Ruptured Patellar Tendon Surgery

[John42]

Welcome JC55 to the RPT thread, not the best club in the world.

Trust that you are aware that you have sustained a rare and serious injury to your knee with a long rehab.  Are you in a plaster cast or a brace?   How did you sustain your injury?  Where do you live.

Would suggest that you read some of the previous posts on this thread and click on the undermentioned site, where you will pick up a number of documents which I have compiled over the years together with KneeGuru.  Read with care -  PATIENCE is the keyword.   Ask questions - lots of buddies out here to give you advice.  Keep posting -

Take care
JohnK/ Manchester UK

https://www.facebook.com/QuadricepsPatellarTendonRupture

[JC55]

John,
Thanks for reply.  i injured it in competition...High jumping against my age group in senior games.  I live in Kentucky.  I am in a leg brace currently and can definitely appreciate the patience advice.  I will take it slow and steady but am determined to maximize my rehab with PT.  I will most assuredly not rush...but I'm sure there will be some anxiety on my part(is it healing?, did I re-injure it?, Am i not doing enough or too much?)I am a good patient and will follow doctors advice to the letter so as to achieve the best possible outcome.

[Beasman]

Concerning the wire for Stuart and any others interested, you might want to go back and read some posts from a guy named “LT”. His username was “cabrev” and was posting back at least a hundred pages ago. I remember a few weeks back when I was reading thru all the PTR posts, he was very informed about the wire and I believe eventually his broke and he had to have surgery to remove. As best as I can remember his recovery went well and he definitely is the subject matter expert on the wire issue.

I continue to read thru all the recent posts and realize that my rehab protocol was very conservative compared to most, so my experience may not apply to many. My outcome of course would be relevant however. The thing is, I really don’t know when to say “this is it, it’s all I’m going to get”. At 5 months, I seemed to have reached a plateau. I have a theory that my problems come from being in leg casts for 6 weeks and NWB for 8 weeks. The atrophy was tremendous. I have read many others that started PT as early as the 2nd week! I simply cannot get my quads back to their previous size or strength. The good part is that I gained most all my ROM back and by week 16 I had 136 on the right leg and 138 on the left.  I walk almost normally(and yes, I did the Frankenstein shuffle for awhile during the immobilizer period!), but steps and inclines remain a challenge for me.

My OS was very cautious and kept me in a wheelchair for 6 weeks…no crutches, walker, cane, nothing. Even when I was in the braces, he wanted me to still use the wheelchair part of the time and I didn’t think he’d ever open up my braces any so I could start bending. However, I started doing exercises on my own. I’ve been a distance runner my whole life and I didn’t want the rest of my body to vegetate too! I had a hospital bed rented and it had this trapeze looking thing over the center of it to assist me in rising up to exit the bed. I also used it to do pull-ups to keep the upper body conditioned a little. I also was able to start doing SLR’s on both legs around the three week point and that is with heavy plaster casts on both legs that went from ankles to buttocks. I also worked on abduction/adduction.

I would say that so far, the best thing for my rehab as been the exercise bike. I couldn’t make a full revolution until I was at about 95 ROM but I had reached that at 10 weeks. Once I could pedal that bike, my ROM was off to the races. For those who aren’t in casts, which is most people, I would think the CPM machine would be golden. Obviously, I couldn’t use it due to being casted, but my OS would not order one for me after I came out of them. He said PT will bring my ROM back. My theory though is that perhaps all this should start sooner and use CPM and PT early to gain ROM and start strengthening after tendons have healed enough they won’t re-rupture. That way atrophy won’t set in so bad and the whole recovery is much easier and quicker. I fear my tendons stretched either from pushing so hard to gain ROM or maybe during the surgery itself. I now have kneecaps way higher than where they were before. I have a tremendously painful and loud popping every time I bend my knees. My PT has stopped my land therapy and put me in the pool. She also doesn’t want me doing squats or anything weight bearing  which makes them pop. She thinks I easily could dislocate because the patella’s are riding so high, they could pop out of the groove they ride in. So this is something that will have to get fixed, but not sure how or when they can do it. Anybody else experience this problem?

A lot of activity on this board lately, good to see everyone progressing albeit slower than you might want, but apparently this injury will take awhile to get back to close to normal. It is a little bit more serious injury than I had first thought. My best to all.

[SkyeGospel]

Thanks Beasman, I'll check these posts out.

[JC55]

Post-op appt, 4 days out.  Doctor unwrapped ACE bandage and underlying gauze...knee was pink with some slight bruising and moderate swelling (I guess the ice and elevation really worked).  I asked about procedure and he said that he didn't need wire,  just sutures.  I told him that I also had low-grade fever and he informed me that this is not unusual and not an indication of infection.  Knee to be kept at 0 degrees for 4 weeks and then transition into ROM brace.  Degrees to be increased gradually accompanied by PT sessions.  Staples being removed next Friday the 20th.  Best of all, able to shower this Sunday the 15th! 

Overall, good news.  I must say that I'm a little apprehensive since only sutures used but my OS was a major college basketball physician.  He assures me that following the rehab in a structured way will achieve the best outcome possible barring any complications.

[carkeltom]

Hello everyone.  Had a busy week with my return to work and PT appointments.  Two good appointments and my measure ROM is left 104 and right 110.  I am getting better at getting in and out of the car and driving.  My work has kept my mind off the pain, but doing well with keeping it iced and elevated when I am home.  The PT wanted me to spend about 15 minutes of our session using the muscle stim, but since I have one, I said let's focus on exercises.  Being 8 weeks post op, know that my tendon has not completely healed, and being a double, I am reluctant to let go of the crutches when walking outside.  When I am in my house or in my office, I walk slowly, but without the crutches.  The PT suggested that I increase my stride length as she said I seem to be doing good with the walking.  I have the braces unhinged to 90 degrees now.

I find the squats hard to do.  I dont really have anything really strong to hold onto at home, so I know I am not getting a full squat to the degree that the braces will allow.  I feel like my knees are going to buckle, so I will go to that point.  I have found that the leg lifts and lifting from 90 to 0 is getting easier, but the pain gets intense in my quad area, especially the quad tendon area.  I can not do a full revolution on the bike at the PT, but the brace was only unhinged to 75 this week.  This OSSUR brace is really funky.

Well, I am off to watch my girls play softball.  Hopefully they will remember the summer coaching and get their hitting and pitching on track. 

Welcome JC55.  Hope everyone has a good weekend

[JC55]

CarkelTom, I couldn't imagine having bilateral tears...you guys with that injury are my new heroes.  Glad to hear you are progressing.  The word I keep hearing from everyone is patience so that will be my mantra too.  I went thru some depression my first few days but have gradually begun to forgive myself for getting hurt.  I was really angry at first...at the injury, the effect this has on my job, on my marriage, etc. My wife has been great and I don't blame her for initially being upset.. I was just so furious at imposing on anyone.

This site has been great for me mentally.  I appreciate all the info and comments.

[oscarsan]

Hi Everyone

First, sorry for the long delay in my posting, should have done it much earlier. So, After 6 weeks of having the donjoy braces to 10 degrees i finally got them out. Already 2 weeks from that. After visiting the doctor on September 2nd and i went to my first PT on 3rd, already we got to 45 and 47 degrees that time, which gave me a lot of expectations, i have been working on my ROM and quads after that visit, to be sincere the PT also ask me to do squats, well they are quite funny squats because i can't bend that much.

This week on Tuesday 10th i had the second PT, i must say i already have 92 and 85 degrees of ROM. For some mysterious reason my right leg is a bit more stiff than the left one. As per today i think the left is getting already somewhere at 98, hopefully 100, and right a bit over 90, WAITING SO MUCH to been able to get inside the bike. PT recommend to make session of exercise every to days which includes

- Rowing machine 10 minutes both legs (no grip with hands, just legs)
- Rowing machines 5 minutes right leg
- Rowing machine 5 minutes left leg
- Push the leg press with 60 kilos (less than my own weight)
- Equilibrium with those king of round tables fro around 5 minutes
- Squads
- Going onto one small step and practicing going up and down.

So, this has been my set in the GYM every second day, the other day i just put some slippery fabric on the floor and try to get better ROM and off course I'm all sore because of the exercises, a bit difficult to sleep at night, but ice always helps.

I can feel that the right leg is a bit more difficult always so i´m a bit afraid of that, but for the rest with a lot of expectations and good feelings about the recovery.

Cheers!!!

[SellaVee]

Massive congratulations to Tom and Oscar for doing so well.  You guys are both double RPTs and each about 2 weeks behind me in terms of surgery, and yet way ahead of me in terms of rehab.  Excellent ROM going on there.

I had another frustrating PT visit on Friday.  Once again I was in and out in 10 minutes.  This time I did take the brace off and sat with my leg dangling over the bed while the physiotherapist gently pushed it back to try and get me to 90^o.  I'd been able to get to 90^o according to the brace the week before but the physiotherapist had locked my brace back to 80^o "to protect my knee".  Fair enough.

I'd been taking my brace off at home and practising my SLRs the way the physio had suggested, 30 quad sets then lift to 2".  I was also pedalling, mainly back and forth, on my floor pedaller.  I was feeling quite pleased with myself, but at PT she asked me to try the lift with my brace on and didn't allow time for me to do the quad sets.  Guess what?  Nada.  I failed the test.  Sent home and told to keep moving the leg on my skateboard.

I'm suffering from a very painful left hip, possibly because I've been sitting at a funny angle during a meal out, or because I'm favouring that side.  Walking is painful and I'm surrounded by the not so delicate aroma of Deep Heat muscle soothing gel. 

Does anyone else feel they've knocked themselves out of alignment?

[JC55]

SellaVee...although I'm only one week out from my injury I'm feeling all out of alignment due to stressing my right side.  My back and hip are feeling the strain.  I've been trying to be more conscious of stretching a little before I get out of my chair.

Glad to read from Tom and Oscar that they are progressing.  I hope my recovery goes well...quite anxious about all of this.  Again, the mental part of this injury has been almost as bad as the pain.  On a positive note I have reached my first milestone...able to take bandage off and shower today!

[carkeltom]

Oscarsan, so glad to hear from you.  Glad you are doing so well.  I was wondering if you are still wearing the braces and using crutches or not?  I am trying to wean myself off them.  I do pretty well in confined spaces, but being on unfamiliar terrain scares me.  I still feel like I have to catch myself at times. 

Sella, so sorry your PT is a sort of "see me and get out," but it sounds like you are doing good with your home exercises.  And don't focus on the degrees of ROM, bet that thing healed, as didnt you have to wait for surgery?  Everyone seems to do so well with the exercise bikes.  I have been using mine sporadically.  I have been so busy with the kids and have been walking, with the crutches, all over the place.  Really trying to flex my quads as I walk.

When has everyone heard that their OS will take them out of the braces?  Getting more anxious as I just dont know when I would be able to safely walk without them?

JC55, I know what you mean by the depression.  I am still suffering a little bit of that myself.  The pressures of life can get to anyone.  And I work as a social worker, so I had a hard time seeing it in myself.  And, I had to wait over 6 weeks for my first shower.  Once the surgeon gave me my current braces, the old ones got wet.  I was sort of a shower a day kind of guy, coaching and working and farming, that not being able to shower was killing me.  I will give a bit of advice for once the staples come out and the steri-strips (if they use them) are off.  Neosporin on the incision and lotion around the knee.  I have two large brown marks on the outer portion of my knee, I am guessing from the surgical resection tools and I am trying to keep them soft and the skin flexible.  I just dont need my scars being the focal point of conversation when I am wearing shorts.

Well, have a good weekend everyone.  Hope it was good for everyone and happy healing.

Tom

[JC55]

Tom, Thanks for the words of encouragement and advice.  I too was once a day shower guy...funny the little things we take for granted.  Just got out of shower and while it felt great I was scared to death at the same time.  Made it back to my chair and icing it down...aah!

I wish everyone on this board all the luck in their recovery...it really means a lot to hear from people who truly understand what we are (or have been) going through.  Peace

[fishy]

Oscarsan, so glad to hear from you.  Glad you are doing so well.  I was wondering if you are still wearing the braces and using crutches or not?  I am trying to wean myself off them.  I do pretty well in confined spaces, but being on unfamiliar terrain scares me.  I still feel like I have to catch myself at times. 

Sella, so sorry your PT is a sort of "see me and get out," but it sounds like you are doing good with your home exercises.  And don't focus on the degrees of ROM, bet that thing healed, as didnt you have to wait for surgery?  Everyone seems to do so well with the exercise bikes.  I have been using mine sporadically.  I have been so busy with the kids and have been walking, with the crutches, all over the place.  Really trying to flex my quads as I walk.

When has everyone heard that their OS will take them out of the braces?  Getting more anxious as I just dont know when I would be able to safely walk without them?

JC55, I know what you mean by the depression.  I am still suffering a little bit of that myself.  The pressures of life can get to anyone.  And I work as a social worker, so I had a hard time seeing it in myself.  And, I had to wait over 6 weeks for my first shower.  Once the surgeon gave me my current braces, the old ones got wet.  I was sort of a shower a day kind of guy, coaching and working and farming, that not being able to shower was killing me.  I will give a bit of advice for once the staples come out and the steri-strips (if they use them) are off.  Neosporin on the incision and lotion around the knee.  I have two large brown marks on the outer portion of my knee, I am guessing from the surgical resection tools and I am trying to keep them soft and the skin flexible.  I just dont need my scars being the focal point of conversation when I am wearing shorts.

Well, have a good weekend everyone.  Hope it was good for everyone and happy healing.

Tom

Hey Tom:
  Just a quick note.  My OS, on week 9 visit, suggested that I might start weaning myself off the braces, my ROM was around 130 for both legs....I weaned myself 30 minutes outside his office.  And the scar will heal, you are taking the appropriate steps to minimize it now...but really, aren't scars supposed to be sexy?  Take care my friend....

[oscarsan]

Hi everyone

Lot to read in the morning on this side of the ocean  . So Tom, basically i'm completely out of the braces now, don't use them anymore, doctor gave them to me and put them at 90 degrees but because i asked him, at that moment 2 weeks ago i didn't feel like walking without them but after my first visit to the PT he told me to just not use them bc basically there was not benefit. Crunches I use, first to go down the stairs at my flat that happen to be really old so no elevator and also to walk on the street just to be sure that i don't misstep somewhere and fall, but i'm pretty sure that if i would use those braces it would be important to use the crunches as the normally get stuck each other. So, crunches just outside and no braces, i thing this have give me some confidence to just put my weight on the legs, of course, i don't wait very much, just 76 kilos (you can turn that to lbs ;-) ).

It is funny to see how different protocols doctors use in different parts, i'm also a shower guy, so, no shower in the morning = not really start the day but i was never told not to shower, actually i was told TO shower minimum every 2 days, for these they gave me a shower chair (plastic) and this king of funny rope which i could put through my feet and pull, so you can pull you leg up and take the brace at the same time, off course first 2 weeks my girlfriend would help me but after that i did it pretty much alone. So, sit shower but shower after all, actually i was instruct to shower straight the sutures without soap, dry with a clean towel and put a new bandage every shower, at the moment both of my scars and totally close.

About ROM, i guess i'm bit behind but i'm pretty sure is because of the fact i start the PT after 6 weeks post operation and i really didn't bend my legs once before that, so it has been hard work, i normally sit and put this slippery stuff in the floor and pull constantly towards my back. But actually doctor and PT were specific that ROM is not the more important, ROM you will recover for sure, the question about ROM is just how much PAIN you can actually take and that most people will just stop the treatments once they felt ok but never recover full ROM. So the more important thing is to recover your muscles, because they are the ones that give you strength and equilibrium so nothing else happen!! don't despair if you ROM is not progressing, train your muscles as you really don't need any ROM to train them, just something small under your legs behind the knees and pull you legs up, trying to stay there 2-3 seconds.

About my fears, i'm just always afraid that i'm doing to much and that i will screw it up, i have been always this kind of person that usually get sport injuries just for the fact of trying pushing to hard, and it sucks. Hopefully the  routine that i'm trying to build is enough but not too much!

Cheers everyone and hoping the best recover for everyone!

PS: Sorry for my english, it is not the best of the best!

[JC55]

Oscar, no need to apologize for your English...you did very well.  I'm glad to hear about your progress.