Ruptured Patellar Tendon Surgery

[vonlehmd]

6 weeks post-op today.  I see OS Friday followed by PT.  Currently at 60 degrees with heel slides and doing walking sessions with brace released to 30 degrees.  Also doing the regular stuff: quad sets, electro stim, calf and hamstring  stretches, patella mobilizations and lots of massaging.  Knee feels good when working it but stiffens in between sessions.  Looking forward to getting released to 90+ degrees on Friday and maybe adding in some active flexion/exercises.  Mental attitude greatly improved but still have to tell myself to be patient.  Will add in extra PT sessions in a couple weeks since once a week is too long inbetween sessions.
Glad to hear from Cooper44, Fishy and Tom and the others and happy everyone is doing well.  Welcome to the new posters an well...I wish all peace and happiness this week and keep celebrating the small steps!

Hello JC.

You and I are very close in time with our surgery.  Mine was on 9/13 (injured 9/11).  I am very lose to you with 60 to 65 degrees of flex on both legs (mine was bilateral).  I need to learn more about patellar mobilization.  Is this just applying pressure to knee caps and moving them around a little?

Also doing Quad sets, leg raises and heel slides.  Doc won't release me to PT until 9 weeks out at soonest.  But am able to do limited moves above. 

Also thinking about asking if I can release to 30 degrees while walking.  May not be good idea given I am dealing with both legs.  I try to fire my quads while walking in extension.  Not sure if it does much. 

[JC55]

vonlehmd and Bballking thanks for the info.  King, I read all of your posts several weeks ago when I first joined this thread...and it made me realize to be extra patient.  I'm a little concerned that I got behind as far as ROM but everything up to now has been passive flexion.  My PT on first visit asked me to do short arc quad and I told her I wasn't comfortable doing those until more healing took place.  She is a good PT but has only had one other RPT.  On my next visit she and I went over a protocol she and OS put together...it was something I was comfortable with and was a relief that we were on the same page as far as PT.  I'm not going to rush it but expect more aggressive treatment at the 8 week post-op date.  Slow and steady is my mantra.  vonlehmd, I could not imagine a double rupture and yours sounded extra gruesome.  As far as Patella Mobilizations, my PT suggested mild pressure side to side and a little forward.  I usually put a drop of massage oil on my patella tendon and quad tendon and rub it in, around and over the patella.  I love massaging my kneecap...and my PT said that it's about 80% in comparison to the other.  I'm at a point that I can really move it side to side and gently forward (I cup both hands around patella and put my thumbs on top and gently apply forward pressure).  Quad Stims are your best friend and I highly recommend asking OS or PT to order an electric stimulator.  The pads are placed on thigh and VMO to help fire those muscles and they really help later doing SLRs and hip abduction exercises.  Good luck to you on this journey of recovery...patience is the word and don't be afraid of questioning OS and PT about protocol.  Remember, it's your knee.

[redspudder]

Tomorrow is 2 years since I RPT,I have come a long way since then I have lost 6stone and feel great. Knee feels great and strong (touch wood).I go swimming 3times a week and regularly play golf. I can jog on the knee but don’t really do much of this. I still pay the knee respect especially in slippery areas and still get in the shower dry and warm the shower up with the head pointed behind me. My knee constantly grinds I have been to my GP but he tells me it’s just the way it is and nothing to worry about.

Stay strong and positive there is light at the end of the tunnel.

Andy

[SellaVee]

It's good to hear how everyone is progressing.  Thanks redspudder for your 2 year update.  How did you manage to lose 6 stone?   I'm sure it would do my knees good if I lost some weight.

Arran, you asked about the wire.  I was told mine was coming out, then on the next visit that it was staying in.  The consultant has now signed me off so I guess it's staying.  My physiotherapist is happy enough with this.  She knows of someone who has had his in for 3 years.  It doesn't seem to be hindering me, although I do get a pain in my shin, but other people have said getting it out made a difference to their ROM.  My ROM isn't equal to my other leg yet but I can cycle on the exercise bike and sit normally so I'm happy to wait for it to return.  At the moment I'm working on strength.

Jerry, I'm also massaging my knee every day, partly to improve the suppleness of the scar and party to reduce swelling.  I'm also icing it at bedtime.

Swelling is my big problem.  Now that I'm walking very much better and going upstairs normally (but not yet down) I sometimes feel I'm further on than I am and when I overdo it my knee swells and just stops working properly.  I also suffer with stiffness.  I've been told to rest often so it doesn't get swollen, but I've also been told to move very half hour so that it doesn't get stiff.  I'm really struggling to find the right balance.

One thing I find useful is a Swiss ball.  I often sit on one while watching TV and move it back and forward to gently bend and stretch my knee.  If I push fully back and dig in with my heels it works my VMO.  If I'm on the sofa I can put my feet on it and keep my legs moving.  I also use it for wall slides.

At private physiotherapy I've been using a kneehab machine.  The therapist says it's the best of the stimulation machines but it's very expensive so I only use it at her place.  My NHS physio has been impressed with the improvement in my muscles but I've still got a way to go.

Keep smiling and remember patience is our best friend.  I need to write that out 20 times.

Sella

[John42]

Hi Sella

You are making good progress.

Have you given any thought of purchasing a floor pedal exerciser?  did me a power of good - no expensive, about £30 from Argus or Amazon.

Take care

JohnK/ Manchester UK

[JC55]

Redspudder thanks for the update.  I ordered a floor peddler on your and John's suggestion.  Not able to use it yet but ready when I am.  Also, I had to look up what a "stone" was in pounds and WOW...84 lbs is a lot of weight to lose...good for you!  SellaVee glad to hear you are doing well.  I also have some swelling but most of mine is concentrated on lower left of my knee (left knee). My OS isn't concerned and PT says she has seen a lot worse and that mine will subside over time.  I think that when I ruptured my patella tendon that was the area of the worse tissue damage.  It is still healing and absorbs the most fluid...it also doesn't help that it is under the numb area.  To me it feels huge, like when you have novacaine at the dentist...but it really isn't that big.  On the milestone front you'll be pleased to learn that today I was able to put on my own sock, get in the drivers side of a car and actually drive for the first time in over six weeks!  My wife was thrilled since she wasn't too excited about driving me to OS and PT appointments.  She is on vacation and has been an angel...so  I was glad I could stuff all 6'4", 200 lbs (14.28 stones?) into my car.  OS released me to 90 degrees (I'm just under 7 weeks post-op) and said soon I'll be ditching the crutches.  I was thinking like, WHAT? are you mad?  I don't think I'm there yet but I do feel like my knee is solid.  However...patience is my friend and I'll listen to my knee, thank you very much.  PT visit was a little more aggressive than in the past.  Added 30 degree squats, SLR with 2 lb weights, and standing on bad leg while gently holding on to back of chair and doing the "star" drill with my good leg.  Then it was stretching time...she gently got my ROM to 80 degrees plus.  Has anyone else experienced thigh pain...most of it is on the inside of knee where the quad attaches.  I need to concentrate on stretching that a little more.  I think I'm going to get 75 degrees first were it is loose and then gradually get up to 90 degrees.  Slow and steady!  Well, sorry for the long post..hope all stay strong, keep progressing and have a GREAT weekend.

[John42]

Hi JC55

Making good progress - just a word of warning regarding returning to drive.

I would advise you to get clearance from your OS, to avoid invalidating your car insurance policy - just try and do an emergency stop.

JohnK/ Manchester UK

[vonlehmd]

Redspudder thanks for the update.  I ordered a floor peddler on your and John's suggestion.  Not able to use it yet but ready when I am.  Also, I had to look up what a "stone" was in pounds and WOW...84 lbs is a lot of weight to lose...good for you!  SellaVee glad to hear you are doing well.  I also have some swelling but most of mine is concentrated on lower left of my knee (left knee). My OS isn't concerned and PT says she has seen a lot worse and that mine will subside over time.  I think that when I ruptured my patella tendon that was the area of the worse tissue damage.  It is still healing and absorbs the most fluid...it also doesn't help that it is under the numb area.  To me it feels huge, like when you have novacaine at the dentist...but it really isn't that big.  On the milestone front you'll be pleased to learn that today I was able to put on my own sock, get in the drivers side of a car and actually drive for the first time in over six weeks!  My wife was thrilled since she wasn't too excited about driving me to OS and PT appointments.  She is on vacation and has been an angel...so  I was glad I could stuff all 6'4", 200 lbs (14.28 stones?) into my car.  OS released me to 90 degrees (I'm just under 7 weeks post-op) and said soon I'll be ditching the crutches.  I was thinking like, WHAT? are you mad?  I don't think I'm there yet but I do feel like my knee is solid.  However...patience is my friend and I'll listen to my knee, thank you very much.  PT visit was a little more aggressive than in the past.  Added 30 degree squats, SLR with 2 lb weights, and standing on bad leg while gently holding on to back of chair and doing the "star" drill with my good leg.  Then it was stretching time...she gently got my ROM to 80 degrees plus.  Has anyone else experienced thigh pain...most of it is on the inside of knee where the quad attaches.  I need to concentrate on stretching that a little more.  I think I'm going to get 75 degrees first were it is loose and then gradually get up to 90 degrees.  Slow and steady!  Well, sorry for the long post..hope all stay strong, keep progressing and have a GREAT weekend.

This was good to see given you and I are so close in time.  My doc has not released me to PT yet, but I am making good progress in what he will allow on my own.  I can do straight leg raises with or without braces.  I do a lot of these in different directions while seated.   I also sit upright which makes it more difficult versus lying down or reclining back.  With heal slides I am getting to 70 degrees.  Also working on scar tissue with massage and "scraping" with a buffalo horn (chip/tool).  Search Graston tools (massage) for more info on releasing scar tissue from this intensive massage therapy with tools.  My wife takes me to he mall every other day for a long walk (with two leg braces and a walker at age 45 I get plenty of stares, doesn't bother me a bit).  Today my walk was longer and more productive than any yet.  I have braces somewhat loose and am focused on flexing quads and allowing a little bend in the leg as I step forward (maybe 15 degrees).  My pace was much quicker today and I walked for about an hour and a half.  I am 6 weeks out from surgery.  Hoping doc will release me to more intense therapy in 2 1/2 weeks when I see him next.  Goal is for 90 degrees ROM on both legs by then.

[Meekxu]

Hey all, isn't this an interesting group. I am a somewhat new member, I tore my PT, ACL, MCL, both menisci on sept 8th 2013, surgery was on sept 19th.

Some back ground on me and the injury:

I'm 34 yrs old, 5 ft 10 in tall, aprox 180 lbs, played soccer and have been fairly active my whole life.

I was playing soccer and was sprinting in for a 50/50 ball between myself and the keeper. It was going to be very close so at the last minute I pulled up to stop and that's when my PT ruptured and I hit the ground. This is my first major knee injury so I wasn't entirely sure what just happened, I was hoping for a dislocated knee that would only require manually straitening my leg as I could not do it on its own. My knee swelled up very quickly and they were unable to determine what all was wrong with my knee through X-ray and ultrasound. After reviewing my MRI, it was determined that I had a complete rupture of my patellar tendon and ACL, I had also torn my MCL off from my tibia as well as torn both my medial and lateral menisci. According to my surgeon, "I've never seen a knee with this combination of injuries and amount of trauma, and all I do are athlete knees. You may very well wind up being a research paper case." We are tackling my knee with 2 surgeries, the first was repairing my PT with an autograph of my hamstring tendon and re-anchoring my MCL to my tibia, while the second will be artho and replace my ACL and repair my torn menisci.

I am currently just over 5 weeks post Op #1 and have 80 deg rom. I was a little worried about not being at 90 deg rom along with my knee being VERY tight and still extremely swollen so I went looking for information and msg boards about this type of injury and recovery. Which led me here, it looks like I'm not all that far off from what is to be expected with an injury like mine so that is comforting in itself.

I started pt 5 days post op, and have been going two time each week for an hour per. Exercises consist of ankle pumps with a rubber resistance band, assisted leg beg with a nylon cord, NMES assisted quad sets, supported leg stretch while sitting over edge of the table, active knee flex to maximum rom, straight leg lifts from horizontal to approx 65-70 deg without brace, lateral leg slides while laying flat on the bench, massaging/moving my knee cap. I was just cleared by my surgeon last Wednesday for limited weight bearing with crutches and brace locked at 0 deg.

That's about all I have for now, going to be a long haul.

[John42]

Hi Meekxu

Welcome to the RPT thread of KneeGuru.

You have sustained a collection of typical sports injuries, including a RPT. You are in for a very long rehab with lots of physio & PATIENCE.

Can only suggest at this stage - ASK questions - read previous posts on this thread - click on the undermentioned link which has a collection of documents which I have compiled over the years together with KneeGuru.  Your first milestone is to reach 90ROM within 12 weeks, and thereafter the next milestone is 120ROM which should be achieved within four months.  With winter creeping on us, watch out for wet areas, snow and ice - listen to your knee - sleep with a pillow/cushion between your knees.

Where do you live?

Keep posting

JohnK/ Manchester UK

https://www.facebook.com/QuadricepsPatellarTendonRupture

[JC55]

Hey all, 7 weeks post-op today!  Update: passive ROM between 85-90 degrees, swelling mainly in lower outside of left knee which is the numb area (little concerning, but will see what happens), FWB with crutches and brace unlocked to 30 degrees, active flexion limited to 60 degree standing leg bends, squats to 30 degrees, SLR with 2 lb weights, plus all the other basic PT routines from previous weeks.  Massaging knee continuously which feels great and scar looks good.  While sitting, I unlocked brace to 75 degrees and used my floor peddler for first time.  Felt good and seemed to really loosen up the knee.  Did 300 revolutions, stretched with passive ROM then did another 300 revolutions.  Have to admit, felt it a little in my thigh... I'll work up to longer sessions but will continue practicing patience.  Meek welcome to the board...you are in the right place.  You seem to be right on track but remember, each case is different so try not to compare to others on this board.  Listen to your knee, ask lots of questions, celebrate baby steps!  John42, as far as driving, the OS said I could since injured leg is the left one...but thanks for the advice.  Vonlehmd good progress,  I too at age 50 love the stares when at the park, and endure hearing all the knee stories of others (mostly ACLs), but I know they mean well so just nod my head.  To everyone else, stay strong! 

[Meekxu]

Hi John and JC55,

Thanks for making me feel welcome to this "fraternity" of "cripples". To answer John's question, I'm from Ohio, USA so, yes, I am a little concerned about the coming winter months and slick surfaces. Ohio is notorious for being located just right to get that wonderful mixture of snow and ice. Going to be a "fun" winter IMO.

I head back to PT today, hopefully I can push to 85deg ROM today and 90 on Friday, the following PT apt. I'm really looking to hit that 90deg ROM by my next post op OS apt 11/4/13.

Meek

[vonlehmd]

Hey Meek,

Go Buckeyes....  I grew up in Ohio myself.  Small farm town around Lima (Fort Jennings, Ohio).  I went to college at Ohio State and worked for Bank One in Columbus out of college. 

I live in Florida now, but my family is still in Ohio. 

[carkeltom]

Hello to everyone and welcome Meekxu.  Sounds like one heck of an injury.  Nothing like doing it right the first time.

So, an update on me.  13 weeks post surgery on Sunday and still working on getting the quad strength back.  Stairs, both up and down are still killers.  Started working on side and front step ups on an 8 inch step at PT today.  That was really tough with a double.  Almost feels like I am going to hyperextend the knee when stepping up and using quads to lift up that other leg.  Got to 50 pounds on the leg press today, so happy about that.  Can knock out 30 reps per leg, so that is an accomplishment.  I still get a little wobble in both legs at times, mainly when standing up.  I feel that I am using my arms less and legs more to get up from a seated position, and not having to "rock" myself out of a chair.  We havent measured ROM the past two weeks, but after stretching and warming up the tendon, I feel that it is pretty good and last measurements were both over 125, so a degree or two or three will come in time.

Funny story from this morning though.  Was sitting on the bed, socks on and started to try and put my shoes on.  Slipped off the end of the bed and landed on my butt, legs straight and no injury to the two knees.  Sitting there trying to decide how to get up.  Rolled onto all fours, trying not to rest on my knees, as that really, really, really hurt.  So, got back into a seated position, put the shoes on (since the socks and wood floors make it slippery) and did a quasi squat, with back against the bed and used legs and arms to lift myself up.  My wife came in and just chuckled.  But my thighs and knees did not forgive me for the rest of the day.  Anyone else have problems kneeling or being on their knees?

And finally, with most of my swelling finally subsiding, I have noticed that the incision scars on both knees are crooked and off the center of my knee.  Well, crap, so much for having sexy scars next summer. 

Keep the faith everyone.  Hope we are all doing well.

Tom

[John42]

Hi Tom

Good to see that you are making good progress - putting socks and shoes on is a challenge, just like walking up and down stairs.

With the onset of winter watch out for wet roads, slippery leaves, snow and ice.

Take care and keep posting.

JohnK/ Manchester UK