific point to ask my (US based) surgeon at the two week followup "is there any limit to the weight bearing I can do if I'm in no pain" and he very quickly said "nope".

Granted I had a "clean" rupture (ha, jumbo shrimp time) so if you significant other damage or have a fracture it will be different, but hey you probably didn't rupture both like I did!

So I think that's the accepted science now at least in the US.  Get on your feet!  I will never forget my first "trip" to the bathroom after surgery.  Literally pulling myself forward with my toes and leaning heavily on the walker.  I pissed all over the floor and high fived someone on the way back to bed.  I left the bed!

I'm an athlete and always have been and I say it every day if you're an athlete and you have this injury the same gung ho attitude that got you into it (years of jumping, squats, etc!) is going to get you out of it with your PT.   BUT -- as mentioned.  You must be careful.

I have learned that well.  My body is not invincible, maybe at 21 it was, but at 31 and older? Hell no.  Be careful.  I mean, hell, I used to run down trails and jump from boulder to boulder at times.

I'm never doing that crap again in my life.  Careful, measured steps coming down the trails, not to mention stairs.  And you better believe I will be wearing some pretty solid braces when I return to sports.

Mental hurdle is going to be really, really tough.

[John42]

Hi Matt

Just bear in mind   " PATIENCE" - healing is not an overnight wonder.

Best

JohnK/ Manchester   UK

[madvillain]

Hi Matt

Just bear in mind   " PATIENCE" - healing is not an overnight wonder.

Best

JohnK/ Manchester   UK

No doubt John, without a doubt.   

[Slow2709]

Hey all I'm new here. I ruptured my patellar tendon 12-9-14 surgery on 12-11. It happened while playing a "harmless" game of horse trying a regular layup. I had a few questions as I have been reading quite a few posts. First I just had my sutures removed and the doc said in two more weeks she wanted to check on the healing prior to starting pt, is there anything aside from quad flexes I can do to start bending my knee? Also I have been instructed to only sponge bath it and it's driving me nuts now that the sutures are removed is it safe to get the knee wet from a shower? Thank you all for any help in advance, and this site has been a tremendous source of hope for me!!!!

[John42]

Welcome to newbie Slow2709

This is a very exclusive club for RPT patients and you have made the first step by reading some of the previous posts on this thread.

It`s quite safe to wet sponge the area of your operation - is the leg in a plaster cast or a brace. Bear in mind that healing can take up to 10 weeks and then the PT will begin - six months of hard work.

Where do you live?

Suggest that you click on the undermentioned thread - it contains a collection of documents which I have put together with KneeGuru and you will then understand your injury and the rehab procedure.

Remember PATIENCE - Listen to your knee - don`t push it - watch out for wet leaves, ice and snow.
Don`t drive until your OS gives you the OK.   Sleep with a pillow/cushion between your knees.

Please ask questions - we are here to give you advice.

Best

JohnK/ Manchester UK

https://www.facebook.com/QuadricepsPatellarTendonRupture

[Slow2709]

Hi john thanks for the welcome. I live in the US, Florida to be precise. I started driving out of necessity as my girlfriend broke up with me the same day as my surgery. She was gracious enough to take me to my first two follow ups but this week I started driving (it was my left leg so it isn't too bad just painful at different angles).

I'm in a brace with an ace wrap. I have made huge strides from week one to week three with mobility, as I have learned a few tricks that work for me. The doc said she wanted to take it slow because she said I did damage to my retinaculum and that my tendon looked like a horses tail from years of tendinitis. I'm 37 and have had patellar tendinitis since high school.

 I'm impatient but I'm trying to take it slow, and keep in good spirits I hit a bout of depression but this site and a few YouTube videos have helped me a lot! Thanks again for the warm reception.