Ruptured Patellar Tendon Surgery

[copper44]

Hello Everyone,

I am 4 days post surgery which according to my surgeon went well.  I had a "clean" rupture which he repaired and now I am home resting and managing with regular doses of pain medication.  My Doctor said he usually allows patients to bathe/shower 3-4 days after surgery, but he is being conservative in my case and will restrict me from any partial or full weight bearing activities until I see him 10 days after my surgery. 

So far things have been good with my only discomfort coming from the brace (Breg) resting on my ankle as I attempt to keep my leg elevated above my heart and sometimes I have a little pain around the knee when I use my crutches to move from my bed to the bathroom.  I'm assuming this is from pressure on the stitches.  I have a lovely ice cooler contraption which allows continuously cooled water to circulate around my knee without the messiness of ice cubes and plastic bags.  Also, the toilet extender is worth its weight in gold.  Highly recommended.

All in all, a good set of days, although I'm told I haven't started the real test yet.  Even so, I am happy to have finally started my journey to recovery.

[carkeltom]

cooper44, glad to hear that your surgery went well.  You are lucky to have the ice compress machine also.  Did you receive a CPM machine for passive movement of your leg?  I found that rest ice and elevation do make a difference with the pain.  and using the toilet can be chore.  Seems like most of us who have done the RPT have come to grips with using a stool or something else to rest our affected limb on also helps.  Keep the faith and WBAT weight bearing as tolerated after a few more days will be awesome.  I also had some knee pain after surgery that was attributable to the staples I think.  Sorry you had to wait so long for surgery.  You would think that with all the specialists we have in the US, someone could have done surgery sooner.

Tom

[Ben5000]

Hi friends, a 7 month update on my RPT.  Just a brief background. Active and physically fit 39 year old male, injured playing basketball.

I will be running a marathon this October. It will be my 13th marathon and first since the injury. I'm running to complete and hope to finish around the 4 hr mark (about 30 minutes slower than my pre-injury time). I can now run a 10k in about 50 minutes, which is 5 minutes off my pre-injury time of 45 minutes.  I haven't been training like I usually do, as the knee isn't ready for that level of intensity.

I have full ROM on my injured knee, but it is still swollen compared to the non-injured. The injured knee is also significantly weaker on any of the leg exercise machines at the gym. About 75% weaker, which is what Tendon Tim noted (he had his RPT about a month after me).  I work-out 6 days a week.

Patience is key, and JohnK is right to make this a mantra. I came out of this injury in full-attack mode. Guns blazing, wow, look at me I can go up and down stairs at 6 weeks, blah, blah, blah.  Not to minimize those important first couple of months, but this injury is really about the long haul.  The gains become less noticeable, but they still happen. Just got to keep pushing forward.

My long-term goal is to get back to where I was. Get that marathon time down to 3:30. Run an ultra-marathon. Play basketball (dunking might be a thing of the past, but I'm 39, and only 6'1 so that was probably something on the way out anyway).  I would also like to get on the leg press machine and be able to press somewhere near what my good leg can do. 

Good luck to everyone!

Ben
PS. at first I hated my scar. It made me feel weak and fragile. Now, I love it. It shows that you have gone through something serious and are climbing over that obstacle. I wear mine with pride!

[SkyeGospel]

Hi there. I am new to this forum and would really appreciate advice regarding pain following my operation.

I fell just over 10 weeks ago and originally was diagnosed with badly sprained cruciate ligaments. Things were getting better except that every so often as I hobbled around my knee would buckle causing intense pain again. About 6 weeks after the injury whilst in for a routine checkup my doctor discovered that I couldn't do even a slight straight leg lift and sent me off for an ultrasound which revealed that my pattelar tendon was snapped.

I had the tendon reconnected nearly 4 weeks ago and since a week ago have been in an adjustable angle leg brace. I am a little concerned as the surgeon who saw me when I had my stitches out and the new brace fitted (a week ago) seemed surprised about the level of pain was in but then disappeared after checking the would looked ok and I didn't see him again. The pain to flex my leg at all was pretty much unbearable. The pain over these last couple of weeks is constant and pain killers have very little effect (I am taking regular ibuprofen and paracetamol and occasional dihydrocodene).

I am not able to get much sleep as am constantly waking up with the pain and can't concentrate on anything during the day for long because of the constant ache. The thing is, if this is normal for the healing process then that is all absolutely fine but I am just a little worried in case there may be something wrong that I am missing? Is the constant pain normal?

Any advice much appreciated.

Stuart

[SellaVee]

[quote author=TendonTim link=topic=8389.msg604138#msg604138 date=1377039254
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.

Tim
[/quote]

Tim, I found that link too, on one of your previous posts and I've extracted the table which I'm going to print out and have with me - I'm building a collection!  The main thing will be doing more as you said above.  Think we all want to get to that point.

Oscarsan, I'll be interested to hear how you get on with physiotherapy in Finland.

Arran, how are you getting on this time round?  Were you wearing a brace when you slipped?

[SellaVee]

Hello copper44, I was only thinking about you this morning and wondering how you were getting on.  I'm in a Breg brace too, the OpLite one which has the advantage of being a bit cooler than some.  I had the same issue with my ankle and would put a small, soft pillow underneath to ease the pressure.  When I first started wearing it I thought it was the most uncomfortable thing - almost an instrument of torture, especially as I'm quite short and it goes very high up my thigh.  Now, while I still wouldn't say it's comfortable, I've gotten used to it.  I'm so glad to hear your surgery went well.  Keep us posted.

Ben5000, it's good to hear from someone who is doing so well.  Thanks for the update - it will inspire the rest of us.  I've bought a couple of maxi dresses to cover up my scar but I'm guessing that's not an option for you guys  .  Would get in the way of your running.

[SellaVee]

Stuart, I love your user name, SkyeGospel.  Is there a story behind it that you feel able to share?  You'll discover that when you spend a lot of time sitting you become increasingly curious - or is that just me?

Your experience with the surgeon didn't surprise me.  Are you by any chance in the UK?  At my first outpatient appointment the nurse cut the bandages off and said my wound looked good.  A registrar popped his head in, told me his name, read my notes and that was pretty much it.  I could see from my X Ray which was on the computer screen that I had a wire in.  It looked like a bit of wire coat hanger in a figure of 8.  I asked if that would need to be removed and was told probably.

When the chap from orthotics came to fit my brace he asked if I was supposed to sleep in it.  I had no idea as I hadn't been told anything about wearing it.

Regarding your pain, do you know if you have a wire in place?  At 5 weeks my consultant sent me for an X Ray to check that it was still doing it's job.  Some people have reported their wires breaking and causing them pain.  My consultant was keen to check mine so perhaps they break quite often (?).  I wouldn't have known I had a wire in if I hadn't spotted the X Ray.  It might be that.

Are you resting a lot with your leg elevated?  Some people say "toes above nose" or "Feet above heart" but I settle for keeping my feet higher than my pelvis, and my swelling has improved since I started putting 3 extra pillows under my legs at night.  I've built a ramp of pillows to support my whole leg and I sleep on my back.

Pain on flexing your legs to begin with isn't unusual, but I'd be concerned about pain after this much time when at rest.  Did you get the pain under control before you left hospital?  I had to make sure I did because my son was getting married 5 days after I left hospital and the wedding was miles away.  I spoke to one of the nurses about it and she got hold of a pharmacist who came to see me.  The nurse then got a doctor to prescribe Tramadol and Paracetamol, two of each, every six hours.  Tramadol has side effects that I have to get used to but it works for me.  It's important when you're on pain relief to keep taking the tablets.  You have to build up to a certain level of analgesia in your system in order to keep the pain under control.  Don't try and be brave.  I kept to the full dosage until after the wedding then gradually went onto cocodamol by 2 weeks after surgery, reducing to one low dose cocodamol at bedtime as my leg feels sore in the night.

I would ring your consultant's secretary and explain your concerns in case something is wrong.  If everything is OK with the surgery talk to someone about pain management.  You don't need to suffer, but if something isn't as it should be you need to get it sorted.

Hope this helps, Sella

[Super_arran]

Arran, how are you getting on this time round?  Were you wearing a brace when you slipped?

Hi,
Yeh I'm doing alright thanks, starting to get a bit of strength back in my knee.
I'm almost able to do some straight leg raises. I don't know whether that's from walking (with crutches) a lot or if it's some exercises I've been doing that helps (standing up and trying to keep your bad leg in front of you; trying to get more horizontal and for longer each time.)

Yeh I was wearing my hinged brace at 20 degrees (4 days in total). My good leg slipped out sideways and I ended up going down in the splits position and my bad leg buckled, twisted and just tore from the inside.
Bad times.

Got a week left in my cast now (can't wait to shower again) then it's the cursed brace again.
I'm a little worried because I go away on holiday a day after I get my cast off to Zante. Going to have to be on super careful mode.

[Beasman]

Stuart, sorry to hear of your rupture and the lateness in getting an accurate diagnosis. I’ve heard that it’s usually better to have the surgery as soon as possible following the rupture to prevent other problems occurring with recovery. After a period of time, the tendon sometimes contracts and that becomes problematic for the rehab process. At any rate, pain is going to be there for a few weeks but should gradually subside with time and rehab. As far as trying to sleep thru the night, if you are a side sleeper as I am, I found a temper-pedic knee pillow to be invaluable. I had already been using one pre-injury due to back problems I’ve been having and it not only kept my spine in good alignment, but really seemed to help the knees at night. My knees still ache and swell and it’s been over 4 months, so besides the pillow; ice and elevation help me a lot too. I was on lortabs for about 2 weeks and weaned myself off. Now I just use ibuprofen and aleve. If you can’t get by with OTC meds at this point, I think I would ask the OS to reassess your pain level to see what's going on. I wish you well, it’s a tough one for sure.

[carkeltom]

Going to add a few links and edit as I add.

http://www.emedicine.com/orthoped/topic246.htm

http://www.arthroscopy.com/

www.emedicine.com/orthoped/topic246.htm
www.arthroscopy.com/patendrep.htm
www.SMA.ORG/SMJ1999/JUNESMJ99/ENAD.PDF

[SellaVee]

Keep up the good work on the links, Tom.  Knowledge is power which is why I was so glad to get the info from John42.

Arran, this is a bit late for you, but I bought a showering aid called a Limbo.  It's like a heavy duty clear plastic leg cover (rather like a baggy stocking) with a rubber cuff which sits at the top of your thigh and makes it watertight.  It's designed to cover casts, which I didn't have, so I use it over my cricket splint.  It's brilliant for showering - you just have to wash your covered foot separately once you're out of the shower.  The hospital had the details but you can Google and buy online.

It's years since I've been to Zante.  Will you be on crutches when you go?  If not, have you considered getting walking poles in case you're walking off pavement anywhere?  I think you can order a wheelchair for use at the airport and you might then be entitled to extra leg room.

[SkyeGospel]

Thank you SellaVee and Beasman for your advice. The thing I notice about what you have told me is that I am maybe not resting my knee enough - I am driving about (automatic car and it's my left knee that's affected) every day (I've done up to 4 hours driving in a day since the op) and am also doing a lot of walking about and being jumped on by the kids! I was never actually told anything about what to do with myself during the recovery period (for instance having my leg elevated was never mentioned so I haven't been doing that, though it is usually higher than normal just to keep it straight.

They did put in a wire since there was concern about the tendon holding up because of the injury being old (the surgeon told me after the op that it was like sewing jelly together!) so they put an extra loop of 1.6mm wire round to hold it together. I spoke to my gp about the pain level and he didn't seem concerned - he prescribed the dihydrochodene temporarily to help at nights though I haven't noticed much difference. I am due to see the physio for the first time on Tuesday so I will see what she says about things and then maybe get in touch with the surgeon again.

SellaVee, my username tends to get used for everything for me! The Gospel bit is because the message of the Bible (which is referred to as the Gospel, meaning the 'good news') is so precious to me. The Skye part is because I am from the most beautiful place on earth: The Isle of Skye off the north west coast of the Scottish Highlands! If you've never been, then you need to go!

Thanks again for your help,

Stuart

[fishy]

Hi there. I am new to this forum and would really appreciate advice regarding pain following my operation.

I fell just over 10 weeks ago and originally was diagnosed with badly sprained cruciate ligaments. Things were getting better except that every so often as I hobbled around my knee would buckle causing intense pain again. About 6 weeks after the injury whilst in for a routine checkup my doctor discovered that I couldn't do even a slight straight leg lift and sent me off for an ultrasound which revealed that my pattelar tendon was snapped.

I had the tendon reconnected nearly 4 weeks ago and since a week ago have been in an adjustable angle leg brace. I am a little concerned as the surgeon who saw me when I had my stitches out and the new brace fitted (a week ago) seemed surprised about the level of pain was in but then disappeared after checking the would looked ok and I didn't see him again. The pain to flex my leg at all was pretty much unbearable. The pain over these last couple of weeks is constant and pain killers have very little effect (I am taking regular ibuprofen and paracetamol and occasional dihydrocodene).

I am not able to get much sleep as am constantly waking up with the pain and can't concentrate on anything during the day for long because of the constant ache. The thing is, if this is normal for the healing process then that is all absolutely fine but I am just a little worried in case there may be something wrong that I am missing? Is the constant pain normal?

Any advice much appreciated.

Stuart

[SellaVee]

Stuart, I was hoping that was the origin of your user name.  I sing in a Gospel Choir.  I haven't been to Skye but I've been to Benbecula and Mull.

"I was never actually told anything about what to do with myself during the recovery period."

I don't know why the NHS are so very poor at sharing with the patients the information that they really need to know.  It's as if it was all a big secret.  I thought it was just me!

I think you're right - you have been overdoing it and that could be the reason for your pain.  I'd sit with your feet up high every chance you get.  Keeping your leg up high will really help with the swelling.  Get the kids to wait on you hand and foot  .

That might be enough to ease the pain but if not is there a handy chemist/pharmacist you could talk to about getting the pain under control if you don't want to go back to your GP?  The one thing my hospital has been great about is pain management, right from the time the ambulance men arrived with the gas and air.  I didn't take Ibuprofen, but while I was in pain I took the highest doses of Cocodamol that I could.  I also rang my GP's surgery to ask for another prescription for Cocodamol for when I start physiotherapy because I expect that to be painful.  I'll find out tomorrow.

Codeine based medicines can be addictive but if you're taking them when your genuinely in pain, I've been told that the pain acts like a sponge and absorbs them.  Don't know if that's a good explanation.

You must be exhausted so I hope by resting in the daytime you'll sleep pain free at night.

Let us know how you get on. 

Sella

[carkeltom]

Hey everyone, sky and sella and others.  I find myself continuing to read all the posts and am getting nearer to finishing the entire thread.  I keep myself busy with reading I guess or I would get bored just sitting.  So wishing that I was able to drive.  I have a follow up with the OS in a week and a half and am hoping that he will unhinge the brace at that time.  I have been following the protocol he gave the PT at the rehab hospital and am thinking I should post it, but dont have access to my scanner or printer at this point in time since they are in the basement.  I have started taking longer walks outside on my gravel road, with two crutches of course, using a slight quad flex to move my legs as I move with the crutches.  I have been diligent with the seated quad sets, ankle pumps, gravity eliminated leg lifts while standing and , passive ROM exercises and have been trying to hold at the point of pain/tightness as I know that by week I should be at Passive Range of Motion at 90 degrees.  I was wondering if JohnK might know where there was a US ARMY protocol.  I was posted but removed by admins and it was at the beginning of the board back in 03/04. 

My protocol calls for no crutches after six weeks, but since I am a double RPT sufferer, I just dont know if I would be safe without that assistance since there is the fact that I dont have a "good leg" to stand on.  Heck, my protocol actually says "Unilateral Patellar Tendon Rupture."  I think I am just getting nervous or anxious or stir crazy from being at home.

If anyone goes to their PT and you have an extra second, ask what they might change for a double.  Not many answers.  Keep going strong everyone.

Tom