Fractured pattella, no surgery, no cast. Still pain and atrophy... Help

[mkylling]

Hi Everybody
I am from Denmark, so pardon my English. 😊

I am a soldier and fractured my patella with a 9mm gun. It happened when I holstered the gun. A stupid accident. Fortunately, I was lucky. The bullet went through the quad, on top of knee and fractured the patella, ending below the knee.  No major artery was hit. Besides cleaning the wound, nothing was operated. I didn’t have to where a cast and the knee did not need surgery. Lucky me…

I was told to use crutches for 6 weeks and from then on slowly start weight bearing. My progress felt really good, so I stopped almost with the crutches after 6 weeks. The stiffness ended after 12 weeks, and from then I started with an external PT. I really felt progress.
I have always exercised and strength trained a lot. I use the exercises the PT gives me, but my patience is beginning to end. I am 50/50 on whether I have pushed it a bit too much in the beginning, but I wouldn’t say far too much because I had major progress in the beginning.

But there is pain in the knee when I fx use the leg extension machine, do lunges where the injured leg is in the back, squats/leg press, when I bend the leg more than 90 degrees. So jumping is difficult.

I am suffering from pain in the knee and atrophy in the quad, but it is only something I notice when I train. The problem is there has been close to 0 progress, the last 2-3 month. So, I asked the orthopedic doctor who went through my X-rays after 5 months. He said there will be 6-18 month for full strength gaining and that I should still push my training to just below threshold and so there will be no pain the day after.

Do any of you have experience as to:
When the pain is gone?
When the atrophy/strength is regained?

As I can read in the discussions most likely it will take approximately a year. Worstcase it will never go away.

Please let me know your experiences, if you have had the same diagnose…

Kind regards Mikael

9. August 2018 – Accident
1 October 2018 -  No crutches. Driving and participating in First Aid classes. Still stifness and pain problems (not major)
15. October – Today -  Training with PT giving me exercise, no progress

[axand]

I am 6 months from my surgery and I still have pain in the knee when I do more requesting movements (like walking upstairs there is some pain, going down stairs, when I do squats, or different leg exercises). Unfortunately for me I don'w know if the pain is due to weak muscles or due to the hardware in my patella.

However on my case I did recovery after the surgery until I had 3 months or so, then my doctor told me that I was doing to much PT and that my bone pieces may move because of this so I've decide to wait 2 months to see if the bone is healing, but at my last Rx at 5 months there where still fracture present so I've restarted PT to recover my quads but I still have pain when I exercise however the pain is there only while exercising, but the next day I have no pain.. my knee is also very swollen compared to the good one.

So I can't really give you to much info, just that I'm in the same condition as you are    

[mkylling]

Thank you for the answer...

I guess most of the pain is coming from muscles being to weak to protect the knee. The balance for me is patience in my recovery, not pushing the rehabilitation training to hard. The real struggle is, that you dont know where you will be in a half, one or even two years... For me, WHO didnt have surgery, i believe it will take a year. Who knows ?! 

[axand]

Mkylling I think it also depends on when the pain is present, at what type of movements/exercises. But for sure the week quads can be a cause also an other reason can be the fact that the elasticity from the muscle/tendons is not the same as in the good leg, so it has to be also recovered, what is your current ROM?

I would be curios if for example you could do sitting leg extensions at the gym (with the machine from the below picture, not sure the name). For example in my case doing only with the operated leg I can't lift more then 5-6kg... and from what I read on the forum a lot of persons that where having the hardware couldn't lift more, but after the hardware was removed things where different.



I think it depends on a lot of factors how fast the recovery is done, but I'd say to continue with PT and every time you exercise you should feel burning in as many muscles from the quads as you could and also my PT is saying that when the leg starts to tremble it is a good sign that the workout is efficient.

[mkylling]

Thank you. I really appreciate the answer...

I have full ROM, with no pain. I am doing lunges, split squats etc. to help build muscle in the quad. When I do these excercises, it is just below pain threshold, and I am feeling it in the knee 1-2 days after. It is really a thin line, as to stop vs. push it.

I am not doing the machine above, I have tried. Sitting and strectching the leg with no resisitance feels good. But doing the machine above with +5 kg that hurts to much... But i havent had any operation/hardware, just rest......

And that leads to my problem, it still seems like an eternaty to get well. And doctors not helping with an exact timeschedule doesnt help.