Ruptured Patellar Tendon Surgery

[SellaVee]

Jerry, glad to hear you're keeping your spirits up.  It takes work

Copper44, my NHS physio was a bit like yours, quad sets and heel slides were pretty much it.  The difference was my consultant wasn't interested in what I was doing at physiotherapy so he just discharged me.  The private physio I've been seeing does so much more, but I wouldn't say it hurts, although I ordered extra co-codamol because I expected it to.  My knee often feels much better, looser I would say, after our sessions.  I do still get many an odd ache.  I'm very pleased to hear that you're happy with your progress and that you have a good therapist.

Although I've taken a slow and steady approach I'm also pleased with where I'm at.

[vonlehmd]

I am at 8 weeks post op tomorrow.  Get to see my Ortho next Tuesday.  Hoping to be allowed to begin FORMAL PT at that time. 

I can:
Do heel slides to 80 degrees on both legs
Unlimited SLR's while seated upright (makes it harder) all day long.
Walking without walker at 0 degrees
Get to 90 degrees on both legs while seated. 
Quad sets with straight leg not a problem.

Anxious to start with stationary and floor pedaling, hearing this takes it all to next level.

Pretty happy with where I am at.  Anxious to start PT. 

Hope all are making positive strides....

[bballkingofnba]

JC55, just curious to know how your kneecaps look in relation to one another since our repair and injury were very similar. When you sit in full extension and do quad sets with both your knees does it feel like the tip of the injured kneecap sits a bit higher than the other one? My surgeon said that almost all tendons healed a little elongated and I am just trying to gather data if that is true.

[JC55]

King my kneecaps look even at this point in rehab, but I am having some swelling issues on days I push the PT.  Also, just at end of 8 weeks so I have quite a ways to go.  Remind me in a month or two and I'll be happy to post picture, etc.  is anyone else having scar tissue issue?  I feel like I have a little hard piece of something in lower portion of knee that I can feel move when I bounce my foot on the floor.  Best wishes to all!

[vonlehmd]

King my kneecaps look even at this point in rehab, but I am having some swelling issues on days I push the PT.  Also, just at end of 8 weeks so I have quite a ways to go.  Remind me in a month or two and I'll be happy to post picture, etc.  is anyone else having scar tissue issue?  I feel like I have a little hard piece of something in lower portion of knee that I can feel move when I bounce my foot on the floor.  Best wishes to all!

At 8 weeks out, my knees are very swollen/lumpy/bumpy. 
Right knee is more swollen than left.  Right tendon was frayed and needed more work during surgery.  I also think I had a lingering issue of tendinitis in the right knee which was the straw that broke the camel's back.

Left knee has a pronounced line of swelling along joint line, outside of knee.  Tender/sore to the touch.  Hoping it is "just" scar tissue and not something more serious like a meniscus tear.  When doing knee slides I hear and feel cracking/popping in this area.

[TomG23]

Hi All

Just joined this great forum.  Seems like a great place for information and advice.  I ruptured my right patella tendon through the middle which I hear is one of the rearer type of ruptures.  This was playing football on the 1st Nov, surgery was on the 5th.

I have been told that I cannot weight bare for 8 weeks.  Is this a normal amount of time?  I commute to London everyday.  How likely do people think that I will Be able to make it into the office if travelling by train and tube?

Any advice or tips would be greatly appreciated

Thanks
Tom

[vonlehmd]

Hi All

Just joined this great forum.  Seems like a great place for information and advice.  I ruptured my right patella tendon through the middle which I hear is one of the rearer type of ruptures.  This was playing football on the 1st Nov, surgery was on the 5th.

I have been told that I cannot weight bare for 8 weeks.  Is this a normal amount of time?  I commute to London everyday.  How likely do people think that I will Be able to make it into the office if travelling by train and tube?

Any advice or tips would be greatly appreciated

Thanks
Tom

Although I ruptured both tendons, I feel fortunate that both were mostly torn from the bone (patella).  From what I can tell, you ruptured tendon from tendon (versus tendon from bone in my case) which likely requires a longer immobilization period in your case. 

My repair involved drilling holes through the patella, sewing up the ends of the tendon and running these sutures through the holes in the patella to pull the tendon back to the bone. 

I was allowed to bear weight (while wearing immobilizers) the day after surgery.  I used a walker and walked like Fankenstein for 7 weeks, and now, 8 weeks out, am walking with straight legs but not using walker (unless away from home). 

You should try to take the time to read some of the old posts and find a poster or two that have a similar injury/repair to yours.  Then click on their name (in one of the posts).  Once in their profile, you can click on "show posts" to see all of the posts they have made on this forum site. 

Personally I have viewed the "bilateral" posters (both legs) and some of those related to weightlifting and golf, which are areas if interest for me.  You could literally spend days/weeks on this link reading through the 337 pages of posts oing back to around 2002.  Great information, better than what you will get from most doctors and physical therapists.

[vonlehmd]

Question re: working through ROM. (range of motion).

At 8 weeks out, I am currently spending hours at a time seated with legs at 90 degrees.  I occasionally (every 15 minutes or so) i straighten the legs for relief.  I get to around 90 degrees and then nudge them back a little further until I feel max stretch without pain.  If I start to feel spasms or pain, I back off a little.

I read a post or two where a machine/contraption can be used to stretch to new points of ROM.  I am trying to replicate this by just placing my feet/ lower legs to a point of stretch while seated. 

Let me know if thoughts.

[vonlehmd]

Try this if able to do SLR's and heel slides.

Lay in bed.
Start with Quad Sets.

Now do SLR's as follows when SLR's while lying become easy:
Prop yourself up to sitting, do SLR's on each leg ( I am up to 20-30 reps per leg)
Do a quad set and hold it while doing SLR.  Really fire the quad.

Then do heel slides.  You will likely notice they are much more fluid and better ROM after higher intensity SLR's.

When seated SLR's get easier, start doing each SLR in sections/phases.
Raise leg as high as possible and do a few reps in top 1/3 of range.
Then lower to middle of range and do a few reps in that range.
Then do reps in bottom third of range.
Finish with a few reps of full range (bottom to top).

Again do heel slides.

Cycle through this as often as possible.

Quad sets, SLR's at intensity level desired, then heel slides.

Hope it helps.  Is helping me quite a bit.  I have been looking to up the intensity prior to Formal Physical Therapy. This is helping. Thougt I would share.

I am 8 weeks out from surgery.

[JC55]

TomGfirst of all you are in the right place.  You will be hearing from the moderator, John42, and he'll share some literature he's collected over the last 10+ years.  This is a serious injury and takes patience to heal properly.  Also, everyone will be a little different due to severity of injury, age, previous physical condition, etc. so listen to your OS (Orthopaedic surgeon) and PT (physical therapist) but get informed, ask questions and become a partner with your medical team in your recovery.  The first 3 weeks for me was the worst...but remember this, you WILL get better.  To answer your question: I was non full weight-bearing for 6 weeks with partial WB as tolerated around 4 weeks.  At 8 weeks post-op I'm walking with brace unlocked to 60 degrees, ROM of 90 degrees max per OS but pretty easy so I have gently done a little more.  My number one tip: do quad sets as soon as possible once OS says you can.  I was able to do SLR(straight leg raises) without brace at second PT session (but I'm tall, thin, 50 yrs old and was in better than average condition before injury). Good luck TomG and stay strong!
Vonlehmdmy swelling is consistent but have noticed a bit of improvement since stretching to about 105 degrees+.  Also, doing short arc quads which seems to have loosened up some scar tissue that I haven't been able to get to with massage.  I think my lateral retinaculum is finally starting to stretch and the muscle used for pulling your leg through during normal gait isn't sore anymore.  Still some tendinitis on lateral Part of knee. 
Hope all have a great weekend...my next OS and PT appts are Tuesday so I'll update then.  Peace and stay strong!

[SellaVee]

TomG, welcome to the forum, finding it will improve your outcome so much.  You'll learn that there is more than one way to recover from this injury and you'll be able to make well informed decisions about how you recuperate.

Like you, I'm in the UK where there tends to be a more conservative approach to rehab.  Having said that, I had complete bed rest on the day of my surgery but the next day I was up on crutches trying to climb stairs under the physio's instruction.  I didn't do well enough to be let out so I had to try again the following day when I passed the test and was allowed to go home.  I never got the hang of using the crutches to "hop" so I used them to "walk" instead putting my injured leg down whenever I stepped through, so I guess I was partial weight bearing from the day after surgery.  I was, though, under instructions not to do any exercises.

JC55 mentions being 50, tall and skinny, and in above average condition.  I'd had surgery on my foot 6 months before I fell so I was in below average condition, short, fat and 60.  My op was exactly 4 months before yours and I'd had to wait 3¹/₂ weeks for surgery, so I would think that four months from now you will be a good bit further along the line than I am.  You can follow my progress by reading my posts.

You asked for advice and tips so here goes:

• Read as many of the previous posts as you can.  You'll have plenty of time  .  I think there is one where someone mentions travelling on the tube.
• Take as much time off work as you can.  You'll need your energy for recovery,but once you get back it'll feel like an achievement.  I took extra time off because I could, I could have gone back sooner.
• Eat a balanced diet.
• Be prepared to suffer depression or fits of frustration.  It's happened to many of us.
• If, when you get to the stage of having physiotherapy you have a problem with the NHS service, consider going privately to a well qualified therapist, preferably one who has treated this injury before.
• Do your exercises as often as you can once you get them and be aware of what other people are doing - you may pick up some tips.

I'm sure others will be on to add to this list.  Poster John42 has useful information.

Hope this helps.  Sella
[/list]

[SellaVee]

vonlehmd,  I think you're doing very well with your technique of just nudging your legs back a little while seated.  Sometimes I think there's too much emphasis on degrees of ROM, which is easy for me to say now that my ROM isn't causing me concern.  At one point I was considering buying a goniometer app so that I could measure my own and make a little chart to illustrate my progress but in the end I just got on with doing the exercises  .  I don't know what my ROM is on either leg.  Last time it was measured the injured limb was about 110^o, but yesterday my physio got me to sit on the bed and slide both my feet back and the operated leg was almost, but not quite, the same as the other one.

bballkingofnba,  I asked my physio yesterday if my kneecaps were the same height.  What she noticed on examination was that my repaired kneecap was slightly off centre, which came as no surprise as my VMO is still very weak.  This is causing me a lot of problems with my straight leg raises which I'm still working on doing by using my knee mechanism.  I can lie on my back and point my foot at the ceiling but my hip is doing most of the work.  Both my private and my NHS physios have said to forget about the SLRs and work on strengthening my quads.

Today I went for a walk by myself and pretended I could walk like a normal person.  Once I got out of our road where the pavements are covered in wet leaves I got into a good stride and I walked normally up a sloping street with no stick or husband to hold on to.  It was a bit tricky in places where I was going uphill and the pavement sloped towards the road and the postman and I had to shimmy past one another on a narrow stretch but I made it.  I did some shopping and it was bliss - not the goods on display but the level, dry surface I was walking on in the store!  Coming home I got a bit wobbly towards the end, especially when I encountered driving rain and wind.  Stuart Rulka, who does proper hiking, will be laughing at me and my adventure but I'm keeping it slow and steady.  I shall be the tortoise to Stuart's hare.  His story is inspiring.

[Frank550]

Hi Tom,

welcome.....

I just wanted to add to what Sella has stated. Ice. Its a great friend. Heat and swelling are an enemy in healing, as I have found out, ice can help you not form so much scar tissue.

My advice would be dont push it too far or too hard, but do keep moving and patella manipulation is very good for stopping the adhesions.

Good luck with everything and keep us up to date on how youre getting on.

Cheers

Frank

ps....if you can avoid crowds I would, any sideways knock could put you down and cause more damage at this early stage. The hustle and bustle of tube and crowded trains sends shivers down my spine, even now, and im 7 months down the road!! Thankfully Im an early pensioner at 52!!!

[bballkingofnba]

Hi JC55 glad your recovery is going well. I am 25 and I was also very athletic before the injury (mine was due to a nasty motor vehicle crash where the door went into my knee). But kneecap not being centered is common due to the muscular imbalance. My kneecap still is a little lateral but thats also because my recovery after getting ROM in terms of strengthening was delayed due to chondromalacia from the trauma behind my kneecap. It has subsided over the past 12 months but the doctor says it can take another 12 for it to fully go away. If you can get pain free activation of the vmo with mini squats and quad sets with elctro stim that would be great for tracking. Also, standing terminal knee extensions are great! In terms of walking I had normal gait by 8 weeks with about 120 ROM which my doctor was quite happy with. I progressed ROM as tolerated starting week 3.... a little aggressive and I am thankful nothing terrible happened. I think being active pre injury definitely helps with the recovery! And in terms of the kneecap height I didnt know mine was higher until an xray and it wasnt higher by much (about a cm) so its hard to notice with the naked eye until swelling subsides.

[vonlehmd]

Hi JC55 glad your recovery is going well. I am 25 and I was also very athletic before the injury (mine was due to a nasty motor vehicle crash where the door went into my knee). But kneecap not being centered is common due to the muscular imbalance. My kneecap still is a little lateral but thats also because my recovery after getting ROM in terms of strengthening was delayed due to chondromalacia from the trauma behind my kneecap. It has subsided over the past 12 months but the doctor says it can take another 12 for it to fully go away. If you can get pain free activation of the vmo with mini squats and quad sets with elctro stim that would be great for tracking. Also, standing terminal knee extensions are great! In terms of walking I had normal gait by 8 weeks with about 120 ROM which my doctor was quite happy with. I progressed ROM as tolerated starting week 3.... a little aggressive and I am thankful nothing terrible happened. I think being active pre injury definitely helps with the recovery! And in terms of the kneecap height I didnt know mine was higher until an xray and it wasnt higher by much (about a cm) so its hard to notice with the naked eye until swelling subsides.

Bballkingofnba

If you don't mind my asking, what part of your therapy/rehab helped you the most in getting your gait and the 120 ROM by 12 weeks?

Seems most say cycling (stationary or regular bike) was what helped most. 

I just ordered a floor cycle from Amazon, should have it tomorrow.

I am 8 weeks out, seeing doc tomorrow.  Hoping to be cleared for PT, at least cleared for using the floor cycle on my own.  Hoping to get beyond he SLR's and heel slides.