Ruptured Patellar Tendon Surgery

[agold55]

First time on this blog. 
I suffered bi-lateral patellar tendon injuries.  Left was ruptured and right was badly torn.
Was lucky enough to have sugery about 16 hours after the injury.
It's be 5 weeks and a day since my surgery.  Locked in straight braces.

PT in the hospital had me up and walking 2 days after surgery, doing quad squeezes.
After 1 week in home PT had me walking with braces on, using a walker, doing side leg raises, rear leg raises and calf raises.  Most difficult part was getting out of a chair.  Pretty easy to get out of a chair or wheelchair with arms....pretty much just use upper body to lift myself up.
Dr saw me at 4 weeks and okayed going to out patient PT.  Dr said the PT was ok to take my legs to 40 degrees between weeks 4-6.  Was able to let her move knees to 40 degrees without much pain.  She also had me walking with a walker, doing side leg raises, rear slow kicks and calf raises. 

Going back to Dr at 6 weeks for check up.
Was checking on other who had bi-lateral or uni-lateral Patellar surgery, to see if anyone has any pointers around rehab, a supplement called Cissus, the use of a T-Unit for muscle stimulation, or helpful / un-helpful exercises encountered.
Looking forward to hearing back.

Thanks so much!
Allen

[John42]

Hi Allen

Welcome to the RPT thread of KneeGuru - my goodness you belong to a very rare group of lateral RPT`s
of which some are currently in the process of getting over this very serious injury.

How did you sustain your injury?  Where do you live.

Read some of the previous posts on this thread - ASK questions - we are all rooting for you.

Have a look at the undermentioned  thread - contains a collection of documents which I have put together with KneeGuru.

Take care
JohnK/ Manchester UK

https://www.facebook.com/QuadricepsPatellarTendonRupture

[agold55]

Hello.
Thanks for the reply.

I live in Austin, Texas.
My day started by going to the gym and riding a stationary bike for 30 minutes w/ some sprints called Tabata - to get the heart rate up.
Then did some light leg work and stretching.
That afternoon I was coaching my sons 7 on 7 football game & was on the field.  They ran a play and I was in a semi-squat position, then took off in a sprint.  About 15 yards down the field my left knee popped & I guess my right one did immediately after on the next step. 
Luckily a high school coach was watching & recommended a great surgeon at a hosital within 5 minutes of the school. 

Quick question....on this blog - did my post go out to the entire forum or just in your thread?  Trying to figure how others who have had this injury would see this post?

Thanks

[John42]

Hi Allen

Texas eh! - hope you are not having the floods storms etc -   this thread goes to all RPT`s who have registered over the years on this site.

For future weeks, have a look on Amazon for a floor cycle - good investment - costs about $50.

Take care

JohnK/ Manchester UK

[bryce73]

Hi,
@champerington : saw for the last time the nurse who was changing my dressing yesterday. I can now wash my knee under shower but she advised me baths would not be very suitable at this time (I'm now 3 weeks post injury/op).

@agold55: wow double PT injury is quite a hard one, hope you're dealing well with it. For myself I injuried my left PT 3 weeks ago (surgery the same day) and I practice daily quad sets and gentle passive mobilization of the knee and the patella. I don't take Cissus but some spiruline and horsetail. I also make sure to have a diet that supply the nutrients necessary for collagen synthesis (from what I read that would include vitamin C, and amino acids proline and lysine)

[agold55]

Good deal.....I'll look into Proline and Lysine.
How did you find info on those?

Where are you located?

FYI - my nurse suggested buying an extra set of braces (on Amazon) and use those for showers....and keep the other set dry.  Awaiting those now....quite challenging showering with both legs in braces ;-)

The quad sets seem to be working a bit  I can actually see some muscle contraction in the VMO and outside areas of the quad.  Definitely lost a bit of size, but at 5+ weeks post-op I can't expect to look like I did before the ruptures. 

[madvillain]

Good deal.....I'll look into Proline and Lysine.
How did you find info on those?

Where are you located?

FYI - my nurse suggested buying an extra set of braces (on Amazon) and use those for showers....and keep the other set dry.  Awaiting those now....quite challenging showering with both legs in braces ;-)

The quad sets seem to be working a bit  I can actually see some muscle contraction in the VMO and outside areas of the quad.  Definitely lost a bit of size, but at 5+ weeks post-op I can't expect to look like I did before the ruptures.

First, condolences on your injuries.  But, it seems you have the right attitude and that helps the most.  I am now 23 weeks out of bilateral ruptures.  I too had surgery less than 24 hours after my injuries and know that that improved your chances of a positive income many times.

I am 100% back to normal routine in daily life and about maybe 50% as far as I want to be with sports and recreation.  I have put in a lot of hard work and research into my recovery and it has paid off so far.

As for some of your questions I do recommend taking Cissus, especially for the first 3-4 months after injury.  There is quite a bit of research that indicates it does improve blood flow in your joints, including the knee.  Also, placebo affect is real and if you think it's helping it is.

I also recommend getting a "gua sha" scraping tool and scraping your knee after exercise.  The theory is that is will align the scar tissue (you want to scrape down and towards your scars, and especially over the outside of the patella where they insert the kevlar.

As for specific PT I highly recommend doing the heel slides and iso sets 2-3 times a day if you can.  The slides are the single best thing you can do to safely improve ROM in the first couple months and the ISO sets will prevent some atrophy.  Google "patella manipulation" as well, you can help loosen up the ROM with your hands by moving the knee cap gently back and forth, up and down.

With the blessing of your surgeon you can also start doing simple step ups, leg raises, situps, etc.   WHen your ROM gets good enough, the exercise bike will be your best friend, the rowing machine as well.  You can use the rowing machine to safely increase your ROM.  I remember how great my knees felt after those early sessions on the rowing machine. 

My surgeon gave me blessing to start jogging and jump roping at week 12.  Jogging is f***ing hard after bilateral, no other way around it.  I still can only jog at 6.0mph for roughly 3 minutes before I have to stop and walk.  I am working hard but it's a slow process to get back to running.

My surgeon told me it will be 12 months before my ROM feels completely "normal" but that at 6 months (1 week!) I can do sports with no restrictions as the healing should be complete.

I did some sprints the other day at the gym and that was the fastest I've run post surgery, not even close to full speed, but def faster than a jog.

You gotta have a lot of patience.

Also I recommend the "pro athlete's pt guide" post that someone put up.  I learned a lot of new stuff from it even though like I said I've gone crazy researching PT for this injury.

Eventually you can add eccentric squats and other advanced PT methods.  I also highly recommend getting a foam roller.  That roller knows where your pain is, it's uncanny.

And lastly -- progress isn't always linear.  Around week 10 I actually felt I went backwards for a couple weeks in my ROM and power and then it picked back up around 12.  Same way around week 20.

Just say patient.  Good luck to you man.  I'm going hiking on a 2200 ft ascent tmr and returning to serious hiking by early summer was an early goal of mine-- the hard work will pay off for you!

[agold55]

madvillain:
Thanks for the great info.  I like your positive spirt too.
Here's some questions that I was curious about:

1) How did you rupture both tendons?   Like I mentioned in a previous post - I'm 47 and stay extremely active by cross training, weights, occasional run, mtn bike, hiking, water sports, tabata workouts, etc.   It was also great to have a surgeon who recently was a world ranked triathlete.

2) I've too researched the crap out of why this could happen when I was just in a sprint.  Did you ever find anything out?

3) Love the foam roller....have one from a company called Trigger Point - can't wait to use it.  Did you use it at some stage of your rehab?

4) Did you take Cissus?

5) Are you in the States or abroad?

Thanks again for your positive comments and info.  So glad I found this site - recommended by a gentleman in Florida who also had Bilatteral Patellar ruptures.

[bryce73]

Good deal.....I'll look into Proline and Lysine.
How did you find info on those?

Where are you located?

FYI - my nurse suggested buying an extra set of braces (on Amazon) and use those for showers....and keep the other set dry.  Awaiting those now....quite challenging showering with both legs in braces ;-)

The quad sets seem to be working a bit  I can actually see some muscle contraction in the VMO and outside areas of the quad.  Definitely lost a bit of size, but at 5+ weeks post-op I can't expect to look like I did before the ruptures.

I read about those on these web pages on healing process http://www.cicatrisation.info/livre/module_2/mann/nutrition.htm and natural source of nutrients for collagen http://www.docpinck.com/sources-naturelles-de-collagene/, but they are in french (I live in France, near Chambery, that's in the Alps near the Swiss and Italian boarders).  The good thing is that you can find these in natural sources, as wheat germ and eggs for proline and cheese for lysine. Hyaluronic acid is also said to be beneficial for repairing damaged collagen fibers and can be found in soy products. There are other sources for these nutrients but as a vegetarian I stick with those. 

good idea for the two sets of braces, I can imagine how challenging that would be with both legs in braces! one is tricky enough 

[champerington]

Thanks Bryce73, I will avoid the bath for another while then.

Welcome to the forum Allen. Sorry to hear you've had to experience such an injury.

I find your rehab protocol intriguing. Again it appears that the protocols in the US are so much more aggressive.

I asked the question recently about exercises that could be done during initial 6 weeks in brace and the general consensus in the UK/Ireland is rest!

Why the disparity?

[John42]

Hi champerington

I suspect that the RPT`s in the States are mainly patients who have sustained sports injury`s - i e  baseball, football, a host of other sport injuries.

Rpt`s in the UK are mainly Trauma injuries.

Keep posting

Best/JohnK/Manchester UK

 

[champerington]

Thanks for the reply JOhn.

I appreciate thats probably the case. I'm in my early 30s and was only 25 when i done my first knee. Both my RPTs were suffered whilst playing football so should i be considering the more aggressive rehab?

@ Allen - Have you a documented rehab protocol you are following?

[agold55]

Hello.
I think the rehab prescribed is on a case by case basis - depending on severity of the injury, the physical shape of the person operated on, how dedicated you are in doing rehab.

My surgeon was in Houston for 28 years working on multiple professional athletes and others too.  He then moved to Austin Texas (where I'm located) and leads the Ortho group at a newer hospital....which is 5 minutes from my house (very thankful for that).  He is also a previously ranked Triathlete...however he was very realistic about having bilateral patellar injury.  He really stressed the importance of 2 things: 1) only do what is prescribed from a hehab standpoint - don't do anything stupid that would case another trip into surgery 2) work hard and stay dedicated daily to what you can do (Which I'll outline below).

My PT is educated & certified and has 20 years experience.  My doctor didn't ok me to see her until last week.  The Dr sent the operation report to her so she could arrange the right therapy. 

As far as rehab:
(Locked inleg braces straight)
Week 1 - very light quad sets -20+ each leg, calf extensions using 6 inch wide rubber rehab band 20-30 reps each calf, started walking with braces locked 3 days after surgery - short distance - 50% weight bearing - your really only using your hips like frankenstein; not utilizing quad or knee at all. 
Patellar mobility drills

Weeks 2-4 - Same info as in week 1.  Also started standing using walker and doing 3-4 sets each - 20 reps of one legged side raises, one legged read glut slow kick backs (these were only moving side and back about 12-15 inches), standing calf raises.   

NOTE: these sets are periodically spred thoughout the day.  Also from end of week 1 through week 3 I had an in-house PT come weekly.  For the first 3+ weeks when I walked with the walker, I tied a strap around my torso & someone would hold that strap while walking with me.  After 3 weeks I felt good enough that I didn't need help.

Week 4 - Same info as mentioned above.  Saw doctor and he allowed me to see my PT for the first time.
She started by massaging the back of the knee area, took braces off while I was sitting and began moving the knees to gain some ROM.  I was easily able to go to 40 degrees on my left knee and 30 on my right.  Doctor told PT it was ok to go to 40 degrees in therapy.   I also started doing passive raises with braces on and release to 20 degrees (means hands under knee lifting the knee to 20 degrees) - did this 5-8 times a day - 50 reps each leg.  Again assisted only.

Week 5 - Same info as mentioned above.  Back to PT again....same info.  Began doing heal slides and worked on passive and active (using hamstring) working on ROM.  Doing heal slides at home with brace on and unlocked to 20 degrees 3-4 sets, 20 reps. 

Week 6 - next week...back to Doctor and PT 2 times.  The following week PT on Mon, Wed, Fri.   While doing sessions at home.

I hope this info helps.  Please let me know if you need clarfication on anything at all.

[John42]

Hi RPT Folks 

I have from time to time suggested that a valuable aid to RPT recovery is a floor cycle, so that you can sit in your favourite chair at home and pedal away.  These cost about $50 or £30 on Amazon.

I have noticed that for my fellow RPT`s` in the U.K,  LIDL are offering these at £14.99 from Thursday this week.

You would be very wise to obtain one - it did me a power of good.

Take care

JohnK/ Manchester UK

[Jase810]

Hello everyone.  This is my 2nd round of RPT, (RPT 2.0)  I ruptured my right leg about 10 years ago and ruptured my left patellar tendon in March of this year (2015).  I am now going on 12 weeks post op and doing well.  I'm at 125> ROM and working to get to 130.  I got the ok from my Dr and physical therapist to get on my bike.  Did a nice ride a few days ago.  Dr said that I should be ok to get on the trails for some mountain biking on the week of july 4th.  Really looking forward to it.

I continue to work hard in PT as well as doing exercise at home.  I dont get down on myself, just work hard and things will get better.  Takes time, but if you work hard in PT, you can get back.

Regards,
Jason