Ruptured Patellar Tendon Surgery

[SellaVee]

Thanks for the explanation, Tom.  Here in the UK, I think everyone does the same basic course, which I understand takes 5 years at university, followed by hospital based training for two years at Foundation Level, another two years Core Training and only then do they start to specialise when they become registrars.  Registrar training lasts 5 years and then they become consultants, so people in the UK tend to refer to their Orthopaedic Consultants.  Each OC tends to specialise in a single joint, so I'm under the care of one consultant for my feet (elective surgery), and another for my knee (Trauma with a capitol T)!  A friend who had rotator cuff surgery saw a whole different team. 

I really like the sound of the holistic approach provided by your D.O.

I have a good friend who is a physiotherapist who works with children.  I asked her about the muscle stimulator machines because I'd heard them mentioned on the forum.  She said they were mainly used to show patients how the muscle worked and what it felt like, but that it wasn't a substitute for working the muscles yourself.  Years ago I used to have a Slendertone machine which was meant to make me slim.  If you read my previous post you'll see that it didn't work that well!  I had been thinking that it was a shame I'd binned it.

Like Tom I'd be interested to hear what others thought.  I'd not long gotten back on my feet (literally) when I joined the RPT club so my quad muscles have me really worried.

[carkeltom]

Hey John, I have going thru all of the protocols for PT that are on the sight, but I have been unable to find any info on a course for bilateral RPT.  Could you point me in the right direction if you have time.

Tom

[carkeltom]

Really nice to hear from others out there like myself. 
I ruptured my Patellar along with medial and lateral retaneculam 15 months ago.  I was jumping to hit a volleyball and it popped 3 times.   Instead of doing the smart thing and call an ambulance.  I let my friends help me to the car and the wife drove me to the hospital emergency room.  We live in a smaller town so the Emergency room did not have a wheel chair that had a leg extension on it or not one they could easily get. So they had a male nurse come out and my wife held my leg in the air as the dude pushed me in.  Beyond painful where i had to wait a full hr to get in to a room. Lesson learned if you are jacked up call the ambulance they will wheel you right in a room.  After Surgery about a week later started having chest pains found out I had blood clots in both lungs due to the surgery.  Double wammy.  They put me in a plaster cast for 6 weeks then straight leg brace for another 6 weeks.  Doing much better now.  I figured it would hurt rehabbing and it did.  What I did not realize is sitting in a chair for longer than 30 mins is what hurt the worst.  My goal from here on out is to be able to run a half marathon at first then a full later.  I don't care at what speed just set a goal and hopefully I can achieve it.  Any runners in here been able to run long distances after Ruptured Patellar Surgery.

Oh and my wife is a PTA if you have any ?s fire away.   I eventually got to where I got full range.  I am at 135 which is really good.

Macdaddybuf, if you wife is a PTA, could you see if she has a protocol for PT for someone who ruptured both of the patellar tendons.  I am thinking it is going to have to be different for me when it comes to weighted exercises that will require me to use the strength of both legs since I will not have either to stand on.  If she has any suggestions, let me know.

Tom

[John42]

Ho Tom

As mentioned in previous posts on his thread, a Bilateral rupture is so RARE, in fact I have only seen about 5/6 double RPT over the last ten years.   

Have doubts if there are any written protocols on this subject.

Take care

JohnK/ Manchester UK

[oscarsan]

Hi Everyone

So, I´m one or the weirds that had a double RPT, happened on July 18th this year practicing SkyDiving, i ahd a pretty normal landing with no wind, so you go faster, but the biggest thing was that i came on the asphalt plus the fact that i had suffered for many years of Jumpers Knee which have come and go. Surgery was done day after so on July 19th (I guess this suppose to be good, the longest you wait the slower they recover), since them i have been using DonJoy braces on both legs day and night, every seems to be going ok but i have been given 6 weeks of NO KNEE BEND, so pretty straight all the time, i had just 10 degrees of freedom in the braces. Only exercises have been extending and retracting my feet and also auto stressing the quadriceps, this will basically move the patella up a bit.

I have been reading this thread fully and had found very different histories, about starting PT before the 6 weeks and so, so having some doubts right now. My PT, which i haven´t really yet met is suppose to be one of the best in the area where i live, so, i hope everything will be ok. There is just 2 week to go on, so, I hope the tendon is already attached enough to the patella. I´m a bit confused about this waiting or not waiting but i decide to just follow the recommendation, i feel a bit that they didn't consider that I´m just 30 years old and quite active, i bike something like 200 km a week minimum and going always on trekking, jogging even started Astanga Joga this year.

I had a Kracow surgery using something named FiberWire, which i understood after the operation is going to be there forever, no need to remove.  At the moment i do not have any recommendations besides the fact that i notice that i can carry pretty well my hole weight without crutches and that doctor recommend actually to walk if i feel like it, so the not all the muscles will just be stop, i have been doing some weights also for arms and back, so i had some activity or i would just go crazy.

Questions: Does anybody has experience with this FiberWire staying there forever, is it going to affect how much degrees i can bend my knee? is it going to work also as a protection for the future?. I´m pretty worried about the future, will i recover full mobility?, how i do prevent this to happen again, i´m planning to do the PT religiously and finally be constant with the GYM and the stretching, is this going to be enough? should i spec problems for the rest of my life?

Cheers and a good rehab to everyone!, good to find a group of people having similar problem.

Oscar

[John42]

Hi Oscar ,

Welcome to KneeGury RPT thread - my goodness, don`t believe that within the space of three weeks, we have three double RPT newbies.

A very serious & RARE injury and there is a very long rehab in store for you.

Read as many previous posts on this thread - a fibre sutre is quite common, but treat your knees with respect - PATIENCE is required.

Click on the undermentioned web  link - there are some documents which I have compiled with KneeGuru over the years - this will give you an idea of a RPT injury and the rehab involved.

Where do you live

Take care -

JohnK/ Manchester UK

://www.facebook.com/QuadricepsPatellarTendonRupture

[oscarsan]

Hi John

Thanks for the answer, i leave in Oulu, Finland. Hospitals here are pretty good so i´m confident but sometimes i have the feeling that if you are not dying they just don´t care that much. I know the PT which will treat me is excellent and specialist in Knees, has been treating many Ice Hockey players and so on, but i was pretty amazed that they didn´t send me to the PT before 6 weeks, in any case i went but myself to a post operational specialized PT but she just recommend to follow the program, 6 weeks with the braces not flection.

Seems that we can now follow progress in 3 double RPT. Actually i realize we had just 1 day difference with Tom, so interesting to follow in our progress.

I will check the mentioned documents carefully!, I already have a quite nice bike, i was thinking actually into buy a power trainer, so you mount the rare wheel and can simulate the road, but i will ask first from PT. I realize that slowly i can start lifting by legs straight without need to lift them with my hands, the left one no problem, right one still with some pain, haven't try without the brace, but i think i will not yet.

Usually i don´t drive to work, even in winter I use my bike, but it seems is not going to be possible this time, any ideas how long it would take me to start driving?

Cheers,

[Beasman]

Tom, sorry to hear of your bilat rpt, that is pretty tough indeed. You are correct, there is next to nothing on the web in ref to a dbl. I have perused this thread to read about the few others who suffered the same misfortune. Only one had a similar experience as mine and he has apparently dropped off KG and doesn’t post anymore although he continued to struggle as I am. There most certainly appears to be different degrees to the extent of this injury. I have read most all 324 pgs, single and dbls, and amazed to read how so many go for a few days after injury before having surgery. Some even reported to work between injury and surgery. Mine was not like that at all. Upon rupturing, I immediately went down and was completely unable to stand, walk or even think about putting any amount of weight on my knee. Both kneecaps were up in the middle of my thighs. I was transferred to a flat board and carried off to the ER and surgery the following am. Meanwhile I was doped to the hilt as the pain was beyond anything I’ve ever felt.  I had a very severe motorcycle accident years ago that nearly claimed my life, but this dbl rpt eclipsed that in the pain department.

You are absolutely correct about there being a difference in weighed exercises for a dbl, I’ve clearly experienced myself. My PT has never rehabbed a dbl and she is just taking it a step at a time. It’s a tough one brother, I feel for you and wish you the best, and to all others, but esp the dbls. Hang in there!

[carkeltom]

Thanks Oscar and John again.  The information is great and I believe I have read just about all 324 pages of this thread and doubles are rarely mentioned and the info on rehab for a bilateral RPT is almost non existent.  When I start active PT out of the home, I plan on getting with my therapist and the OS for more accurate protocol for my injury.  I know I am biting at the bit to get a jump start on regaining my mobility.  But I just have to wonder how this is going to work.  With one good leg, I would be able to guard against re-injury and depend on the good leg, but that will not be the case.  I emailed the Univ of Wisconsin PT who had input into the PT protocol John has posted, but of course, they will not give out advice to someone they have not seen.  I the past two days, I have been more diligent in my weight bearing, as I still have the crutches and walker, but my home is small (less than 1300 sq feet, so getting around is easy as there is always something to lean on.  I am a pretty big guy 6'2" and over 300lbs (150kg) and a former football player, so my upper body strength is still there.  I am still investigating the muscle stimulator, even if it just keeps the muscles firing as it is on the protocol but since the in home PT is only coming once per week and she does not have a muscle stimulator to let me use, I can afford it.

Oscar, that is crazy that we suffered the same injury a day apart.  I will be active especially when the PT starts and we can share our progress.  I did read that the sooner the surgery, the better.  I am sure the different health systems in our respective countries have differing opinions and practices, but the scar tissue and swelling have to be a reason.  I have read where some folks have returned to work prior to having surgery and then been in a complete mess when they have to been immobile for 6 weeks.  I have been prescription free for the past 2 weeks, as pain is an indicator of injury and I would like to know if I am injuring myself.  Sorry about your having to endure not riding your bike for awhile.  I live in the rural part of America, so riding to work would be a chore for me.  Hopefully though, when my ROM is more, I will take up some bike riding for cardiovascular exercise.  Right now I am doing the ankle and toe pumps every hour and then standing and doing gravity assisted leg lifts and sideways leg lifts.  I do a ton of quad sets, but my legs are still jellyish.   I am also removing the braces and doing passive ROM every two hours or so.  I do not have a measurement tool, but I bend my knee passively until I feel tension and then hold it there for 10-15 seconds.  I would put my angle of bend around 60-75 degrees, since I know what a 90 degree angle is.  I am also doing extensions when the braces are off by resting my heels on pillows or rolled towels and letting my knees just sort of fall to the bed or recliner.  I did read that -5 degree extension is good, to keep the knee cap moving on the knee.  There are some great knee massages on youtube.  not much for RPT but for the quads and shins there is some info.  Hope that might help some one else who comes along also.  Necessity is the mother of invention.

Good luck to everyone and keep going forward.  If I find more info on double RPT, will pass it along. 

[hages1]

Thanks to all for the welcome!
John 42- i'm 34yr male living in Israel.
two weeks post surgery,I started taking a few steps without crutches.
 I got my stitches out yesterday. the OS said that the knee looks good.
he told me not to bend at all for now, I asked him about other patients who start bending before, he said better safe then sorry!I am staring some pt just to strengthen quad muscle, and to try to get to straight leg lifts.

  I hope everyone is feeling well.

[carkeltom]

Hages1, I am four weeks post surgery and I am still not actively bending my knee, that is, I am not firing the muscles to bend the knee on purpose.  I passively bend my knee by pulling my heel and holding the back of my knee and bending it to about 75 degrees, which is what the OS and PT protocols are calling for.  I also stand with either my crutches or walker and do gravity resistant leg lifts, which is pretty much standing on one leg, while holding onto the crutches or walker, and then using muscles to swing my other leg out.  I also lift both legs out to the side while standing.  I try to do this at least every hour or so while awake.  I do my ankle pumps every hour if not more.  I can not do a leg lift with either leg at this point in time.  Keep us posted.

tom

[TendonTim]

Hey everyone. I haven't been writing as much because of school and other things in life but I just passed the 6 month point for my recovery. I just wanted to tell everyone that's going through this LONG recovery process that patience is the biggest part of this recovery. As I look back on most of my posts, most of my flexion came between weeks 8 and 12. Most of my strength returned between month 5 and 6. While i'm still not squatting the 315+ that i was doing before the injury, I'm very happy with the results that I've had. Just to quantify things a bit, my injured leg is still about 75% weaker than the good leg. I can run for about 2 miles now with no problem. The limit there is more my own conditioning. My overall goal is to get back to dunking a basketball comfortably again but I'll save that for the 1 year anniversary. I remember someone posting a while ago that your knee never truly feels the same regardless of the time and rehab that you do. I would say that this is true. My repaired knee still feels different but that doesn't mean weak. The more i work it out, the stronger the knee feels and the more that I trust it again. Trust the process and keep the faith.

[carkeltom]

Hey fellow RPTers, this link while going thru the 324 pages of this blog:


http://emedicine.medscape.com/article/1249472-overview

Pretty cool.  Not sure if this is in the links John42 has sent out. 

Tom

[SellaVee]

Thanks, TendonTim for the useful timeline information.

I am torn between wanting to go faster and worrying about doing too much. 

I'll let you all know how I get on at my first physiotherapy session which is at the end of this week.

Can anyone tell me how they got on at their first session?  Mine will be 7 weeks after my surgery.  What can I expect to happen?

I asked the booking physiotherapist to measure my ROM on my good leg but he said he could tell by looking that it was >100^o and that was all he was interested in.  I will try and be more 'encouraging' this week.  I've learned such a lot from this board.

I've been treated very kindly, though not speedily by the NHS, but they seem think that information is something the doctors need to know but I don't have to worry about.

[TendonTim]

No Problem SellaVee,

It's cool that the link carkeltom posted is the one that I posted during my recovery process. I tried to stick as close to that protocol as I could without upsetting my OS because it's a bit faster than some protocols. As far as your first day in therapy, I think they start really trying to get your ROM going. I think that's the most challenging part of the whole recovery because it does hurt quite a bit. I would use a couple Aleve to help get more out of the sessions. The best part about therapy is that you get to DO more and sit around less. I wish you luck in your recovery.

Tim