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Author Topic: Ruptured Patellar Tendon Surgery  (Read 1430583 times)

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Offline abros

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Re: Ruptured Patellar Tendon Surgery
« Reply #3705 on: June 20, 2011, 09:19:37 PM »
Wheels 22:

Look at the articles JohnK will send there are good.  You are young and should expect a complete recovery.  Your quads have shut off due to the injury.  They are slow to return and pain is common in the quad some people even get spasms.  Follow what your OS/PT say.  Your quads will turn back on when you get close full ROM back.  They will take 6 to 12 months to get 90% recovery.  Remember its 12 weeks to get bone back to tendon then 6 to 12 month to remodel for a strong heal.  Get to the gym and pool as soon as you can to strengthen the rest of your body.  An exercise bike will help with your rehab but you need to have 110 of flexion to get on an exercise bike.

Offline cabrev

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Re: Ruptured Patellar Tendon Surgery
« Reply #3706 on: June 21, 2011, 06:50:10 PM »
Hi Monique,

Welcome [unfortunately] to this group.† It appears that yours happened not too much later than mine, i.e. a couple of weeks, timewise.† For starters, be careful not to judge/compare too closely with others, as progress seems to vary quite a bit, but certainly the rate doesn't in any way dictate where you'll be down the road or where you'll get.† Also, try to not get discouraged, as progress is indeed slow, but deliberate (as JohnK and others say..."be patient").† That has been very difficult for me (the not getting discouraged/depressed), and I find that the encouragement I get from others, like this site, and my physical therapist, is what keeps me going.† It's hard to see the progress, but as you look back to where you've been, you'll certainly see it.† There are times where you'll get "stuck" with progress, and feel like you're noting setbacks more than anything, and then you'll see suddenly see progress.† As the others (that have far more information and experience than I) have often noted, the injury is uncommon, and there doesn't seem to be much consensus on rehab approaches.† Yours and my surgeon and physical therapists seem to be similar in approach and such, on the relatively more aggressive side (i.e. starting PT earlier, etc).† I started PT in week 4.† Don't be discouraged about the being at about 90-deg ROM at this point.† That's about where I was, and all of what you describe certainly rings true to me and what I recall as feeling.† It took a while to get to 90 for me, and the "dangling leg" was very painful and difficult when around that point...all the same things that you are saying.† I finally had a pretty sudden improvement to around 105, and then got to where things could really pick up in PT (i.e. was able to begin to pedal the bike, etc).† That was a huge boost in mind-set to be able to start doing things, as I've seen pretty good regular improvement in ability to do various exercises for the last week and a half.† I had/have a lot of pain in both my knee and quad when doing various of these.† I'm surprised you don't have more knee pain.† Seems to me on some exercises I get more knee and tendon area pain, and sometimes some quad pain (I really get this one when they try to put me on my stomach to do more ROM work).† I seem to be stuck at about 115 ROM for a few sessions (and that is assisted).† I actually get less when in the "on stomach" approach, and I do get a lot of quad and actually some real hip pain, too.† As of about late week five, he started me on some small muscle/strength exercises, and has picked up quite a bit since.† My quad is almost non-existent, and I couldn't do anything at first...the hardest thing of all for me was that I could barely lift my lower leg out when sitting on the table, and that was the utmost pain.† That is still my one of my hardeest exercises, but can now do a several sets of 10 with a 2lb ankle weight, whereas a couple of weeks ago I could do nothing (though this is murder).† To your question about the quad, specifically, my therapist told me that the quad pain is not abnormal at all (I'm just surprised that you have so little knee pain).† One difference that I do hear is that my surgeon changed my brace to 40-deg range after 3 weeks, and to 90 at my next appt, just as I was getting to near 90 ROM.† I do all things at PT with the brace off, which honestly scares me for some of the tihngs I have to do.† The benefit for me has been for beginning to learn to walk again, non-peg-legged.† Hang in there and keep us posted.

LT

Offline Barro

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Re: Ruptured Patellar Tendon Surgery
« Reply #3707 on: June 21, 2011, 08:49:24 PM »
Hi guys, I havent posted for a while so thought I'd update.

Im six months post op now. With a bit of stretching I can touch my heel on my backside so my ROM is pretty good. Strength in the leg is pretty pathetic still. I can only lift about 20kg on the bad leg on a leg extension machine. Progress is pretty slow and my knee aches a lot.

But on a positive note over the last two weeks I have gone for a 4k jog and played tennis doubles (being careful and not stretching too far - had a leave a few I would normally get...!). Im also going to start cycling back to work (14k each way) from next week. When i think back to those six weeks in a full cast over Xmas I can see Ive come such a long way.

Two questions if anyone can help. My knee GRINDS so much when I bend it. Not just normal cracking but a really horrible and audible grind. PT says it may be that the kneecap is not sitting in the groove correctly. Has anyone else had this and will it go away? Also in terms of knee brace/supports for sport, can anyone recommend one? Should it be open or closed patella?

Hope everyone is recovering well. For those who have just suffered this injury - stay positive, it gets better. My life is back to normal aside from being unable to play contact sports. I even danced the week away in Ibiza last week with no problems!
Full RPT playing football - 14 Dec 2010
Repair with wire - 17 Dec 2010

31 year old male, London, UK.

Offline Wheels22

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Re: Ruptured Patellar Tendon Surgery
« Reply #3708 on: June 22, 2011, 05:02:44 PM »
Thank you all for responding to my post.

John Ė Thanks for the information you emailed to me. It has been very informative of this whole thing.

Abros Ė Thank you for the encouraging words. I am looking forward to the exercise bike. Iím almost there, just a few more sessions. At my last PT session, I got my ROM to go a little further than 90 (with assistance), but it was very very painful. Seems like whenever they put heat on my knee, I can get my ROM much further then while Iím at home.

LT Ė Thank you for your response back! The last two nights were the first nights that I couldnít sleep since I started PT (the pain is pretty crazy). They had me do a lot of new things, since I was able to reach the ROM of 90. Once I saw that I was very capable of doing all these new exercises they had for me, I was very excited! I pushed myself to get through the exercises, and I almost regretted it while trying to sleep later that night. I have the feeling that from this point forward, sleep will be deprived for me. Iím willing to give up sleep, to make progress. I was very happy with the reaction that my PT gave me yesterday. I enjoy seeing the progress and I really enjoy seeing my PT proud of how far I have come since she first saw me. It gives me a lot of hope. I can tell that since Iíve started PT my life has changed a lot. Iíve only been to about 5 sessions, and Iím much faster at getting things done, and Iím not as unhappy as I was before. I noticed a lot more pain in my knee at my last PT session than normal. They had me doing exercises that were much different from what I was used to, and that may have been the cause. Whenever they give me new exercises, it is very exciting and motivating. Iím glad to be making progress, no matter how small the progress may be.

At my last PT session, she had me sit on the table with my legs straight out and asked me to do a straight leg lift (this is the second time she has asked me to do it, the first being on my first day there). I couldnít do it for the life of me. Everything above the knee was all about lifting up, but anything below the knee cap was dead. I expected that to happen, so it didnít disappoint me too much. It looks like Iím working toward being able to do at least one leg lift. The thought of even doing one leg lift terrifies me. Itís so painful all around the tendon/knee. I think thatís amazing that you can do several sets of 10 with weight on them! That must be exciting for you! I know that Iíll get there sometime soon!

My surgeon hasnít opened my knee brace up at all yet. He seemed to want to, and was confused by what the PT place was having me do. They will communicate soon, and Iím sure eventually they will figure out what they want me to do with my brace. For now, its locked at 0 deg while walking. I do all my PT stuff where I have to stand, with my brace on, even if it is just walking to a different part of the room. Ė Itís very interesting to hear of the different ways surgeons and PTís do things. I really like my surgeon and PT and will continue to listen to exactly what they have to offer me.

When trying to learn to walk, non-peg-legged, have you used some sort of assistance (like a cane or a crutch) or was it relatively easy (just more of a slow walker)?
Ruptured Patellar Tendon

Offline John42

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Re: Ruptured Patellar Tendon Surgery
« Reply #3709 on: June 22, 2011, 06:36:22 PM »
Hi Wheels 22

As far as sleping is concerned, have you tried sleeping with a cushion/pillow between your knees - not sexy, I know, but oh boy, it makes a difference because it takes the pain away from the injured knee.  Even after eight years, I still have that pillow between my knees.

JohnK/ Manchester UK
Ruptured Patella Tendon January 9 2003
Slipped on black ice.  Manchester UK

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Offline Wheels22

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Re: Ruptured Patellar Tendon Surgery
« Reply #3710 on: June 22, 2011, 06:53:51 PM »
John,

Since my first day at PT they allowed me to sleep without my brace on. Iíve been trying to figure out how to get comfortable. The whole time I had my straight brace on, I could only sleep on my back. I did find that placing a pillow between the knees does help with the pain. For some strange reason, I always manage to kick away the pillow while sleeping. I think thatís why I canít seem to get a good nightís sleep. When the pillow is there, itís amazing. Iím going to have to invest in a body pillow, so that I can hold onto it. Now thatís sexy!

Monique
Ruptured Patellar Tendon

Offline cabrev

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Re: Ruptured Patellar Tendon Surgery
« Reply #3711 on: June 22, 2011, 11:20:48 PM »
Hi Monique, it's great to hear about your most recent days of real progress.† Your experiences seem to be very similar to mine.† It is indeed exciting and motivating when you get to those points where you can do new exercises and such.† The chronic pain, particularly at night when trying to sleep is for me about the worst part of it.† I wish I could tell you that I have the answer for you on that one, but I haven't figured it out.† The "pillow-between-the-knees" that JohnK recommended certainly helped me, but I seem to only be able to enjoy being on my side(s) for a bit of time, before pain starts to flare up and I resort to going back on my back...just can't get to sleep before I reach that point.† I tend to get up a few times during the night to walk around, which seems to setlle the knee-pain down for me, then try to get back to sleep for another period of time.† I, as you also said, feel that the hard PT work probably aggravates that condition (as the therapist confirmed), but feel it's worth it for the "progress".† JohnK, when you and others speak of "patience", do you mean more mental patience, in order to retain some sanity, or physical (PT) patience, i.e. to not overdo the PT work? (probably a bit of both).† I wonder if I'm really doing what's best.† My physical therapist let's me be quite a bit in the driver's seat on telling him what is too much, and I tend to at least try to be pretty aggressive (not sure if I really am compared to the norm, but try to be at least relative to my nature), so wondering if I push a bit too hard, which maybe causes the degree of chronic pain later and especially at night.† I just don't know what's really best.† Monique, don't be a bit discouraged about the leg lifts...I could not do a single one, either, at your stage, and within a week got to where i could do what I had described.† Interestingly, today was my worst session for quite a while, in that I seemed setback in many areas (and got almost no sleep last night), but My today PT says not to worry, we probably just pushed too hard in the previous session.† As example, I couldn't get the 2lb weight leg raise going, so he took it off, and after some fits and starts really at least got it going without the weight.† I spent a lot of extra time on the bike.† I'm anxious to see where I am at next session.† As to your question about the walking with the brace partially opened up, I actually found that one to not be difficult to get going.† My PT now has me doing time on the treadmill specifically to work back to a good (non-limping) walk.  Up to now, walking is one the things that I seem to enjoy doing most, as I just can't stay in any one position very long (sit, lay, walk, exercise...on and on).† Walking on good flat surface is quite easy, but avoid odd/irregular surfaces.  I would ask them to describe their specific thinking on this, at least for understanding. They do seem to be doing well for you, but nice to discuss.


Offline cabrev

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Re: Ruptured Patellar Tendon Surgery
« Reply #3712 on: June 22, 2011, 11:44:45 PM »
...one thing I meant to add (with a question to others).  I have PT three times a week (Mon, Wed, Fri), and had been doing a lot of the exercises (even exercising pretty hard on my own, as possible, given the equipment needs) on the off days thinking that this was probably a good thing...i.e. "the more the better".  Due to the chronic pain I seem to have, I discussed with the PT and he was pretty explicit about only wanting me to work hard on the PT days, and to rest up on the off-days...that this work/rest cycle was the best method.  I am now doing this.  It hasn't yet seemed to help a lot regarding the chronic pain (especially at night), but I have noticed improvement of feeling on the off-days (except at night), and usually the ability to attack it better on PT days, with good improvement noted (except this last session which I mentioned before).  What are you others being directed/told about frequency of this work and rest?

Thanks, LT

Offline Wheels22

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Re: Ruptured Patellar Tendon Surgery
« Reply #3713 on: June 23, 2011, 08:26:37 PM »
Hello,

I had a really good day at PT yesterday. I did my first unassisted straight leg lift. It came out of nowhere. Then they had me do 10 of them. Once I got the first one out of my system, the rest were relatively easy (hardest part was the pain I felt in my knee on the way down). They also had me do every exercise without my brace on (including walking around), and they finally unlocked my brace to 40 deg!! It feels so good to be able to get a bend in my knee when I walk. Iím still trying to figure out how to walk semi-normal again, but people around the office have noticed that Iím walking with more fluidity than I did yesterday! I knew I was going to be in a lot of pain when I got home so I took a good amount of ibuprophen and I slept much better (with the pillow between my legs, of course). LT - Are you taking any pain medication before you go to bed? I remember reading that you donít like to take very many pain pills, but from what I understand pills like Motrin help with swelling as well. I hope that I wonít have to depend on pain medication in order to sleep in the future, but I think I will take something before bed on PT days for the time being. Now I canít wait to finally hop on that bike. I am probably a week or two out from being able to do that, but thatís what Iím looking forward to next. It is very true what abros said about seeing a big change between weeks 5-8. Last week, I never thought Iíd be this far now.

LT Ė Iím not to the point of aggressive exercise yet, but my PT encourages me to work on my ROM and the small exercises that I do have while at home (especially on the weekends). I also have PT three times a week (M,W,F) and that seems to take its toll on me. On my off days, sometimes I donít want to work on my ROM because itís so painful, but I force myself to.† Iím not so sure that once I get to the more aggressive exercises that they will encourage me to do it while at home. So I guess Iím not the person who should be answering this question, but I am curious to know the answer for future reference.

Iím still icing and heating my knee daily. Is this necessary at this point? I do it because my knee is still very swollen. Has anyone been told anything directly about ice/heat this far into PT (just about 6 weeks post-op)? I donít think itís a bad thing, but I want to be sure that Iím doing it enough. If Iím lucky I get about one heating session a day and two icing sessions in (20 minutes each).

Monique
Ruptured Patellar Tendon

Offline cabrev

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Re: Ruptured Patellar Tendon Surgery
« Reply #3714 on: June 24, 2011, 02:05:33 AM »
Monique, nice to hear you got the leg lifts going, and got some additional freedom of the brace being opened up a bit.  I too noticed that in a given session once you get through one leg lift, some additional follow-on ones are much easier (and I agree that in most of the exercises the leg return is very painful...I really see that on the heel-slides).  I think you'll find that you'll be walking well very quickly now that you have some brace range.  As for medication, I've tried to avoid pills during the day, but have been taking Ibuprofen at bedtime.  As you say (and my PT recommended) they do help with inflammation, too.  On a few really bad days I have resorted to a leftover Hydrocodone.  Btw, to your question, my PT ices my knee after tough sessions, and always uses the electrical stimulation.  I haven't been using much heat cycles at home, but I think I should use more (my PT does suggest the heat/ice cycles, but he's only been icing).  I would recommend to keep up the icing (of course do what your PT says)...my OS and PT always say "ice is good".  By the way, I bet you'll be on the bike well before a couple of weeks.  Once you hit about 105 and can get it over-the-top/around, you'll be cranking.

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Re: Ruptured Patellar Tendon Surgery
« Reply #3715 on: June 24, 2011, 11:26:41 PM »
Well, Iím nearing the week 8 point and beginning of my first PT session on Monday-very nervous about that but with cautious optimism I will then start seeing some improvement beyond what Iíve noticed the last 2 weeks, post-cast removal.† LT and Monique, Iíve enjoying reading over each of your posts and noting the improvement as it comes and the excitement that it generates.† My injury is within the same timeline as you guys; of course I was unfortunate enough to not be satisfied with one knee rupture and had to do a bilateral! A single is pretty darn rare, but from what I can tell, the bilateral tendon rupture of the knee is practically unheard of. My OS (who is great by the way!), is well into his 70ís and told me I was his first bilateral of this type. He said heíd had 2 other patients in the past who had torn tendons in both knees but they both were on separate injuries and not concurrent as is mine.
Anyway, I can certainly relate to some of the issues you mention, in particular the pain at night. Right after I returned home from the hospital, I had my daughter get me one of those foam cushioned knee pillows that is made of similar stuff as TempurPedic mattresses. While I had the long, heavy cylinder casts on, it was worthless-there simply was no sleeping in any position except on my back which Iím, not crazy about.† †However, at the 6 week point (he almost decided to wait until 8 weeks), when my OS removed the casts, the knee pillow has definitely become my friend. I still have the pain at night and likewise, I too usually take a couple ibuprofens at bedtime. However, I have to alternate between left side, right side and back. When Iím sleeping on either side, the pain will present itself, sometimes very acutely. I then go to my back. There the pain subsides in time and I get a little sleep. So Iím constantly rotating in my sleep each night going from one side to the back, then the other side to the back-the process continues all night. Like one of you mentioned, I too get some relief if I get up for awhile and move about then go back to bed later. It appears to me that the pain in the knees at night is simply going to be the nature of the beast.
As a bilateral, I know protocols and timelines will vary from single ruptures. For instance, you guys are already well into your PT sessions, at 8 wks, Iíve yet to start. I have had to sleep in a hospital bed equipped with a trapeze handle so as to facilitate my entry/exit from wheelchair to bed. I also use a transfer board to slide from the chair to the bed and vice-versa so as to not put any weight on either foot during the process. At discharge, the doc ordered me a bedside toilet which also requires use of the transfer board for me to go from WC to potty. That became problematic as once I slide over onto the potty seat, I still needed to pull my shorts down obviously to do my thing and it required the assistance of another person. I found out you simply cannot lower your shorts w/o putting weight on the feet unless you have 3 arms which I donít! Since there are all girls in my house except me, I opted to use the bed-pan method to save any awkward moments. The 6 weeks in those dual casts about put me over the brink. So far I have handled the physical pain fairly well but not so much the mental or emotional aspect of this injury. It is so against my nature to be restrained as I have, that I had to have medication prescribed to help me with the anxiety and depression it has brought on. Iím better now since the casts are off, but my life is so restricted from what my normal routine is, itís been a challenge for me to adjust to it and realize that I really ainít got much choiceÖto use a little of my local dialect!
I noticed that many of you have been fitted with knee braces which the doctor apparently can set the amount of degrees flex and you progress a little at a time. My OS put me in what he called immobilizer braces which have no such device. I was kinda surprised about that, as having a bilateral rupture, I figured I was in for all the bells and whistles and then some. My braces are easily removed with six 2 inch wide Velcro straps; they run almost full length of the legs and have a circular cutout in the knee area. They are reinforced with 4 rods sewed inside the brace and running linearly. He was very adamant about absolutely zero weight bearing for the first 6 weeks, but after that, he said wear these braces and get up on your feet as much as you can tolerate using a walker. He said crutches were out of the question for a bilateral. He said I only need to wear the braces if Iím standing or walking. Initially, I slept with them on, but I have determined the nighttime knee pain to be a speck better w/o them. Iíve been walking quite a bit, and thatís loosely defining walking as my wife calls it the ďFrankenstein shuffleĒ when she sees me walk! At any rate, after what Iíve been thru so far, Iím just tickled to get up out of the wheelchair. I do active ROM and that part scares me. Without any kind of proper gauge, I guess my ROM to be around 75 right now and hasnít improved much during these 2 weeks of active ROM. The quads may be in better shape I think/hope.† I started doing leg lifts right from the start and daily I do 3 sets of 10 count lifts (10 reps per) a couple times a day. Also I do abduction and adduction quad sets, all w/o any serious pain.† When I had the heavy casts on my legs, which offered a good bit of resistance to the lifts Iím sure.† However, as soon as the nurse cut my casts off and I took that first look at my legs, I was reminded of the line in Kings Row by Reagan when he said ďWhereís the rest of me?Ē. I was shocked how skinny my legs had become in 6 weeks.† I could completely circle just above my knee by using the tips of my middle fingers and thumbs. I could touch just below the knees circling it with the index fingers and thumbs. Thatís skinny for me, as a former runner, Iíve always had strong legs, a few problems with the knees, but the legs otherwise good to go for a bunch of miles.
So far, no one has mentioned to me about the icing or heat applicationÖthatís interesting concept. Iíll inquire at my PT session Monday if that can help me. Likely, after they get thru with me, Iíll be needing that and anything else! For the last 4 or 5 weeks, Iíve pretty much stopped all the narcotics and surviving with an ibuprofen when needed. I probably will pop a lortab before my session. I anticipate big time pain associated with the passive ROM. When I take my braces off and try to flex my knees as far as I can, Iím getting serious tightness and pain when I get to about 75 degrees. Iím tentative right now as to whether I should try to push it further and go ahead and experience some of the pain. On the other hand, I donít want to screw anything up worse in there by trying to do too much. I'll get back in a few days after Iíve experienced some PT.
My best to each of youÖbeing able to commiserate with others in the same boat helps me out a great deal!
Thanks, JC

Offline cabrev

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Re: Ruptured Patellar Tendon Surgery
« Reply #3716 on: June 25, 2011, 02:03:54 AM »
Hi JC, wow(!) a "double" is unimaginable to me, I'm sorry to hear that.  Welcome to the discussion.  I hope I'm not boring people posting too much, but I find that it really helps in staving off the depression/insanity to post and commiserate with others.  As you said, it is such a mentally challenging life change.  The stories, updates, incremental wins, and encouragement from others is extremely helpful to me, and I hope it is equally helpful for others.  As you noted, different doctors and PT's protocols are so variant, and as you say, I'm sure they will be quite different for your bilateral injury, too.  Please keep us posted on your progress along the way.  It is indeed a shock when you see your legs not that long after surgery.  My quad is little more than a "cable" at this point, and it's amazing to me that I can even do as much as I can with it at this point.  I hear a lot of things that resonate with me from what you have described (the night situation in particular).  As for me, after a bit of a discouraging session on Wed, I had my best session yet, today.  I upped reps and weights and made progress on ROM (but, I'm sure I'll feel it this weekend).  Hang in there and keep us updated!

-LT

Offline abros

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Re: Ruptured Patellar Tendon Surgery
« Reply #3717 on: June 25, 2011, 04:03:48 PM »
1. Ice as much as you can for the first 10 week.  Inflammation is good for healing but you need to reduce swelling for improved ROM.   I use a cryocuff still at 3 months.  Expect swelling for 6 months to 1 year (or more).  Swelling will get better with neovascularization and improved lymphatic drainage but that takes a while in the knee.  Heat for helping ROM then Ice again after in the first 2 to 4 month.  I did not use heat until 2 months. 

2. Remember the quad will shut off with this injury its universal and protective for healing.  Mine is starting to rebulk at 3 month but has a long way to go.  Don't over do with exercises. Use the bike, weight bearing, balancing, home EMS, walking and ROM it will turn back on but expect 6 months to 1 year for 90 % strength and size.

JC - think about purchasing a spin bike gym quality.  You will be able to get around when you hit 110 deg and that feels good.  You should look into GII rehab braces. 

http://www.youtube.com/watch?v=se71kCOz1No

http://www.youtube.com/watch?v=idDXU2QHPDs&feature=fvsr   -   (this one is for JC)

http://www.youtube.com/watch?v=sGLRN6eqelA&feature=related   (bilateral quad ruptures, this is the sister injury to the patellar tendon)

http://ajs.sagepub.com/content/36/2/316.abstract

Finally I will leave you with this thought - I went back to work part-time at 2.5 months (2 weeks ago).  I am a physician and the first patient I saw was a new T-Spine fracture with permanent paralysis below the waist in a 22 year old.  That put my injury into perspective!!

We are all going to get better and back to you normal life within 1 year of the injury.  The young woman I saw will not.  Keep working and appreciate the little gains, the people who are helping you and love you.

abros

Offline cabrev

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Re: Ruptured Patellar Tendon Surgery
« Reply #3718 on: June 26, 2011, 12:28:49 AM »
abros, thanks for the good information and perspective  -LT

CSM4thCAV2014

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Re: Ruptured Patellar Tendon Surgery
« Reply #3719 on: June 26, 2011, 01:43:40 AM »
abros,
Thanks for the good info and the links to the videos...when I go to my first PT session Monday, I hope I'm not like the guy in the other room mentioned in Big Mike's video! I will look into obtaining braces like you mentioned.

You make a good point about keeping proper perspective. I had an aunt who was diagnosed w/MS when she was a very active woman and mother of four and in her thirties. The next 23 years were pure hell for her until she mercifully passed away. I think about that young 22 yr old woman you mentioned and it kinda takes away any right I may think I have to complain or boo-hoo about my current situation.

It appears that relaxed suture method has worked well for you so far, I hope that continues for your entire recovery...your progress is very encouraging and motivating!

JC















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