Ruptured Patellar Tendon Surgery

[Mikey_O]

Just wandering if anyone out there has experience a pop in the patella when going down stairs or down portion of the squat? I get one pop then seems to track better.  I am assuming poor patellar tracking from swelling and week quads (VMO in particular).  When does this resolve?

Abros

Abros, i get this too - particularly when doing leg extensions. Spoke to my OS about it and he did some Xrays. Turns out my patella is being pulled to the left (outside) as my VMO isn't yet strong enough to get it tracking correctly. The more strength work i do the better it gets - 30 degree wall sits using an e-stim machine on 10 second cycles seems to be bringing my VMO back to life!

[Mikey_O]

abros,

 I have an additional concern about my kneecap position...it appears I have a little bit of high riding patellas. They definitely are riding higher than before the injury. It is my hope of course that as I progress thru therapy and strenghtening of the quads, that they will settle down close to the original positions...I have no idea if that is typical or not.

JC

I had this same concern, as my PT and everyone i had seen told me that my patella was riding way too high. I got very anxious about it as i understand it can lead to easy dislocation and a host of other complications. My PT then called my OS and asked him what was going on - his response was that there was no way my patella was riding high, if anything it was low!

As you can imagine this really confused me so i went in for some Xrays. Turns out my OS was correct - in spite of all appearances, my injured patella is sitting a couple of mm lower than my good leg. I had multiple images taken, and all confirmed his diagnosis. I would definitely recommend getting some xrays to set your mind at rest.

Also, as abros mentioned, you need to account for not only the swelling in your knee but also the atrophy in your quad and the surrounding muscles - it puts everything out of proportion and makes like for like comparisons very difficult.

Finally, don't get too hung up on the appearance of your knee, i don't think my knee will ever go back to looking like normal, but so long as it's functional and allows me to get back to the sports i love then i'm find with that.

[CSM4thCAV2014]

Mikey…thanks for the explanation concerning my fear of possible patella alta in my knees. From what you and abros have stated, I feel a little reassured now. Of course I don’t have the option of getting an x-ray to compare to the “good” leg since I’m a double rupture! I’m just going by where I recall the general location of my knee caps prior to the accident. Right now, whether they are high or low, I will say that they appear to be exactly the same height as each other. I’ll see what my OS thinks about them when I go in for an appt next week. Thanks,

JC

[abros]

I am now pretty convinced my popping is due to swelling and weak quads not allowing my patella to stay in the femoral grove..  Its improving (slowly but improving).  Its mainly with the eccentric load on the quad (going down stairs, down portion of the squat or walking downhill).  Its occuring less frequently.  I have a route that I walk my dog on which is hilly and initially popped on all the down hills and now it just does it once.

The high riding patella is from all the inflammation and quad contracture, that I am will also improve.

[IneedICE]

I've been reading the posts here for the past 3 weeks, mostly to understand the process in my recovery.  I injured myself on May 16th and have made it to this point through the  pain, discomfort, and frustration getting my questions answered here amongst my fellow gimps.  But now I have hit a wall.  The reason?  Last week was my 2nd week of therapy where begin range of motion exercise.  Whew.  I was not prepared for the type of pain it created.  My first day we made it to 30 degrees.   I did my exercises at home and was dreading the next appointment.  This therapist wants to go 10 per week and I don't see how that's possible.  2nd day of ROM  thurs. the 30th of June hit 40 relatively easy.  I think my therapist was just as shocked as I was.  Then the 4th of July, I had to get out of the house.  So we went to a parade.  I felt good about being able to maneuver through the crowds and get to our spot.  I live in a small town and the parade is basically outside my front door and around the corner.  My spot is about 1/2 a mile away.  I stood for about an hour and sat elevated for about 30 mintes.  Then we walked around for a bit, until my triceps were telling my to go home.  The day didn't end there.  We went to a bbq with family and left around 8pm.  Definitely the most getting around since my injury.  I had a therapy appointment on the 6th of July and took a step back.  The pain was like my knee was going to pop out and I literally felt like I was going to pass out.  I told my therapist that it hurt to much and he kept pushing.  I'm not the type of guy that lets pain show. I like to think I have a high tolerance.  But my goodness, I haven't groaned and moaned like that since I was heavy into lifting.  Anyways we were able to only get to 38 degrees and that is my concern.  Has anyone taken a step back in the ROM sessions?  And is there a certain point in the exercise that you push past the  fear of my knee getting re-injured?  That's what it feels like.  Tight and ready to blow if pushed to far, is that normal?  I'm off to therapy hear in about 4 hours to try to get to 50 degrees. Yikes!!! 

Oh another dilemma, my quad has shriveled to a noodle and it's just not to exciting to look at.  Any motivation to a positive outcome to this unsightly mess would be greatly appreciated.

I saved the best for last.  I injured myself trying to show my 5 year old son how to properly do the high jump at our local high school track. Talk about humbling.

Thank you

MK aka IneedICE

[cabrev]

Hi MK,

It is not abnormal to have a step back on occasion, along with the steps forward.  My experience certainly mimics yours about the feeling that the knee will literally explode off the leg through some of the work.  Not fun, but you'll get there.  The knee still seems to feel like an unmoveable solid rock, and I often felt like I'd rerupture, too, but it hasn't happened yet     I just got back from my 10 week post-op appt with my OS and received positive feedback.  I made a record 125 ROM (on my stomach) today in PT.  Never thought I'd get there (can remember the point about where you are in time now, and all of what you say sounds very familiar.  Hang in there!  I think that JohnK (the board veteran) will see your post shortly and will send you much good info.  Keep us posted.

-LT

[IneedICE]

Thanks for the response, LT. I feel alot better today than the previous week as I hit 48  on my recent ROM session.  The therapist said that it is possible the long 4th of July may have contributed to the step back.  The pain is intense, but after a few sessions I am more prepared with what I have to deal with.  The reality that this is truly.... NO PAIN, NO GAIN ..... at work.  The only pain medication I use is prior to PT.  Ice is my cure. Patience is really what I lack, so this is a lesson I'm learning daily. Can't make the Earth spin faster, can I?  I got my eyes set on 90 degrees.  Therapist is going for 50 on Tuesday, but I'm going to press for 60.  OUCH.  I use my brace as a measure for degrees.  I unhinge it and set it from 20, to 30, to 40, step by step.  Working to 50 possibly tonight.  I'm 3 weeks from my 10 week post op, I have  a check up with my OS on the 21st.  125? WOW that seems like a lot of work. Good for you.  How's your swelling?  Quad?  My swelling seems to be in the general knee location and my quad seems there, but at the same time, not there.  I've been massaging out my scar tissue, elevating and icing.I've been searching the web for info, but always end up at sites I've already visited any more would be great.  Especially since I've read every book and watched every movie I could possibly bear.  I need a break from this break

Thanks
MK

[Gutted]

Hey guys,

Just thought that I would post as I haven't been on for a while, though I have been reading, I'm at about 7 months I think. You guys at the moment seem to be doing far far better than myself and the others who had their injuries around the same time as me. We were on average getting full ROM at about the 4 month mark I think, a bit later than that for me personally.

I remember trying to gain my ROM back and it was very painful. However, I remember being too keen to get it back and pushed harder than I should have done at about the 100degree mark. I had to back it off a bit and by being a bit more patient and consolidating each level (100deg, 110deg, 115deg) I was far happier as it was a true ROM measurement and it was less painful. Granted it would take longer, but it isn't a race!

My knee is still swollen but it has gone down a bit.

I am currently working on the strength in my leg, it shrank like you read about! It takes a lot of hard work and time to put the strength back in to the leg, so whatever you do, keep persevering as it does come back. As someone said to me, the reason why sportsmen come back from injuries like this is not because they are different to you or I, its because rehab becomes their life. To put it into perspective about how much strength you lose, atrophy of the quad starts about 6 - 8 hours after the injury and they reckon you lose 3% - 4% of your leg strength a day!

I can currently leg press (concentrically) 50kgs, 3 sets of 8. Leg press (eccentrically) 75kgs, 3 sets of 8. My leg extensions are by far the worse part of my rehab. They have not really improved at all. I can do 10 - 12.5kgs, 3 sets of 8 on the leg extension machine before it hurts too much. Hopefully it will start coming good soon. Has anybody had an issue with weighted leg extensions? My normal leg extensions are good with no weight on.

I do the leg strength exercises 3 days a week which allows the recovery and any pain to go away. I also do balance work using a BOSU ball, wobble boards and other balance related bits of kit. Generally doing balancing on the injured leg only for 30secs or a minute then make it more difficult by balancing on the injured leg whilst throwing a ball against a wall and catching it. The other days I do CV work on either the cross trainer or a spinning bike. I am slowly getting back into using my road bike. I also do hydrotherapy twice a week which I found was great for ROM and general conditioning. The reason I do balance work is as the rehab instructor said, there is no use having power without control.

So, the good news! Well, it does get better, it is a very slow process and one that I couldn't really get my head around until about 4months post injury. I would say that you do have to push yourself, but at the same time it is NOT a race and your knee/tendon will not thank you for rushing it. I only walk with a limp now after a hard gym session when I have pushed it too hard. I can enjoy going to the pub again(!) and can do jobs around the house. I have to get 80% of my good leg's strength in my bad leg before I can start on the jog/walk programme - so that's my next goal. One of the biggest things to come from this is, as you pass each hurdle you begin to appreciate what normal life is like a lot more. I for one will savour even the normal things in life like being able to go up and down some stairs. The little goals and rewards are what keep you going, so continue working hard.

I hope there has been some information that people find helpful here. please feel free to look back at my earlier posts to find other information. Keep up the hard work, don't push too hard and I promise, it does get better!

[cabrev]

Hi MK, good for you on your progress.  Everyone [rightfully] preaches "patience", and man they are right.  I like you (and probably most) have a hard time with patience, and progress just doesn't seem to come very fast.  It all sure is a balance of being aggressive, yet patient, I think.  Those that have been out there for a long while have really put the swelling in perspective...the knee will be swollen for a long time.  As for the atrophied quad and the swollen knee, someone, I recall, had used the term "flamingo leg", and that is sure about right    MK, you'll want to celebrate when you get your ROM to 90 and dangle your legs, and then a bit more to where you can turn the bike.  That's a real milestone.  Gutted, thanks for the dose of reality, the words of wisdom from a veteran, and the encouragement.  At the point I am at, the leg extensions about kill me, and I think they are what cause my high level of chronic pain, too.  It seems from what you say, they can be painful quite far out in time, unfortunately.  What is your ROM now at 7 months post-op?  Do you feel like you've gotten to the limit of what you will attain?  I've got the wire, and my OS says that it won't be the limiter on ROM, man that sure seems counter-intuitive.  Wonder if I'll break the wire at some point (Gutted, seems you did pretty early on).  I wish I knew better how to tell if the wire is causing a lot of the pain.

-LT

[mstare]

Hello fellow RPTS survivors!

Almost a week ago I ruptured my patella tendon while playing basketball. Went for a layup, and upon planting my leg slipped on wet pavment just as I was exploding off the ground, and then felt the "shot by a gun" sensation you all know too well. Saw my patella riding up my thigh, and I knew exactly what happened. I'm a 36 year old physical therapist, with a business, 2 small kids and another on the way, and I immediately knew what I was in for with this injury. The realization of how my life was going to change for the next several weeks overshadowed the pain at that point. I was fortunate to get an MRI and x-ray immediately, adminitted to the hosptial that night, then had surgey in the morning (on the Fourth of July Holiday!). Surgery went well and they found the medial and lateral retinaculum was also ruptured. I was dissapointed that there were no burgers or beers to great me in the recovery room  - that is no way to celebrate independace day here in the USA!

I hope to share some perspectives from my experience in recovery as well as my clinical experience as a physical therapist. I have not seen many of these cases, about 2 in the last 10 years, and a few quad ruptures. I'm absolutely sure this experience will escalate my understanding of the condition!

Right now I'm in the dreaded wait around and rest/recover phase. I am constantly reminding myself how lucky I am because of my resources at my disposal, and knowledge that this will completely resolve. As much as I know how painful the rehab process will be, I can't wait to get there. The passive process that I am going through now is frustrating. But I know how vital it is.

For those who are in the early stages like I am know, here are my best pieces of advice thus far:
1. Eat well: studies show that caloric needs rise by up to 20% due to the recovery demands from surgery. Also, the meds can irritate the stomach if you don't have some food on board.
2. Insist on having visitors: this has been an isolating experience, but frequent visits from neighbors and friends have helped.
3. Use the top part of your crutch as a way to assist in lifting your leg for bed transfers. SLR are contraindicated and next to impossible, not to mention painful at this stage, This is the only way that I can get in/out of bed or out of the car.
4. Change yur bandage daily. Taking the wraps and banddage off feels great.
5. Stagger your meds: I take vicadin and ibuprohen every 6 hours. So, Vics frist, 3 hours ater ibu, 3 hours later vics, and so on.
6. Have sex often: it is a natural analgesic, and has been the only time frame I've been completely pain free!

That's about all I can think of for now - more to come down the road. Can't wait to bend this damn leg!

[Gutted]

Hi Cabrev and all,

To answer your questions, Cabrev, about the ROM first. I haven't really had my ROM measured accurately (the PT did a rough measurement, somewhere in the order of 135 degress ROM) compared to my other leg. But I do know that by lying on my back and doing an unassisted heal slide I have the same ROM in both legs. I can do wall slides and go right down but I am careful doing it as I can feel that my knee is weak - I certainly wouldn't do it without warming up first! I would however say that my bad knee isn't as flexible/smooth as my good knee when I am assisting the bend by pulling it back when I am doing something like quad stretches. I am quite content with the ROM I have as I am confident that it will become more sturdy and I will be back to normal, though I am more than aware that it'll take quite some time, which I have come to terms with.

The guys who had the injury at the same time as me didn't report that they suffered from the same pain as I have with respect to the leg extensions. I just guess that it is very specific to each person, how bad the initial injury was, the repair and how your body has/hasn't mended itself. I'm keeping my fingers crossed that the pain will eventually go away. The good news is that the leg press work doesn't generate the pain and I can get on with that.

I too was told that the wire wouldn't limit my ROM. I was sceptical but they are the experts. I think that I snapped my wire prematurely because I was doing a lot of rehab on the knee. Probably, in hindsight, maybe a bit too much. Snapping it so early set me back a month in my rehab. So that's why I preach about being more patient than you would normally be when it comes to exercising. How did I know the wire was broken? Well, when I was lifting my leg up over a small hurdle there was a loud crack and the knee felt like it would move a lot more freely! I can't begin to tell you how scared I was, I thought that I'd re-ruptured it! When I tried the knee on a ROM machine later on it moved much more freely but then I started to feel a needle like sensation digging in to my skin from the inside. At that point I was fairly confident that it was the wire - sure enough, it was. My OS said that he would normally take the wire out at 3 months anyway, but he said that other surgeons will leave the wires in if they aren't causing any issues.

Feel free to fire any more questions my way. Chin up everyone, I'm still in, what I consider to be, really early stages of rehab, but I am in a strange way enjoying the process of getting better.

[CSM4thCAV2014]

mstare-sorry to hear of your misfortune of suffering a PTR. To be an injury of such rare occurrence, there is quite of few folks on this forum who are at various stages in their recovery/rehab and check in from time to time to offer their insight and experiences, offer advice or perhaps ask questions of the group to specific areas of concern.  As a physical therapist, your experience and knowledge will offer a great deal to this forum and I trust you will post often to advise in your area of expertise to those of us that are still heavily engaged in our recovery. I’m at 10 weeks myself, and have a long way to go yet. And as is the case with all who post here, your personal recovery experience will be of great interest to us as well, if for no other reason than to commiserate and to encourage and cheer each other on!

I appreciate your advice you’ve already offered…I’m particularly fond of comment #6!!   

Wish you all the best and a speedy and total recovery!

JC

[IneedICE]

Just out of physical therapy.  Hit 50 degrees with relative ease.  Don't get me wrong, there was some serious pain and a quick bout with dizziness.  That was erased with the feeling of achievement.  Physical therapist is giving me a week off because he feels I'm doing great with home exercises, which I cannot stress enough, the importance of very diligent work on.  I must admit I did not take the at home work as serious until I saw the benefits.  Well, enough said.  Off to the beach .  Have a great day and good luck to all with this crazy injury.

MK

[CSM4thCAV2014]

Greetings all,

Update for 10 weeks post op as of today. First, I had a follow-up appt with my OS yesterday and he was pleased with my progress after just 2 weeks physio. He said I am further along recovery road than he had expected but reminded me that he had no real baseline for that assessment given I was his first and only bilateral PTR patient. I was pleased that he gave me the go ahead to lose the braces and the green light to return to work next week. That will be about a month earlier than I had first told my boss my return would be. That was made about 2 weeks post op however when things looked quite bleak to me. He also gave me paperwork for a temporary handicap parking permit. When I saw him, my last reported ROM measurement was 100-L and 105-R. I was a little disillusioned when discussing ROM outlook, he stated that 120 was a reasonable expectation. I asked him if was okay for me to expect 130 instead and shoot for more!

I had PT this morning and I guess the race is on between the two knees. All along, the right has maintained 5 degrees more ROM over the left. Today that changed as the left one inched ahead. It has been puzzling to me about each knee’s progress as the right knee has from day one looked worse and clearly has felt worse, yet continually does better with ROM. However, I have patella popping on mini-squats with the left knee that right one doesn’t have. Manipulation of the right patella generally feels a little painful whereas the left knee doesn’t. Actually, I guess just as two different peoples PTR’s will be different, I should assume I can have differences between my two knees. However, for the most part, they are both progressing at about the same rate which I’m thankful. It could be very problematic in my recovery if one knee was at 110 ROM and the other at 65 for instance. The stats recorded today are:

ROM:  Left- 111    Right- 110
Quad circumference (5” above ctr knee):
6-14-11   left-17.5  right-17.75 (@ 6wks post op and cast removed)
6-25-11  left-18.75  right-19.00
7-7-11  left-19.25   right-19.75
7-12-11 left-20.00  right-20.38 (@10 wks)

Positive issues: walking more w/o cane; balance has improved; popping in r knee has stopped; graduated from the wheelchair-can now sit down and rise out of most types of chairs; ankle swelling has diminished to almost nothing; ROM advancing well; overall, both knees tolerating PT and home exercises much better than about 2 weeks ago.

Negative issues: leg extension weak; pain and tightness in both knees persists, esp. during squats or heel slides; still suffering considerable pain during sleep; unable to kneel, even on a soft surface; little confidence going up or down steps; lacking confidence knees will not buckle at times; swelling and aching after more than 20 minutes of standing and/or walking.

Next week will be a big test for me as I return to work and will resume a 40 hour schedule. If I can handle that, I will be greatly relieved. Then I just have to focus on doing PT and home exercises and patiently wait as my body heals.

JC

[cabrev]

Here's a little bit of encouragement for all (and JC, maybe even more so for you, given you're a ruptured quadriceps tendon guy specifically...and a double at that).  I bumped into a a guy while at the gym yesterday, and he noticed my knee and struck up a conversation (he was well versed on the subject    ).  Turns out he is a recovered ruptured quadriceps tendon guy.  I didn't ask his age, but I'm guessing 50-ish.  Well, this guy looks like the classic mega-thigh-muscle hulk, and was bending and squatting weights I'd never come close to even in my prime.  Said he suffered the rupture about 3 years ago, and joined the gym at that time to rehab and workout, and has really kept after it.  He said it so happens that what was his "good" leg is now his weak link (i.e. the leg he injured is now stronger than the "good" one).  We all gotta keep after it.  MK, good to hear your progress!  I worked things so hard yesterday, I'm almost chair-bound today...hope I'm recovered enough for a good session tomorrow.  My knee's so stiff and swollen right now when I bend it to 90 at the moment the scar binds in and it looks like a plumbers crack.    Monique, are you still reading?...haven't heard update on your progress in quite a while.

-LT