muscle wasting after orif patellar fracture

[Sampson19511]

Help.  I am tired of this muscle atrophy.  I want to bad to get back to gardening, mountain hiking, snow skiing, etc.  My postop ORIF patella leg is 1 to 1.5 inches smaller than the good leg and I workout all the time, lift weights, mow one acre with regular mower (although it takes three days now instead of 3 hours).   Do I have nerve damage.  TENS unit really does nothing.  I had no health problems until this fracture of the patella and surgery with screws and wires.  Please help.  Thanks, Susan

[wahootri]

Help.  I am tired of this muscle atrophy.  I want to bad to get back to gardening, mountain hiking, snow skiing, etc.  My postop ORIF patella leg is 1 to 1.5 inches smaller than the good leg and I workout all the time, lift weights, mow one acre with regular mower (although it takes three days now instead of 3 hours).   Do I have nerve damage.  TENS unit really does nothing.  I had no health problems until this fracture of the patella and surgery with screws and wires.  Please help.  Thanks, Susan

Hi Susan, I went through the same thing and I feel your frustrations!! I'm now 16 month postop and 8 months post hardware removal. How far out are you? I couldn't really advance much quad strength until I got the hardware removed as it was too restricting on my range of motion and ability to exercise. My background is as an athlete (marathon runner, triathlete and skiing) so I have been determined to get back as you are. Cycling has been huge for me as it's a great way to build quad strength without tough impact on the knee. I've been cycling 3 days per week either outside or on an indoor bike trainer and I've noticed the largest gains from that. That said, my doc told me it takes nearly 2 years to rebuild the quad (and 2 weeks to lose it!) so it is a long process and you may always notice it being smaller forever...it's a long process!!

[Sampson19511]

Hi and thanks for your reply.  I just noticed it today 5/17/18.  Not sure how to keep up with these posts.  If I still have hope if I wait another year that is good!  I am 13+ months out from ORIF right patella fracture with two screws and wires.  I have had good ROM a few weeks after brace removal.  Problem is leg circumference and weakness, can't do anything for more than an hour.  I am going for second surgical opinion very soon to a more experienced surgeon.  PT told me there are many nerves damaged with a "fall/trauma" and breaking and surgery of patella.  Apparently some nerves do not come back enough to tell the muscles what to do.  I guess a neurologist can tell me this for sure.  If this is true my good leg may stay 1 to 1.5 inches smaller in circumference than on good leg. It goes up to the hip area and down to the mid calf, even my surgical leg butt is smaller on that side!!  I will ask about hardware removal, although I lost a good part of my hair from anesthesia so I would hate to start that all over again!  I am very frustrated but will try to be patient. Will let you know what second surgeon says after June 4th.  Thanks again for your comments.  S

[kcknee]

You might find this thread on peroneal nerve recovery interesting.
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=21825.0

There are posts on this thread regarding nerve damage from major knee injuries to unfortunate crossing of legs for too long, and the testing, rehab and recovery procedures that patients have tried to get damaged nerves and muscles to recover some function.

[Sampson19511]

Hi KCkneen.  I do not believe my symptoms are from peroneal nerve injury.  I am seeing a new surgeon.  PT told me there are just lots of nerves damaged with a fall hard enough to fracture the patella and they do not always come back. 

The peroneal nerve is a branch of the sciatic nerve which runs down the outside of the lower leg, serving the peroneal muscles which help pull the foot upwards and inwards.  Symptoms include numbness & tingling in the lower leg and is often caused by a blow to the outside of the knee.  Symptoms of a peroneal nerve injury, also known as peroneal neuropathy, include numbness or tingling in the front and or side of the lower leg. T here will be decreased sensitivity when touching these areas. Weakness in lifting the foot upwards and turning it outwards may be experienced and in severe cases - foot drop  will occur where the foot cannot be lifted up enough to clear the floor when walking. A slapping gait may be seen as the foot slaps on the ground when walking.

[Sampson19511]

Hi wahootri.  Thanks for your post.  My quad still not really responding.  Went to third surgeon and he said to do simple
quad exercises, as many as I can each day, you know just lifting your leg, tensing, and pulling your foot back (I used a small
weight also).  I am stronger than 18 months ago.  I am going to try snow skiing again this year.  Thanks for
your encouragement.  S

[Sampson19511]

By the way surgeons all say hardware it not causing any problems!  Not sure
what to believe anymore.  I had one PT tell me I had nerve damage and that
is why my muscles were not responding!  I am still trying but not happy.