Ruptured Patellar Tendon Surgery

[Jedward]

Hi Clinton, not sure what you you but I work in IT.  my job involves travel as I work away and tend to sit at my laptop for almost all of the day.  I was signed off for 8 weeks and signed back on for amended duties only.  Occupational health (for my employer) signed me on for 3 days a week for 4 hours a day only as I was still in a leg brace although after 10 weeks this was set to 90 degrees so I could sit better.  After 12 weeks I am back full time but from home for a further few weeks as I have only just started to drive and not ready for long distances.  Plus, my employer acknowledges I need to have regular physio.

I think your questions are based around your situation.  Mine where all about, why can't I do this, why does this hurt, when can I do this, when can I likely do that, what are the next steps. Best of luck to you.  It is a lengthy process and you just have to try and keep positive, focussing on little goals each week.

[TendonTim]

Hey everyone.

Just got back from seeing my Surgeon. My PT and I ran into some problems when we started lunges a week and a half ago. My patella started popping/clanking (not just clicking) against my lateral epicondyle and the PT couldn't figure out why because it popped during passive and active motion. The surgeon said that it's a tracking problem (not a shocker there) and the lateral muscles and structures are pulling my patella lateral and it's rubbing against the femur. He said it's not pathologic and it should ease as i strengthen the vmo. Also, I should do as much as i can to loosen the lateral muscle and lateral aspect of the knee. If that doesn't work within the next 2 months or so, he may have to go in with a scope and release a few of the structures that are causing my problem.

Other than that, things have been going great. I'm at 125 degrees active flexion and 135 passive flexion. We started leg press and terminal knee extensions. Literally everything is going according to plan aside from the pop. So my question is, has anyone had to deal with maltracking of their patella and how did that get sorted out?  Thanks

Tim

[boing]

Folks, I also ruptured my knee tendon while I was playing basketball this past Sunday 4/28/13. I am already scheduled to have my MRI and initial meet with my surgeon doctor on this coming Monday 5/06/13. With this being said, my surgery time will be at least 10 days after my initial injury time. Is this a little bit too late? Would this delay significantly affect my surgery result and my recovery time? Thank you all in advance!

[CSM4thCAV2014]

My PTR update which happened 2 years ago today.

Positive:
Full ROM both knees
Walking almost completely normal w/o limping
Quad strength matches pre-injury

Negative:
Bilat patella alta, esp on L knee
A catching, popping in patellar area on weight bearing bends
Left with large numb area on lower left leg following a failed TTT surgery to repair severe patella alta
Chronic swelled ankle following ruptured brevis tendon after TTT surgery
Stinging, burning pain in L knee and tibia tubercle area at times
Negotiating stairs slow and quite painful with popping and flexing of both knees
20 lb weight gain since injury due to very limited ability to work out as I once did

My recommendations from what I’ve been thru over the last two years are a couple things most notably. First, if at all possible, be very selective who performs your PTR surgery…don’t settle. Secondly, be even more selective if there are problems remaining which indicate possible follow on surgery. I failed badly on both. Not saying that is the only reason for my current knee issues, but certainly didn’t help. My follow-up surgery for the TTT left me worse than before which I believe goes against the Hippocratic oath. Remember, just because an OS says they are confident they can make something better, doesn’t automatically mean they actually can. In general, be very deliberate before having any type knee surgery.

As I’ve said before, my PTR experience is certainly not the norm. Most, it appears, recover quite well and resume most, if not all pre-injury activities within a year or so. For whatever reason, I was left with very high riding kneecaps following my PTR surgery and I’ve been told several reasons over the last two years why that happened. At this point, it is less important to me how it happened, rather I’d be more interested in how it can be reversed.

My best to all who are unfortunate to suffer this rare but serious injury.

JC

[Clint]

@Boing,

Waiting 10 days is not optimal, but it isn't the worst thing in the world either. I ruptured mine early morning April 11 and had surgery 5 1/2 days later. I'll repeat the advice my OS gave me in the interim before surgery: Do not take any more anti-inflammatory meds than you absolutely have to. Even if the swelling gets pretty bad, I'd just ice, elevate your knee and take whatever pain medications they give you as needed. Taking too many anti-inflammatory drugs (Ibuprofen, etc.) will work against your body's natural healing response. My knee was the size of a very large melon and was actually stretching my knee brace before my surgery, but my surgery went very well. Hang in there, and if there's any chance you can bump your surgery up a few days, jump on it. In the meantime, this website is a phenomenal resource for help, and if I were you I'd read as many of the posts here as you possibly can. I read all 316 pages over the course of the past two weeks and it's helped me immensely in knowing what to expect and do - from pre-surgery all the way through to a full recovery. Hang in there pal, Good luck

Clint

[John42]

hi and welcome to the RPT surgery thread

Ten days should not be too late for surgery, but you have sustained a very serious injury, with a long rehab. A typical sports injury.

I would suggest that you read some of the previous posts on the Ruptured Patella Tendon Surgery thread and read the attached documents which I have compiled over the years.

ASK questions - lots of buddies out there to help you along this road.

Where do you live?

Take care

JohnK/ Manchester UK

[Clint]

Hello everyone,

I had my first visit with my PT Monday afternoon and I must say, she was a little surprised that my OS recommended therapy so soon. Based on the advice I received from John K and other helpful folks on this board, I asked the PT if she had ever dealt with rehabbing this injury before. While she said she had, she admitted that she has not run across very many RPT patients her seven year career as a physical therapist. Based on what I've read about the rarity of the injury on this website, I wasn't at all surprised or shocked, and I really appreciated her honesty.

Back to Monday's visit - seeing as though I was only 13 days removed from surgery and already reporting for PT, there obviously was not a whole lot we could do during the session. She started by measuring the circumference of my knees - right above and right below the 5-inch Steri-stripped incision on my left knee (the bad knee) and did the same on my good knee. The measurements of my bad knee averaged out to 4 ½ centimeters greater circumference than those of my good knee. I don’t know if that is normal or not as I somehow forgot to ask and I also forgot to ask her to measure the ROM of my good knee - I know, I’m an airhead 

After taking the measurements, she proceeded to put her hands under my knee and gently lifted it to perform Passive Range of Motion (PROM) heel slides. She repeated that process several times and oddly I felt zero pain - just a weird, tight, elastic-like tension emanating just below my invisible kneecap.

During PROM, the therapist was easily able to get me to 45 degrees before I felt any tightness, and I was actually able to achieve 60 degrees with own hands, without recruiting the help of any leg muscles. Being just 13 days removed from the operating table, I was quite pleased with my PROM 

At 6' 2" 235 pounds, I was a bit surprised when my PT called my OS and confirmed that I could bear weight (as tolerated) with my Bledsoe immobilizer brace locked in full extension. I will report for PT again on Monday (20 days post-surgery), I'm hoping we’ll be able to do a little bit more than last time. In the meantime, my PT instructed to continue performing PROM heel slides at home - three sets of 15 repetitions, three times per day.

To answer your question, Jedward, my job is primarily a desk job, but I’m a news reporter, so I need to be able to get up and drive to various meetings (like city council and school board), and attend various community events, court proceeding, etc. My OS said he is hoping to release me back to work in early June - approximately 5 to 6 weeks post-surgery. I love my job and I can’t wait to get back, but at the same time I understand the risks associated with rushing myself back into the hustle-and-bustle of a frantic, fast-paced newsroom are very real.

Before I left the rehabilitation/mobility center on Monday, my PT provided me with a copy of the following PTR rehab guidelines - from Penn State University’s Milton S. Hershey Medical Center - which is where my orthopedic surgeon completed his residency:

PARTIAL PATELLECTOMY / PATELLAR TENDON REPAIR
Post-Operative Rehabilitation Guidelines

Weeks 0 to 3
   Toe-touch weight bearing with knee brace locked in full extension
   Cryotherapy

Weeks 4 and 5
   Active knee flexion to 45 degrees
   Passive knee extension
   Weight bearing (as tolerated) with brace in extension

Weeks 6 and 7
   Active knee flexion to 90 degrees
   Passive knee extension and straight raise with brace locked in extension
   Scar and patellar mobilization

Weeks 8 to 11
   Discharge brace once satisfactory quadriceps control
   Gait training
   Scar and patellar mobilization
   Short-crank (knee flexion < 90 degrees) with progression to regular stationary bicycle (knee
   flexion > 90 degrees)
   Straight leg raises
   Pool ambulation or underwater treadmill
   Retro-ambulation and forward step-up program

Weeks 12 to 16
   Continue knee flexion ROM exercises
   Progress to PREs for quadriceps, hamstrings, adductors, and abductors
   Progressive squat program
   Soft-tissue massage, myofascial release, contact-release techniques
   Agility and Elliptical training
   Running and jogging
   Home exercise maintenance program

My tentative PT schedule is as follows: Once per week until 5; once or twice per week in weeks 5 and 6; two or three times per week in weeks 7 to 11; and once or twice per week in weeks 12-16.

Finally, sorry for the length of this post, but I’m really hoping a some of the old RPT veterans, like John K and others and some newer RPT guys, like TendonTim, Jedward and others can look over the guidelines I listed above and provide some feedback on them. Is the plan similar to what you or others you know have done to rehabilitate? If not, where do the plans differ the most? Do you feel it may be too conservative or too aggressive? If so, why? Any thoughts or advice - any recommended additions or subtractions? Any suggestions at all would be greatly appreciated.

What strikes me the most is the fact that the guidelines I was provided seem quite a bit more aggressive than what the vast majority of other posters here have adhered to.
 
I am looking forward to hearing from you guys - my next appointment with my OS isn't until May 24.

I hope everyone else is making good progress in their efforts to overcome this rare, debilitating, and downright wicked injury. I know that complete recovery from RPT surgery does not come quick or easy, but I truly believe that each of us can overcome the difficult challenges that lie ahead.

Clint

[boing]

Clint and John,

I live in Houston, Texas. I reached out to my doc, Marc Labbe, regarding to the waiting period. His assitant assured me that the time I am waiting now is ok. It seems they know what they are doing firmly. Clint, I like your Rehabilitation Guidelines a lot. It gives me ideas of timeline and preparation at certain time. Surely, I will try to read through all 317 pages long but knowledgeable and helpful thread. In fact, I have already started taking notes while reading.
Thank you guys! I am going to kick this injury's butt!

Boing

[TendonTim]

Hello everyone,



PARTIAL PATELLECTOMY / PATELLAR TENDON REPAIR
Post-Operative Rehabilitation Guidelines

Weeks 0 to 3
   Toe-touch weight bearing with knee brace locked in full extension
   Cryotherapy

Weeks 4 and 5
   Active knee flexion to 45 degrees
   Passive knee extension
   Weight bearing (as tolerated) with brace in extension

Weeks 6 and 7
   Active knee flexion to 90 degrees
   Passive knee extension and straight raise with brace locked in extension
   Scar and patellar mobilization

Weeks 8 to 11
   Discharge brace once satisfactory quadriceps control
   Gait training
   Scar and patellar mobilization
   Short-crank (knee flexion < 90 degrees) with progression to regular stationary bicycle (knee
   flexion > 90 degrees)
   Straight leg raises
   Pool ambulation or underwater treadmill
   Retro-ambulation and forward step-up program

Weeks 12 to 16
   Continue knee flexion ROM exercises
   Progress to PREs for quadriceps, hamstrings, adductors, and abductors
   Progressive squat program
   Soft-tissue massage, myofascial release, contact-release techniques
   Agility and Elliptical training
   Running and jogging
   Home exercise maintenance program

My tentative PT schedule is as follows: Once per week until 5; once or twice per week in weeks 5 and 6; two or three times per week in weeks 7 to 11; and once or twice per week in weeks 12-16.

Finally, sorry for the length of this post, but I’m really hoping a some of the old RPT veterans, like John K and others and some newer RPT guys, like TendonTim, Jedward and others can look over the guidelines I listed above and provide some feedback on them. Is the plan similar to what you or others you know have done to rehabilitate? If not, where do the plans differ the most? Do you feel it may be too conservative or too aggressive? If so, why? Any thoughts or advice - any recommended additions or subtractions? Any suggestions at all would be greatly appreciated.

What strikes me the most is the fact that the guidelines I was provided seem quite a bit more aggressive than what the vast majority of other posters here have adhered to.
 
I am looking forward to hearing from you guys - my next appointment with my OS isn't until May 24.

I hope everyone else is making good progress in their efforts to overcome this rare, debilitating, and downright wicked injury. I know that complete recovery from RPT surgery does not come quick or easy, but I truly believe that each of us can overcome the difficult challenges that lie ahead.

Clint

I definitely don't think it will be a problem going with a more aggressive approach to the rehab Clint. Just about everything that I've read about the injury points to the idea that the repair of the knee joint is solid and secure so the main issue is the atrophy that comes with disuse of the leg. Particularly the VMO. From the looks of that rehab protocol, it should get you back on your feet pretty quickly. You might even ask your PT and surgeon if you can ad electrical stimulation to try and keep that vmo working. In any case, the protocol looks good.

Tidbit of advice, do everything you can to get the vmo stronger and hypertrophied. We tend to use the lateral (outside) muscles of our leg more often and that can give you problems with tracking of the patella. Good luck.

[Jules257]

Just a little update on my progress. My PT had me stop weight training because the wires in my knee were getting too aggravated.  I am however still able to do plyometic stuff, but am limited still.  It's been about 7.5 months since I had a complete RPT and today I go for a second surgery to finally get these wires out. Hopefully once that's all healed, I'll be on a quicker road to recover!

[Kneeds]

Hi fellow RPTer’s, I’m an alumni to the club and today marks the 5th year anniversary of my RPT surgery (complete rupture occurred on May 2, 2008).  I don’t post much anymore however I do visit the forum occasionally to catch up on what’s happening with this injury and I’m still willing to answer any questions people may have.

As encouragement for the new teammates with this injury I would like to summarize where I’m at after 5 years.  For my complete story I posted regular updates and answered numerous questions during my recovery which can be seen in my former posts.  My summary is as follows:
1.   Although I recovered quite quickly post RPT (based on averages) I still consider it to have taken 2 years for my knee to be at a point where I completely trusted it.
2.   Looking back at the process it truly feels like a flash in the pan, it’s amazing how life charges on and fades the memories of a painful experience.
3.   My knee is no longer the center of my universe.  I can go about my normal routines without it haunting my every thought.
4.   My knee takes everything I can throw at it and some of my hobbies are punishing to knees.
5.   I have become what I call “knee smart”, which essentially means I try to do everything I can to protect my knees while still enjoying the things I like to do.
6.   I have no desire to experience a RPT ever again.

If I was asked if my knee is as good now as it was pre RPT the answer is unfortunately no.  Although I don’t have any pain on a day to day basis I’m always aware it feels differently than it did before.  My knee can get sore in the patella tendon area after a hard punishing or impact and I don’t recall having that sensation before the injury.  The good news is the knee performs as needed and recovers from any pain quickly.

To all the newbie’s, the recovery road ahead is a long uphill battle however once you crest the hill and start down the other side the shadowy slope is behind you and the sun will be shining on your face going down the bright side!

[Kneeds]

In response to the recovery schedule Clint posted above my comments are to use caution.  Every injury and person is different so everyone must tailor their recovery plan based on themselves and not get caught in a mindset that they must achieve whatever documented standard is out there.  I was very aggressive with my recovery plan but still held myself back to give my tendon time to heal.  Some sources indicate the tendon can take as long as 12 weeks to heal so I kept that in the back of my mind in my approach and focused on ROM for the first 8 to 12 weeks (I spent 1 to 2 hours per day on ROM).  Once I achieved my full ROM I shifted more to strength building which was no mystery to me as bodybuilding has been a multi-decade hobby of mine.
Re-ruptures can happen so try to leave a safety margin between how hard you are pushing your recovery and the breaking point of your repaired tendon.

[Ben5000]

Hi friends. I'm now at 12 weeks post surgery and here is my update.

The knee feels great. I have started running again. Did a 10km run the other day in 1 hour, about 15 minutes slower than my usual pre-injury time. Should be able to get that down by end of May.

I have long since lost any type of limp. My gait is normal and I can speed walk. I can walk up and down stairs normally. I have 130 ROM in the injured leg, and 135 ROM in the non-injured leg. I have no worries about getting that last 5 degrees.

I've got 2 more physio appointments this week, and then done with that. Have enough exercises to do on my own. I go to the gym, or run, or bike, everyday (which is what I did pre-injury).

I still have some limits. Dropped out of an ultra-marathon that will be held in early June (signed up pre-injury). No way am I going to be able to run 120 miles, on a trail and at night, just yet.  Also, still cringe watching guys play basketball (I injured myself playing basketball). Maybe in the fall I will play again - no rush or burning desire there.

Clint, your plan looks fine to me. Everybody heals different and every rehab path is different. Listen to your body.  Now that I am at the magical week 12, I am much more confidant in what I can do.

Ben

[John42]

Hi Kneeds

A very good summary after five years - I can vouch for report as I am now just about ten years and learnt to respect my knee - keep up with the good work.

Best wishes

JohnK/ Manchester UK

[boing]

Hi folks, tomorrow my surgery is finally here after 11 days long wait after my initial injury happened on 4/28. I have tried to read and digest as much as I can before the surgery, however I still didn't complete my goal of finishing all 317 pages. Hence, friends, would you all please provide me some insights and points that I should watch and pay attentions to post-op? Thanks in advance