Recovery From Ruptured Patella Tendon

[BustedWheel]

Update.  Injury plus 8 weeks and surgery plus 7 weeks (more or less). 

Got script to start PT next week, which will be week 8 after surgery.  ROM at about 60%, with surgeon saying goal of 90% in another 2 weeks, which would be week 10. 

Repair solid, but knee cap did sneak up a little after surgery based on x-ray comparison.  Surgeon says this is normally seen as the repair heals (or, alternatively, it could be function of positioning of x-ray angle, it's apparently not an exact science).  From the naked eye, both kneecaps look to be in about the same place. 

Can do straight leg raise which means repair is holding.  Not easy or pleasant, but I can do it.

Haven't noticed an incredible loss of thigh size/muscle on repaired leg, but muscles are definitely not firing the same on both legs.

Have been walking and weight bearing with no cane or crutches since about week 5-6 after surgery.  Have brace to be locked at 60 degrees, although I don't think you actually flex your knee to 60 degrees to walk, so I am not sure what effect brace has with the walking.  I can't easily flex to 60 degrees anyway, more like 45 degrees with no real discomfort.  Still have limp, right leg (repair leg) lags in my gait, even if I will it to move faster.  Hopefully rehab will work on that.  Drove for first time at about week 6 after surgery, no problems except getting in and out of the car (and it was easier than getting in and out of the cabs I've been taking).  Luckily, I only need to drive infrequently even when healthy, so it's not a big deal.

Surgeon said it takes 10-12 weeks for tendon to heal, there is a fine line between taking it easy and moving it that varies patient to patient.  Too aggressive and you can re-tear, but not enough movement will make it difficult to recover range of motion and normal use later.  I will admit I have daily worries about damage or re-tearing requiring another surgery.  I have not been aggressive with the knee, but I haven't been completely babying it either, and my daily activities put some strain on it, I would think.  If I had the luxury of spending 6 weeks post-surgery on my couch watching TV I would, but since I don't I haven't.

As far as practical aspects, the most difficult thing post-surgery was taking a dump, which is not easy (and quite painful) when trying to maneuver a leg in a locked brace.  But that gets easier every week. 

As far as showering, I was told not to shower for 3-4 days after surgery, but then I had to change the dressing so could shower.  Problem, was, for the first 2 or 3 weeks or so, I couldn't get in the shower as I couldn't lift the repaired leg over the bathtub and into the shower.  Best I could do was straddle the shower with one leg in and one leg out, and do my best with a washcloth to get clean.  My surgeon said even with sutures, you can shower, just don't have water beating on them. 

My incision healed fairly well, I am working on the scar now with some scar gel.  Knee is numb on outward side, and incision site burns a little when my pants rub against it, but surgeon says that is normal and may clear up in time.  It's noticeable but not that bad. 

Moderation in all things might be good advice post-surgery. 

[bballkingofnba]

Busted - Thanks for sharing your experience. I think I was in the same mindset as you when I had my injury. I agree with everything you said about noticing improvements on the regular. Mind you, I also did not have a clean rupture like most people. I was in a car accident and the door smashed into my knee cutting my tendon in half and breaking my kneecap.

However, in terms of ROM tho it was a long while before I could bend my knee with weight on it due to the fracture, my PT let me passively bend my knee as I could tolerate it with a rope on the table. I was 22 at the time and I think for young people they put you on a more aggressive protocol. My doctor wanted me to bend upto 90 degrees by 6 weeks but I think I was able to get to around 110 in 6 weeks without too much pain or discomfort. And i think by week 11 I had full ROM.

Hardest part of my recovery was getting my muscles to fire because my leg would not bend when i would put weight on it due to severe pain from my fracture. In fact, 2.5 years later I still have pain from the fracture when i go up and down the steps but the surgeon said the tendon healed as well as it could have. Even my kneecap is slightly higher and my surgeon said that is very common because scar tissue heals the injured tendon and to gain the same amount or close to the same amount of ROM scar tissue tends to stretch more because it is not as flexible as normal tissue. With people fortunate enough to have a clean injury, I think it should be a successful recovery given that the PT is followed religiously.

[madvillain]

You're doing great Wheel keep it up.  We all heal at various rates you know your body better than anyone else.

I admit I am terrified of the shower, slipping in it.  I won't let myself get in the tub right now I just lean over (hurrah core strength!) with my hand on the tile wall and let the water wash over me -- works great for hair and upper body, lower body is basically just a sponge bath, but it gets the job done.  I use high quality anti-jock itch powder all over the crotch area  really helps keep everything nice and clean and dry.

Today is day 29 from surgery for me and day 30 since I ruptured both patellar tendons.  I must say things are progressing so much better than I imagined.  Surgeon gave me permission at 4 weeks to set braces to 20 degrees for walking and boy it's great to just walk with a little hitch now instead all stiff legged like a weirdo.  I admit I am getting sick of some of the looks people give me.

My legs are still shrinking but I've started lifting again at the gym and I do as much with the legs as I can.  All straight legged and really low weight stuff but I figure some is better than nothing.  A lot of just "all way" leg lifts, some using the yoga ball, some just on the ground or grabbing a railing.

I have a bit of a persistent (comes and goes) minor ache in the left knee.  I wouldn't describe it as pain it's sorta like the feeling you get when a bone is healing almost like an itch mixed with just the slightest ache.  On the pain scale I'd give it a 1.  usually it starts around mid afternoon, comes and goes, and stops overnight.  It's nothing that worrisome but I will ask the doc about it in a couple weeks.

I'm going to joke with my surgeon he musta practiced on the left one first 'cause the right one is even better, zero pain at all!

ROM is to about 40 degrees but that's plenty for now.  I do my heel slides every other day until failure, which is usually around 50-100 depending on what else I did first.  I really think the heel slides are key they work both the ROM and the Quad and when you can't go any further you just stop, natural safety barrier, unlike a knee buckling in the shower.

I have been doing research on this compound called "Cissus" that is a well known herb used for healing in Thailand and Africa.   Personally I don't give much credit to "traditional" herbal healing (lotta hooey) but the more I research this herb the more it sounds like something that should be at least discussed as a healing aid post surgery.  I am going to mention it to my surgeon but frankly at this point I've already read more studies on it than he has probably.

Does anyone have any experience with it?  It's fairly well known in the body building community as an aid for tendonitus.  Apparently it increases collagen levels.

[BustedWheel]

Coming up on 9 weeks after surgery to repair RPT right knee, clean injury, tendon off of lower right knee cap.  Holes drilled through kneecap, repair made, protective suture also put in (also called relaxing suture).  All sutures stay in, so don't need any more operations (knock on wood).   

Can walk with not too much problem.  Operated on knee is a little stiff, mostly above the knee cap, or even under it slightly on the top side.  Easily have 90 degree range of motion.  Rehab is 2 times a week, hour session each, plus "homework."  TENS unit on teardrop muscle in quad.  Quad sets (easy exercise, but still working on that teardrop muscle), straight leg raises (can do no problem) and side leg raises (also no problem).  Exercise bike, no tension, 15 minutes, able to go all the way around first try.  PT will add some sort of squatting exercise next session.  Massage of knee and scar.  Icing at end for swelling control (even though PT says there is hardly any swelling).  All in all, PT said repair is solid, everything looks good, should come through this fine, even though healing could take up to a year.

Practically, can go about day to day activities relatively normal.  Still have a little hitch in my gait.  Stairs are still a problem.  Can go up slow in normal fashion with good handrail.  Going down is one step at a time.  Still tentative walking on downslope, going up slope is no problem.  Walking speed coming back up, but still slow going.  PT says the joint wants to move, so walk as tolerated and concentrate on gait.  Would not even consider at this point any weightlifting with legs like I used to do, but still getting to gym 2-3 times a week for workout (maybe that will come later in PT, not sure).

Thinking that by the time spring hits here in the Northeast US, I will pretty much be back to normal as far as day to day activities, and able to ramp up exercise a little.  I set a goal for myself to be able to jog my normal route in my normal time at operation plus 6 months, we'll see.

[madvillain]

wheel, you are doing great, certainly ahead of most people.   Good to hear your success.

[Kaddydee]

Busted Wheel

So glad to hear everything is going well for you!
I'm also 9 weeks post op and am amazed at what you are up to.
Your post gives me an insight into what I might be able to achieve in a couple of weeks (!?!?) Can't wait to get on that bike again!

Take care,
Kath

[BustedWheel]

12 weeks since injury, 11 weeks since surgery.

Walking no crutches, no brace, no discernible limp so long as I concentrate.  Can go up stairs okay, starting to go down but it's a challenge.  As far as ROM, pretty much the same on both legs.  As far as strength, repaired knee is much weaker.  As far as day to day activities, can pretty much go about them without too much trouble.

As far as athletic/work out activities, go to gym 3 times per week.  Can lift free weights and machines for upper body and core pretty much the same as pre-injury.  No leg extension machine.  Can do hack squat machine, leg curl machine, some other machines that don't put pressure on knee. 

Have formal PT twice a week.  For knee specifically I do some squats on a hack squat machine, some squats against the wall using an exercise ball, leg lifts, heel slides, and some other exercises to get quad strength up.  Gait training is walking on treadmill under observation.  Nothing complicated.

Pretty happy where I am at week 11.

 

[madvillain]

12 weeks since injury, 11 weeks since surgery.

Walking no crutches, no brace, no discernible limp so long as I concentrate.  Can go up stairs okay, starting to go down but it's a challenge.  As far as ROM, pretty much the same on both legs.  As far as strength, repaired knee is much weaker.  As far as day to day activities, can pretty much go about them without too much trouble.

As far as athletic/work out activities, go to gym 3 times per week.  Can lift free weights and machines for upper body and core pretty much the same as pre-injury.  No leg extension machine.  Can do hack squat machine, leg curl machine, some other machines that don't put pressure on knee. 

Have formal PT twice a week.  For knee specifically I do some squats on a hack squat machine, some squats against the wall using an exercise ball, leg lifts, heel slides, and some other exercises to get quad strength up.  Gait training is walking on treadmill under observation.  Nothing complicated.

Pretty happy where I am at week 11.

 

Hey busted sounds like you are doing well and putting the required work in.  Do you notice any pain after you workout?  I went very hard at the gym this Tuesday and had some soreness towards the bottom of my left tendon, by the shin, afterwords and took yesterday off to try and get it to calm down.   That and a lot of icing seems to have worked,but as I ramp up my workouts finding a balance between pushing it and not going to far is going to be a challenge.  I'm capable of of it but need to be conscious of it.

I'm also still working on my gait.  I have to remember to try and put a little bend in the knees when I'm walking.  It's annoying but last week I hadn't even remembered and/or had the VMO strength to do it, so that's progress.   This is the first week (8 weeks and 4 days now from surgery) that I've gone completely braceless (I bought some smaller ones a couple weeks ago) during my workday and it's a nice feeling.

Going up stairs is not a problem for me but going down is still pretty tough.  I get a lot of practice at my apt which I guess is a blessing!