Ruptured Patellar Tendon Surgery

[Invincible17]

Had appointment with surgeon today which is 2 weeks after op. They told me I'm in the brace for 6 more weeks and to stay on 2 crutches, is this normal? Hopefully starting physio next week which is a step in the right direction. Knee seems to be healing well though and the scar is not too bad.

[Bascat]

Hi invincible,

Normal to keep the braces on for a while longer yet. Do you have any flex permitted ? Think the crutches depends on how they fixed your knee up. I recall teetering around the house without crutches quite early on but the surgery was designed to be weight bearing. Hopefully you'll get a decent pt and they will be able to advise. Or ask the surgeon if you can. Cheers

[Invincible17]

Thanks Bascat.No flex surgeon said the brace needs to keep my knee straight the next 6 weeks. He did say the physio will start bending my knee for me though starting  next week. I asked about getting rid of crutches but surgeon said it's important for knee to repair the first couple of months so it's not worth the risk of not using crutches,makes sense I suppose but just limits what I can do. Any advice for clothing for the winter,only shorts I can fit over this brace 🙈

[Primetime_21]

Invincible - i’m 16 week’s post surgery for left PTR, during the first 2 weeks I Spent most of my time on the settee with my bad leg up resting. After day 2/3 I reduced intake of painkillers (codeine)  I took  a couple before bed and again if I woke up in the middle of the night only, if I had taken them during the day I might’ve used up my daily dose and would have to wait.  During the first Week or two try and get as much rest/sleep as possible. Do ankle pumps and static quads (flexing quad muscle) as much as much as you can (if ok with your physio).  After the first 2 weeks I was able to get around much easier, with a lot less pain/discomfort.   I always had my bag handy, with meds, water bottle, hand wipes etc, so I didn’t gave to get up as much. 
Pain is a good indicator of how your knee is feeling, but if your Taking strong painkillers and feeling better when you’re moving around, It’s kind of hard to tell what’s really going on..   You might want to try some  natural anti inflammatories like tumeric.  Don’t know if that’ll help you at this stage, as you’ll need something fairly strong. 
Hang in there buddy, as each day passes you should hopefully feel slightly better.

As for me, i’ve Not been able to get past 115 degrees flexion for the past 3 weeks. I do stretches every morning and  do 2 sessions of cardio at the gym where I focus on elliptical trainer, cross trainer, bike and add 3 sets of legpress at a mighty 30kg on my repaired leg. I started back at work 4 weeks ago, so I’m also walking a total of 3 miles per day from Mon-Fri.  My walking speed has built up, no more limp as far as I can tell, on some of the days i’ve Also been able to speed walk.  On other days my knee feels tight so it’s hard going, especially if i’ve Overdone it with the stretching. I took leave from work yesterday, spent the day resting, with my leg up, adding in a few massages, i’m doing the same today, my knee does feel a lot better. 

Anyone else at a similar stage as I? What’s your protocol / gym regimen look like?

Its been awhile since I have been on here, as I have been traveling quite a bit recently. Anyways, Im at 6 mos. post op. I have had issues with scar tissue under the knee cap. For most of the recovery process, it felt like my patella was sitting a little too high on my knee. I had plateaued at about 120 rom. i was walking well, but counldnt do so for any extended period of time without some sort of knee brace or sleeve on.

Well I visited London for about a week near the end of October, and was able to handle walking 20+ miles a day (with my knee sleeve on). the day after returning home from London, I was walking without my sleeve and my knee had a loud pop, and i felt the patella shift down a bit to where it feels more natural. the sound of the pop was pretty scary, but the feeling after the initial shock was pretty amazing. rom almost instantly increased to 140+ and i feel a lot less strain when walking without any sort of knee protection. my os was pretty surprised at this, but believes its the scar tissue breaking down allowing the patella to adjust to a more natural state. whatever it is, it worked! I am walking more comfortably without the aid of a brace or sleeve, although if I overdo it it does stiffen up. when this happens, I slide the sleeve back on and the compression and heat tend to get me comfortable again.

as i've stated before, my os has been very cautious with me due to the severity of my injury, but I have pushed myself (with the guidance of my pt).  I am in the gym at least 4 days a week. I am always doing 20+ min of cardio, whether on the stationary bike or eliptical. On days when I am doing strength training on the injured knee, i warm up on a recumbent bike for at least 15 min. i typically move the seat both closer and further away from the normal position every 3 min or so to really get a good stretch of the knee. for strength training im doing leg press, calf raises, weighted hip hinges, step ups (this is a struggle), unweighted squats on a balance trainer, and lots stretching. On days that I dont do weight training, I am doing ladder work and starting to jump rope. I have had the same type of routine going from about 4.5 months post op, gradually increasing intensity. my os still doesnt want me run, jump (jump rope is fine tho), or make any athletic type cuts/movements yet. but working my way towards that goal.

I havent been icing my knee as much as i probably should, but have started using a cryotherapy chamber every couple weeks which has helped a bit too.

this injury can definitely get frustrating. there are times where you may feel like it wont get any better, but keep pushing. listen to your knee. ask questions. set goals. after the first couple months, progress is much slower. it takes discipline to develop a plan and stick to it. but if you do, you will get better. i am nowhere near 100%. nowhere near where I want to be. but I know if I keep working at it, I will get there. you all will too.

[Johanna]

Hi folks.

It's been a while since I've posted here.  I thought I'd share this good news/bad news update since my tale of woe last August.  Good news is I was able to successfully appeal my request with my insurance company to see a highly recommended revision knee specialist, Dr. William Long, in Los Angeles.  He spent a couple of hours with me and reviewed my life long chronology of knee issues.  It was especially validating that he understood why I had experienced so many surgical failures prior to the RPT rupture. 

A little about him:  He trained with Kerlan/Jobe who practiced state of the art procedures in LA.  They introduced ground breaking surgical techniques during their tenure.  Dr. Long shared about his participation in 'master classes' for surgeons globally. 

And now the bad news:  At these master classes, first rate surgeons world wide bring their most difficult cases, and yes, to a one, it's my condition...failure of the RPT...and related issues...i.e. cadaver tendon transplants.

Some more good news...it wasn't my fault that the cadaver tendon stretched.  Dr. Long stated that they all do.  Some patients have a 90 degree lag, which of course makes for no stability at all.  At least mine is holding steady, so far, at 40 degrees.

He did say that should I experience further deterioration of the tendon, that there is a procedure he unearthed in consultation with surgeons managing after care for cancer patients.  For those who lose RPT function due to cancer, there is a procedure that is done in which some of the calf muscle is separated out and pull around to connect the patella to the tibia.  He called it a muscle flap.  And, for patients in which the RPT has failed, it has restored their ability to walk.

It will be a wait and see matter for me.  I am continuing to be monitored by my OS and will also see Dr. Long at regular intervals as needed.  In the meantime, I will be getting a Breg 20.50 brace to keep my patella secure as it has loosened as a consequence of the tendon stretch and is in a bit of an alta position now.  It should help it stay tracked and avoid the return of dislocations. 

I was advised to avoid weight bearing exercises.  (My surgeon and I were concerned about such tasks as leg extensions while wearing ankle weights.  When I performed them in PT, I felt quite hesitant and worried about the impact they would have on my repair.) The two that were safe to do were aqua therapy movements and riding on a recumbent bike.  I'll do some isometric exercises too...i.e. quad sets.  At least now I don't feel like I'm out in the abyss/uncharted territory wondering how to proceed. 

I must regain my momentum and renew hope that I can achieve some improved mobility.  My goals were extremely modest in comparison to other participants here, especially the younger athletes who prior to the RPT injury had structural knee integrity.  However, I at least have some action plan now and I am glad of that.

I have come to understand that there is a significant variance between RPT repair and RPT transplant recovery.  It is important to maintain realistic expectations accordingly.

Wishing you all recovery success.

~ Johanna ~

[Bascat]

Good to hear of some positives and you're doing OK Johannah. So difficult and you endure the rarest of rarities but like you say having a plan and an aim gives something to work at. Onwards and upwards.

[Bascat]

Dem wires coming our today hopefully:-o  Just waiting. Like a cattle market :-))

[Bascat]

Well after all that anxiety about wires and operation I'm back at home now. For the record which others may be wondering and need a bit of help, it was a simple day case even for both knees. They gave me a staggering 4 weeks sick note 😁but don't feel inclined to take advantage. It's takes it to crimbo anyway.
I'm walking about fine and even managed the stairs. It's a little sore. Reminds me of schooldays falling in the playground. Definitely feel less pressure on the knee and the side of the knee where they twisted it. The wire itself was in bits and they left a small bit in there that was safer to leave in. Bandages making it difficult to test out the rom at the moment. Sitting bended knee is a little uncomfortable and sore. Os recommended 6 weeks from strenuous exercise 🤔will see what physio thinks 😇Early days perhaps but don't feel at the moment there will be significant set back. I would say the op date helped me focus exercise wise so will be difficult to reset some goals. Already worried about falling back into sedentary lifestyle and overeating.  Cheers J

[Invincible17]

4 weeks after my op and everything getting slightly easier. Having physio once a week and doing my own passive bending of the knee. Only at around 10 degree bend but physio is taking it slow and says I'm on track, so feeling good with xmas on the horizon.
Forum has been a big help for finding out info 👍🏻

[Joe Dublin Ireland]

Hi All,
14 weeks now from injury and 12 from op and everthing going along ok until the last 4 days when the pain in my underneath my knee has been unbearble when i move my leg in a certain way.
My OS put wire in to protect the join and i dont know wether it is this or something else but the pain is terrible.
Sometimes i amnearly afraid to move my knee incase i get the dart of pain which would nearly bring a tear to your eye.

Anybody else experience this kind of pain in there recovery??

Hoping this will get better soon.

[Immy]

Primetime, You walked 20 miles per day? That’s a lot, with or without a recent injury. Well done! 
I’m 5 months post surgery, the most I’ve walked is 5 miles in a day, I don’t have any issues walking whatsoever, but want to slowly increase my activity.  I too think my patellar is sitting too high, Is this common with everyone?

I’ve not been to see the physio for a few weeks, so I don’t officially know what my ROM is at the moment, but when I got on the bike today, I was able to lower the seat from the highest position 15 to 10 and still felt I could have went a bit lower.  Which is something I haven’t previously been able to do when I last posted, I’ve now also incorporating the stair climber, very light deadlifts with the trap bar, plate loaded leg press (very light weight) and sledge pushes into my workouts.  I find the deadlifts the hardest as I have very little strength in my VMO muscles, and it seems to hurt a little to.  With that in mind, a friend of mine who had reconstructive knee surgery recommended I do the Peterson Step up, been doing it for a couple of days to help strengthen my VMO, link below.

https://youtu.be/venxzC5TDfg

Here’s another interesting video regarding weight training and how to Increase tendon strength.

https://youtu.be/mlEm5BG9yZY

[John42]

Hi Immy

Once again I am suggestion that you purchase a floor cycle - from Amazon or similar - about $50 or £35.   You can sit in your favourite chair and pedal away to your hearts content.

It did me a power of good - keep posting

JohnK/ Manchester UK

[Immy]

Thanks John,

 I’ll Put it on my Christmas present list, if it’s not too late

[madvillain]

Primetime, You walked 20 miles per day? That’s a lot, with or without a recent injury. Well done! 
I’m 5 months post surgery, the most I’ve walked is 5 miles in a day, I don’t have any issues walking whatsoever, but want to slowly increase my activity.  I too think my patellar is sitting too high, Is this common with everyone?

I’ve not been to see the physio for a few weeks, so I don’t officially know what my ROM is at the moment, but when I got on the bike today, I was able to lower the seat from the highest position 15 to 10 and still felt I could have went a bit lower.  Which is something I haven’t previously been able to do when I last posted, I’ve now also incorporating the stair climber, very light deadlifts with the trap bar, plate loaded leg press (very light weight) and sledge pushes into my workouts.  I find the deadlifts the hardest as I have very little strength in my VMO muscles, and it seems to hurt a little to.  With that in mind, a friend of mine who had reconstructive knee surgery recommended I do the Peterson Step up, been doing it for a couple of days to help strengthen my VMO, link below.

https://youtu.be/venxzC5TDfg

Here’s another interesting video regarding weight training and how to Increase tendon strength.

https://youtu.be/mlEm5BG9yZY

I'm at three years and still experience mild discomfort dead-lifting and squatting.  It's nothing that bad and usually goes away after the first couple sets and doesn't persist throughout my workout or day.  In fact my knees always feel absolutely the best the next day after a tough leg workout.

Yea VMO strengthening is tough.  I do some band work that targets it and also I think hiking mountains (especially going down on uneven terrain) is the absolute best way to regain your athletic balance, gait, and strength all at one time.  If you live near big hills try and incorporate hiking into your routine.

I remember hiking Oyster Dome (like 1800 ft again over 3 miles) at my six month mark and crying with joy at the top.  Ironically I was slower going down.  I was still experiencing patella tightness at this point and could feel it.  I really don't feel any of that anymore, especially with compression sleeves.  This past summer I did a 4800ft gain hike with a 30lb pack on.  That was the most amazing feeling in the world up at the top around 7500 ft.  It's a hike I'm not sure I could have done pre injury and 50lbs heavier.  I lost about 50lbs in the first year and have kept it off since.  I think that was important for my knees, obviously. 

When I put on my trainers and compression sleeves I feel almost like I never got hurt, especially running on the treadmill in a straight line I can't tell I had surgery at all.

My knees still get stiff when sitting for longer periods (plane rides can be bad).

Anyways, glad to see we haven't had too many more injuries in the last few months.  Your recovery is going really well the fact that you're even attempting deadlifts at 5 months is impressive and aligns pretty well with my recovery timetable.  I felt that months 6-12 were frustrating because sometimes I'd have weeks where I felt I wasn't making any progress, especially after how rapidly you see it in months 2-6.  Just keep pushing and still do your kneecap dances, iso sets and heel slides and stationary bike throughout your recovery for warmups.

You also might went to look into eccentric training, which many argue is the best way to safely strengthen your tendons.  In general focus on "closed chain" exercises like squats.  Open chain stuff like the leg press isn't ideal for your recovery.

Happy new year everybody.  Work works and stay positive.

[DeanP28]

Hi All,

Good to read other peoples experiences and see that other people are going through the same frustrations as I don't know anyone else who had this injury. I've never even heard of it until it happened.

I have had the misfortune of rupturing my patellar tendon twice in the space of 8 weeks. First time back at the start of September playing football just went down awkward and 2 days later was getting surgery to repair. First ever surgery so was not great.
Surgery went well had crutches and brace for a few weeks and had ROM of 90 which i thought was good after 8 weeks so got a little to brave and went out and about with no crutches, slipped and had a re rupture.

Frustration of it all hit me hard while waiting to get the second surgery and also after surgery while waiting to get discharged (was kept in for a week as i also had a deep gash in my knee from the fall and there was risk of infection). Second time round was placed in a full leg cast for 4 weeks, then a brace with no movement for 2 weeks and then the last 2 weeks i had the brace open to 60 degrees started PT and have a 60 degree bend now as of yesterday but it is stuck solid at 60 degrees which is really frustrating as reading other peoples experiences i should be much further on after 8 weeks. Hopefully this is all due to being locked straight for so long and it being a re rupture means a slower process.

OS is happy with the repair and PT seems to be content but thinks we need to push on a bit. The PT in the hospital is not much good however as they just look at the knee give exercises and send me away for 2 weeks. I am going to go to a private PT to see if the can work with me a little more to get this improving a bit.