Ruptured Patellar Tendon Surgery

[aggie_ks]

Hey Dan - So far they have only given me three exercises to do at home; quad setting, heel slide and a hamstring stretch. They had me doing some leg extensions with a pillow under my leg but it was causing to much pain where the OS drilled through my knee cap. I'm sure I will get more exercises this week. 

Kerri

[darrellb85]

Hi all,

So I had PT this morning, and we were able to get my ROM to 52 degrees with my leg hanging of the end of the table and my therapist supporting/bending my leg to the point of  tolerable discomfort. I will be 5 weeks post op this coming Wednesday, with a visit to my surgeon scheduled for this Friday, and so far I'm very happy with the progress. I've been able to walk around without my crutches for the last two weeks (with my Bledsoe knee brace locked at 0) and I'm pretty happy with the mobility.

-Dan and Kerri-

Since you guys seem to be on a similar timeline as me in terms of PT and surgery dates (I know you were a bit further back on your surgery date Dan) what my therapist has me doing is some hip flexor work with raising my injured leg to the side and behind me, trying to get that stretch in the hip area. He also has me doing side step drills and walking forward and backwards (with my brace on) to get my gait back to normal and my injured leg firing off with what it should remember how to do (walk). And I'm still doing the usual stuff (quad sets, heel pumps/calf raises, hamstring sets, and some hyperextension work), I do these in sets of 3-5 (10-45 reps depending on the fatigue level), 3 times a day.

It also sounds like you and I had the same type of patellar tendon repair Kerri (sutures and holes drilled into patella where sutures were threaded through) without the use of the wire, and it seems that for this type of repair they're a bit more aggressive with PT (starting PT 1-2 weeks post op), which seems to be ok for my knee so far.

Darrell

[Dan]

They have me doing a similar set of exercises.
Heel slides, quad sets, hip work, step stretches, (very limited) squats.

Still using the crutches, lost a lot of leg strength during the extra weeks of immobilization.

I wonder if the conservative approach is related to the specifics of the tear.
From what I've read on the net, most of these injuries involve the tendon separating from the patella.
Then the repair is made by drilling holes in the patella and passing sutures through.

Mine didn't happen that way, the tendon tore about 1 cm below.
So the two ends had to be reattached, and the cable inserted to protect it.

[aggie_ks]

Darrell - It sounds like we had similar repairs but not quite the same. The OS sutured together the tendon and then threaded a cadaver ligament through my knee cap and anchored it to my tibia. I'm not sure if that type of repair was used because of where my tendon ruptured or if that is his standard repair. I'll have to ask him at my appointment next week.
Kerri

[aggie_ks]

Toady is the start of week six post-op and week three of PT. My leg is getting stronger and I can put most of my weight on the leg without fear. I'm not sure what my range of motion is without assistance, but I can get to about 75 degrees with assistance. PT is still mostly massage, working the knee and a few basic strengthening exercises. I will say when my therapist added the trampoline to my routine, I have never been so afraid of such a little thing in my life. I had a little more pain than normal this weekend due to my overdoing it a little on a day trip with friends visiting from out of town.

Kerri

[madvillain]

Today is 4 months from injury and surgery for me of dual RPT.    I played tennis yesterday for the first time since the injury and although I can't move side to side well I can jog and and was able to hit some nice shots.  Was pleasantly surprised really.

It's self limiting for the most part I don't have enough strength and ROM when the quad and hip are fully engaged to  sprint or cut hard so it's safe and fun and my knees felt good after like they usually do after activity.

I've been doing some more jump rope (was able to jump for almost two minutes straight the other day which was a huge improvement) and continuing all my rehab in the weight room as well.  I can almost do a body weight squat to parellel with no pain, that's encouraging and my running on the treadmill is getting better and better as well.  My left leg is still weaker than my right and I "think" too much about my stride but mostly I think that's just because the power isn't there yet.

Once I'm fully cleared at 6 months I hope to really start ramping up the strength training again.  I watched a video of Victor Cruz (WR for the NY Giants) doing rehab at 6 months today honestly he looked to still be a long way away from returning to the field.  Could tell he was still working on a lot of strength and ROM work when fully engaged with the hip and quad.  If it's taking a pro athlete that long well we know it's a severe injury and we need to be patient.


Seems like the thread has taken a turn for the better with some more successful healing and surgeries since I last posted and I'm really glad for that.  This injury is so devastating and it's nice to read about good recoveries.

Does the woman that had the 2nd surgery still post?   I hope you're well and that you're in less pain.

[madvillain]

Hi all,

So I had PT this morning, and we were able to get my ROM to 52 degrees with my leg hanging of the end of the table and my therapist supporting/bending my leg to the point of  tolerable discomfort. I will be 5 weeks post op this coming Wednesday, with a visit to my surgeon scheduled for this Friday, and so far I'm very happy with the progress. I've been able to walk around without my crutches for the last two weeks (with my Bledsoe knee brace locked at 0) and I'm pretty happy with the mobility.

-Dan and Kerri-

Since you guys seem to be on a similar timeline as me in terms of PT and surgery dates (I know you were a bit further back on your surgery date Dan) what my therapist has me doing is some hip flexor work with raising my injured leg to the side and behind me, trying to get that stretch in the hip area. He also has me doing side step drills and walking forward and backwards (with my brace on) to get my gait back to normal and my injured leg firing off with what it should remember how to do (walk). And I'm still doing the usual stuff (quad sets, heel pumps/calf raises, hamstring sets, and some hyperextension work), I do these in sets of 3-5 (10-45 reps depending on the fatigue level), 3 times a day.

It also sounds like you and I had the same type of patellar tendon repair Kerri (sutures and holes drilled into patella where sutures were threaded through) without the use of the wire, and it seems that for this type of repair they're a bit more aggressive with PT (starting PT 1-2 weeks post op), which seems to be ok for my knee so far.

Darrell

Hi Darrell seems like you are working hard at getting better.  In general the Science seems to be moving towards aggressive rehab and as little time off your feet as possible.  I had the same repair done and was full weight bearing on both knees day 5 or 6 out of surgery.  It wasn't a lot of fun walking around like Frankenstein but I do attribute a lot of that early movement to the success I have had so far in my recovery.

Remembering how to walk took me about 7 weeks so you should start to feel it soon.  For me it came suddenly but then slowly to not consciously "remind myself" to bend a little and not walk so stiff legged on my heels.

Seems like you have a good attitude that's the most important thing.  I found personally that recovery speed slowed quite a bit from weeks 8 to 16 so don't let that get you down and just keep working.

How are stairs for you?  They are real buggers on the way down aren't they!  Luckily (hehe) I have dual RPT knees so I don't get to "cheat" on either step.  I can walk down the vast majority of stairs no hand on the rail at 4 months but it takes full effort (core engaged and quads) and it's tiresome really.  Usually on the way out the door in the morn on the way to work I grip the rail hard in order to expedite things a bit !

I think in a few more months I'll really be good with stairs but boy it takes awhile to come back.

[darrellb85]

Hi guys, I'm officially 6 weeks post op. ROM is getting tougher and tougher to improve because of the scar tissue around the lower outside portion of my knee (where it's still numb). I was able to get around 58 with my PT's assistance, and it just feels like the outer portion of the knee and the scar tissue is not letting my knee break past that 58 degree range. I'm able to walk around now without my brace (for longer walks I'll wear it set to 40 degrees). Still trying to stay positive, and go hard during PT. My gait is improving as well.

Had my checkup with my OS this past Friday, and he seemed pretty happy with my knee and the progress, and felt that I shouldn't be rushing things, and that he would rather stay on the safer side of things. I'm just worried he's a bit conservative, so I'm going into PT with a bit more of an aggressive approach than I think he'd be ok with.

Thanks madvillain, I'm trying to go as hard as I can (without overdoing it). Definitely trying to keep my spirits up, that's the best way I feel to stick it out. As far as stairs go, they're still pretty difficult for me, I still find I'm sort of swinging my injured leg around to get over the step versus bending my leg forward, but they're manageable.

I go back to PT this Friday, so looking to just get better each and every day.

Take care everyone and I'll keep you posted on things.

Darrell

[BustedWheel]

5 months out from complete RPT, right knee, tendon off bottom of kneecap, drill holes and suture repair.  47 yo male.

Pretty much back to normal. 

Things I am still working on in day to day activities is going down the stairs.  Can make it down with relatively normal gait, but still knee handrail just in case, still don't trust the knee completely. 

As far as ROM, as near as I can tell, both legs are the same and the repaired leg is pretty much same ROM as pre-injury.  Nothing noticeable as far as flexibility, etc.

As far as gym and fitness activities, leg extension machine is still my worst exercise.  Still working on getting weight up on that one, pretty much stuck at 15 lbs one leg extension.  Not near where I used to be.  All other leg machines exercises are pretty much what I used to be able to do, strength and repetition wise.  Still a little pain, and still don't trust the knee as much as I used to, but it's not that much of a hindrance.

I can do the ellipitical, stairstepper and exercise bike pretty much in the same intensity and time range as before.  Again, still a little pain, and still don't trust the knee as much as I used to, but it's not a big hindrance to getting through a workout.

Things I can't yet do with any degree of comfort or confidence:  run, jog, jump rope, jumping jacks, stuff like that where there is a transition where pretty much my whole weight will come down on the repaired leg.  I have been questioning whether this is partly psychological.  I think my next attempt in my own personal rehab will be to work a very light and slow jog on treadmill into my routines (I like to shake things up/add as each month milestone goes by).

All in all, the injury sucked but like many things, not as bad as I feared or as it could have sucked.  My hat is off to the surgeon.

[Dan]

Time for a quick update.

Hit 70 degrees of motion this week.
Strength and muscle control in the leg is improving, albeit slowly.
I am able to go down to one crutch for walking, and gait is closer to normal.

[mitchm]

I just found this thread and sure wish I had last year. I am 44 now and I tore my patella from my knee cap and also breaking 2 pieces of kneecap away as well February 16, 2014. I had surgery 2 days later. So, I am 14 months out of surgery and in pretty good shape. I can jog but my knee gets really tight after 1/4-1/2 mile. I've honestly been way to scared to run harder than a jog for fear of hurting it again. I do work out every day at a crossfit gym, but it does not limit me in most exercises. I do not attempt full depth squats. I have considerable popping in my knee cap which I am told is normal. My knee cap also seems to be much looser than my other. I know I have had trouble building up my lower quad just above this knee so I'm sure thats why its not as tight as other knee. I guess I have full range but its much weaker than my other knee. Is there anyone reading this thats past where I am at or near same time frame? Happy to discuss with anyone --

[darrellb85]

Hi everyone! Just a quick update. It'll be 7 weeks post op tomorrow, and today in PT I hit 65 ROM with little discomfort, so pretty happy with that, my therapist and I are going slow and steady but persistent with PT. I'm walking relatively fine without the brace (I'll wear my bledsoe brace to work and when going out), over-exaggerating my step with my repaired knee to bend more when I take a step. Swelling is down as well, although still definitely looks bulky in comparison to my good knee. Take care everyone.

[bustedwheel10]

This thread is incredible. I could spend days and days in here. Thought I'd share my experience and also get feedback as to whether I'm pushing it too early.

Background: Formerly very competitive full-time athlete (collegiate All-American in Decathlon); Now - 34 year old, quasi-competitive recreational athlete - Master's Track and Field, Weight Lifting. Clean and Jerk at 310, Deep Back Squat at 405, Could still dunk 2 handed pre-injury 3 months ago. Could still run mid 11s in 100m, Long jump 21 feet, Shot put 45 feet, Bench Press around 300. Was suffering some mild overuse patellar tendonitis prior to injury, but was certainly not concerned that I was approaching a big injury.

Injury: Occured on 1/16 during a practice take-off on high jump.  Heard a pop, went down and could tell immediately that it was completely ruptured. Knee cap was elevated by about 2". Went to ER, saw surgeon next day, and he scheduled operation for 6 days after the injury. (1/22/15)

Standard screws in knee cap and disolving cables connecting those to tendon.  Shaved the tendon and bone down to get them to stick, etc.

Only did painkillers for 1 day, as I don't like them. First weekend was horrible. After that pain was nominal, but mobility was terrible.  Showering was the most nerve wracking.  Bought a shower seat, which made life easier. 

Nothing but ice, elevation, and working from couch for the first 10 days or so.  Then started getting on my feet with 2 then 1 crutch. 

PT at begining was mostly: mobility, E stim, attempting to contract quad (I would do static flexes where I was doing as much as 400-500 contractions per day).  After about 4 weeks, Began introducing leg raises, though still had a little lag.

Weeks 4-8 progressed rapidly, same for PT, progressed to totally unlocked brace by week 8, and could flex to about 110 degrees. Stopped crutches at week 6. Reintroduced upper body weight training at week 6.

Week 8-12: Continued progression, leg raises with now lag, can now do as many as I want.  Pulled brace off at week 10. Introduced rowing machine and stationary bike at week 10. Not pushing it, but maybe 10-15 minutes total per day. Flexion at nearly full ROM without assistance. About 1" less ROM than good knee, meaning I can pull heel to about 2" from butt.  At week 10, intrdocued stationary stability (standing on one leg, bent for bouts of 20-30 seconds). At week 8, also began doing reverse hypers in weight room to get a little work on glutes and hamstrings.

Current (week 12): Introduced sled drags - did 200m with unweighted 45 lb sled.  Introduced very slow box squats to a 20" box - 3x10 with 45 lb. No pain or swelling - although knee is certainly a little stiff. Did a 2000m row in 7:30 yesterday, without issue, and limiting flexion to about 90 degrees. Limp is minimal, pain and stiffness greater in the morning. Biggest day to day activity I struggle with is descending stairs.  I just can't quite bring myself to do it normally. So still going one step at a time for the most part.  Going up, I can do normally with no pain.

Other things I've noticed: Both knees sensitive on inside/MCL area - I imagine this due to an alterd gait... My hips, calves, hamstrings, quads, and IT bands are unbelievably tight. I have to think this is due to lack of activity.

Questions: So I know I'm progressing quickly, which is great - but how do I know if I'm going too fast.  You hear stories like Louis Simmons doing loaded carries with wheel barrow very quickly, and a few of the other EliteFTS and Westside crew back to squatting lifetime bests within 4-5 months - which makes my recovery seem slow.  Real question is - How much can I do, and should I let pain and progress be my guide, or what? Doc is giving me quite a bit of leeway now, as is my PT - but I would hate to have recovered this well and then re-injure it and similarly hate to progress slowly because I'm being too conservative.  Getting back to where I was (and then past that) will unquestionably hurt, bcause progress always does, and my right leg is so heavily atrophied.  Thoughts?

[bustedwheel10]

Hello all. I had posted here a while back, and I wanted to give an update on my situation, ask a couple questions, and also give a bit of advice and encouragement based on my experience.

I'm going to start off by saying that my tear was no a full rupture, but partial tear of 3/4 of the patellar tendon. A lot of people have the quick onset of injury with the complete rupture, whereas my situation was more of a longer term chronic type of issue. In October of 2014 I started noticing a difference in my right knee compared to the left. I didn't think much of it. It continued to get worse to the point of severe pain, cramping, and stiffness. I went in for an MRI in December where I was diagnosed with a huge partial tear of the knee. I basically caught it just in type to prevent from a full tear. Being that I am 19 years old, 7 feet tall, and a basketball player my surgeon believed that surgery would be a better long term option over the conservative treatment. I had surgery 12/04/15.

I am now 16 weeks post op and doing pretty well. I am on an elliptical, doing tough strength stuff, and a bit of light jumping and jogging. I still have a bit of swelling in the knee, and I am not to where I want to be with range of motion. I can't quite do a hamstring stretch on my repaired leg. From my experience, I would tell everybody that is going through this situation to make small goals and take things 1 day at a time. As humans we like to see the big picture and look towards the end goal. But when we do this it really makes things worse because we see how far we still have to go. It sounds cliché but you have to take this 1 day at a time. What I mean by this is to have a goal of being better today than you were yesterday. When you have a small goal and you accomplish it, it will give you a sense of confidence in what you're doing.

The first 2 weeks are going to be tough. In my opinion the 4-7 week stage is the hardest. This is the time where you will start to really work on PT and you get tested physically and mentally. I became very depressed during this time because it is easy to doubt yourself and question if you can get back to where you were.  It's a bit of a hopeless feeling. But I can tell you that it IS temporary. It can be a devastating injury. But that's only if you let it. Try to find a positive from it. When it's all said and done you will be stronger in a bunch of ways, and you will also have a greater deal of appreciation for little things, and it's a good time to learn more about your body and health to prevent or help with these type of things in the future. Patience is a key to recovery. Listen to your body and don't rush anything. If you aren't comfortable with something, tell your PT. Only you know how you feel.

Now I do a couple questions, and If anybody that is reading this can answer them I would really appreciate it!

Is it common to be swollen and have some range of motion limit at 16 weeks?

Has anybody else had a feeling of a 'cramping pain' or stiffness during or after exercise? Sometime when I am doing PT exercises my knee will feel like it has a cramp in the knee and I have to move it to loosen it up. It's hard to explain but maybe somebody can relate.

Lastly, how can I stretch my quads and hamstrings on my repaired knee-leg when I have limited range of motion. By limited I mean about 120 degrees. This isn't enough to pull my leg up for a hammy stretch, or to lay on my back and pull my knee to my chest. I am having back pain from tight leg muscles.

Stay positive everyone and feel free to ask me anything you may need help on! I might not be able to relate to full ruptures, but I can definitely help with the mental or spiritual side of the injury! I am studying phycology in College to become a sports psychologist later on. I enjoy this stuff. Good luck!

Re: Stretching - here's what I've done with similar ROM:

Hamstring - Try from standing - with really straight legs and neutral spine.
Hip - Lay down (suppine) and lift your full leg perpendicular and then turn to the side, repeat multiple times on both sides
Glute - Stand and find a surface about mid-thigh height - and lift foot on it (knee should bend to about 90 degrees) then lean upper body into top of thigh.
Quads - Lay on your side, bend knee to about 90 degrees and then keep pulling foot back while doing really gentle pull forward against the resistance of your hand.

[Stuart Rulka]

Bustedwheel10. Won't bore you with my whole history. You can check anyone's story by clicking on their name. I had a very good PT who put me on a bike on my first visit,at 2 weeks,  and had me go gently back and forward as far as I could. By the start of my second week, 4th post surgery I could do a full revolution and never looked back. At 6 weeks was back to hiking up a local mountain (Grouse Grind) taking the gondola down.
  I am one of those who believe rehab protocols are for the most part stuck in the 1980's which to my kids is antediluvian. Trust your body and your PT, at this point you should be good to go!