Ruptured Patellar Tendon Surgery

[The Eejit]

Hey All,

Quick question, did anyone get or does anyone still get their injured leg going to give out on them sometimes. I can only describe it as walking and then it either goes back or forward I can never tell. It's happened me a few times but the other day I got a really bad one while at the top of some stairs, wondering if it's just muscle tiredness as mine don't seem to be repairing as quick. My still still refuses to let me descend stairs normally as well.

Steve just noticed your earlier posts, I have a higher kneecap now too, I mentioned it to the surgeon last time and asked could it be what is causing my click but he did not seem overly concerned.

Wednesday is MRI results day so everyone please keep everything crossed for me that I don't have to go for any more surgery!

[John42]

Hi Jules

Give consideration to wearing an elastic stocking - I have had one for the last two years - waist high with a velcro fastening around the waist - boosted my confidence no end - available on the NHS free of charge.

If you are interested, revert back to me, and I will give you the manufacturer as it`s made in Germany.

Take care

JohnK/ Manchester UK

[bballkingofnba]

Hi Jules,

Hope your MRI goes well. For me it took me over a year before I properly able to descend stairs. Some ppl can do it earlier. I guess it varies person to person. Once the VMO function in the quad is properly restored, thats when stairs got easier for me. Try to do some biofeedback work with the VMO of the injured leg to make sure it is firing properly.

[boing]

Hi friends, it's almost 4 weeks post-op for me. The swelling has gone down quite much. Should I use heat patch to increase blood circulation instead of icing it 3 time/day? Thanks!!

[awpalmer]

Hi everyone,

It's been a couple days over 4.5 months and i thought I'd give an update as to my current situation. Since the beginning of May, I have been trying to bike around as much as possible which has made a considerable improvement in terms of muscle buildup/recovery I would still say my previously injured leg is around 60%-70% compared to my other in terms of strength, but there is still a noticeable lack of muscle "girth" when compared to my strong leg.

In terms of mobility, walking at any pace is no longer a problem and I can jog at a steady, regular pace but still have to concentrate to eliminate any sort of limp or overcompensation. I am also able to hopp from one leg to the other (i.e. hop scotch excercises) without any problems.

In terms of walking down stairs, the pain has gone away for me when descending and it's now an issue of strength compared to agitating the repair site. A slight difference is noticeable but with concentration it is almost back to normal again.

My question to the those in a similar place/ those with experience is regarding pain in the knee when performing certain exercises. This pain, which seems to originate from different areas around my kneecap (and sometimes on the tendon area) happens during certain exercises. Leg presses, wall/bodyweight squats and hopping routines are fine, but lunges (when my bad knee is behind) and squats with an empty bar bell seem to cause flair ups of pain. Did any one else have to deal with this at this point of their recovery? The pain is gradually reducing over time, but still there nonetheless and I feel it shouldn't be.

To those in the early stages of recovery, it does get better eventually and once the crutches/cane are ditched, you won't be looking back at all!

Wishing a speedy recovery to all

[boing]

Hi friends, today is my 6 weeks post-op. I have gained almost all my ROM back, maybe just another 10 degrees to go. However, my injured patella is sitting about 1/4' higher than my normal one. My OS said it's not abnormal. There isn't any better way to fix it other than PT. I know some of you have experienced the same situation. Do you mind sharing your tips/tricks/magics to correct it? Thank you!

[John42]

Hi Boing

Interesting reading your two posts - must admit, not heard of any RPT patients having reached nearly a full ROM after six weeks - my words of advce would be - just remember your tendon has not healed and you must take utmost care not to rerupture it.   

Best wishes

JohnK/ Manchester UK

[bballkingofnba]

Hi Boing, what you are describing is called a patella alta. It happens because the tendon elongates as we try to get ROM back. My doc said theres usually no way around it because you have to bend the knee to get ROM back and the physiology of the tendon just works like that. Almost everyone I have talked to has one and it doesnt seem to have any functional impairments associated with it. Most likely, your knee will always have a higher kneecap.

[boing]

JohnK, perhaps I am just lucky. When I was released out from the long immobilizer at 4 weeks post-op check up, I was immediately able to bend to about 75-80 degree. I reached to 90 degree in another couple days. Today I had my 4th PT session, my PT told me that I only have about 15-20 left to achieve full ROM. Thank you for your advice. I have learned my painful lesson. I will certainly not to push myself too hard this time.

bballkingofnba, thank you for your information. According to my reading on the internet, PA usually comes with pain, swelling, click, etc. I have yet had any of these symptoms. Also, PA is detected if there is more than 20% variation in patellar position. Over 20% variation is considered abnormal. My variation now is about 1/4'-1/3'. Thus I wasn't sure if I should be considered as having PA. Anyway, I don't have many options other than just working hard on my quad and hamstring, hopefully they will be strong enough to help stablizing patella.

[bballkingofnba]

Hi boing, you are indeed correct that PA usually comes with pain. But that happens when PA is caused by unexplained factors such as tight muscles or something. In our case, this is caused by the anatomy of the healed tendon. PA is just a term and the 20% variation you are describing is done using the Insill Salvati ratio which is the ratio of the length of the knee cap to the length of the patellar tendon. With good quad control and strength a slightly higher kneecap wont affect to in any way, This is all what my doctor told me. He has done several patellar tendon repairs. Also I am just curious to see how your patela alta compares to mine. If possible, put a pic up showing your two kneecaps. Hope the recovery goes well.

[boing]

Hi boing, you are indeed correct that PA usually comes with pain. But that happens when PA is caused by unexplained factors such as tight muscles or something. In our case, this is caused by the anatomy of the healed tendon. PA is just a term and the 20% variation you are describing is done using the Insill Salvati ratio which is the ratio of the length of the knee cap to the length of the patellar tendon. With good quad control and strength a slightly higher kneecap wont affect to in any way, This is all what my doctor told me. He has done several patellar tendon repairs. Also I am just curious to see how your patela alta compares to mine. If possible, put a pic up showing your two kneecaps. Hope the recovery goes well.

Here is the pic. Like I said it's about 1/4'-1/3 variation. Can I see yours as well?

[bballkingofnba]

Sorry for the late reply. Mine is pretty much identical to yours. Its not letting me upload pics for some reason. A better way of measuring this would be if u stood on both legs and flaexed your quads and see how high the top of your kneecaps are on both legs.

[mxbigd17]

Hello to everyone. I'm new to this thread, unfortunately. Let me start off with how this all came about. Im a healthy active 36 year old male for starters. Memorial Day 2013, me and my girlfriend go to a local Motocross track to spend the day with friends and have a cookout to ring in the summer in front of us. I have been riding for 24 years and am considered an A rider. But on this day, I made a costly mistake in the whoop section on this track. Whoops are a bunch of mounds of dirt between 2 to 3 feet tall in succession. I got out of control and gave my bike full throttle by mistake (kx450, heavily modified) which the bike ripped a huge wheelie and spit me off the back. I was literally 3rd gear wide open and for those on here that have ever ridden a 450 MX bike knows how fast and scary this can be when out of control. I landed on my butt so hard my legs came up to my face at full extension, my left knee smashing into the front part of my helmet and that's when I felt and heard the dreaded POP. I finally rolled to a stop, which now I could see my bike flipping end over end to when it finally stopped. I knew at this exact moment that 24 years of riding had come to an abrupt end. While laying on my side, my leg was totally bent and I could not straighten it and I felt a huge lump in my thigh area, I didn't know if my femur was broke or my knee was broke but I knew I was scared. When I went to take my helmet off I realized something was wrong with my right shoulder, turns out I dislocated it, so know I'm really scared. My shoulder hurt 5 times worse than my knee which was really weird. Ambulance took me to the ER were I laid on their backboard for 4 hours before I was given pain meds (thank god for pain meds) and then the Dr put my shoulder back in which hurt like hell going back into the socket and also put my left leg into a straight brace and said, you need to see an OS ASAP. My X-rays showed I had a RPT. I could not use crutches due to my blown shoulder so now I'm the proud owner of a wheel chair and crutches. Lucky me.......
       Next day I see an OS and surgery is set for the following day on 5/29/13. OS said my patellar tendon was shredded and that he sewed it together in a special pattern, drilled 3 holes thru my knee cap an anchored it to my knee cap that way. Dr said when he was in my knee it looked like I also tore my ACL but he could not repair it due to it having a different rehab than the RPT rehab. So that surgery is later down the road. I had my right knee ACL fixed in 1994 with a patellar tendon graft so know I have 2 messed up knees with both patellar tendons involved one way or another.  Sent me home, and I must say that this surgery is very painful. I have had 12 major surgeries and lost my spleen thru dirt bike accidents and this one takes the cake on pain. The next two weeks were a living hell, pain was so high and I was stuck were ever I was when my girlfriend went to work because I could not move due to the shoulder being messed up and my knee in severe pain. I usually just stayed in bed and would pee in a pee container, thanks again ER for giving me 2 pee cups. It made life a little easier. It took me 2 weeks before I could use my crutches, shoulder finally felt a little better to do this. Also the pain went down to a normal level in my knee. After 2 weeks the staples came out, but the Dr said I needed to be in my straight brace for 4 more weeks and by then we will start PT which starts on 7/11/13. So now it's just the waiting (going crazy) game.
       I have been reading earlier post on this site and it looks like I'm in a rare club. Never really wanted to become a member, but here I am. It looks like I'm in for a long slow recovery and the protocol for rehab is not very consistent. I seems it would be best for me to ask the PT if they have ever dealt with this injury before as I do not ever want to go thru this pain ever again. I have a few questions for you fine folks out there with this injury. Will my knee ever look normal again, what are the long term effects of this injury and how long will it take for my wasted away leg to look like a leg and not a twig again. Any help would be greatly appreciated by anyone on this forum.

[boing]

Dear friends, yesterday was about 7.5 weeks post-op for me. I was officially proved by my PT to reach full ROM at 133 degree. I don't know if I am the quickest to reach this big goal, nonetheless I am just really grateful about my recovery. Once again, this is not about bragging, neither a race, nor a competition. I'd just like to share my little experience to encourage other fellow kneeds who are still having hard time of gaining ROM. Will is the motivation, the power that kept me pushing forward. Youself is the person who knows the best about your body, about your knee. Having proper communication with your PT/trainer is very necessary and important. What is more important is to always hold your head high, and to remember what doesn't kill you makes you stronger.
bballkingofnba, looks like while my muscles are getting stronger, the variation of my 2 patellae is also getting shorter.
Wishing a speedy recovery to all! 

[John42]

Hi Boing

Delighted to read that you have reached 135ROM after nearly eight weeks - however, be advised that the tendon has not 100% healed , RESPECT your knee, we don`t want to read that the tendon has reruptured.

Best wishes

JohnK/ Manchester UK