Ruptured Patellar Tendon Surgery

[lamoncarter713]

had my 6 week appt with my OS, he did some manipulations of my knee and he said it feels like its almost healed and little scared tissue. I still have some stiffness but hopefully with rehab that will go away. They have unlocked my brace to 45 degrees and my doctor gave me the green light to start driving again. I was like a kid in the candy store when he said that. So I go back in 6 weeks and by then I should be losing these hideous crutches. The end is near, June 10th seems so long ago to me now.

[Andy___H]

Blast from the past, I'm back 11 years since surgery! I was one of the original posters in this thread all that time ago, happy it's still going, albeit meaning we've had some more RPT's, but the support for everyone is never ending 

For the newbies looking for a "fairly" quick end-to-end story to read, check out all my posts. I haven't posted here for quite some time, but if you go back and check from the first post of mine, you'll see the timescales involved in my recovery.

http://www.kneeguru.co.uk/KNEEtalk/index.php?action=profile;area=showposts;u=4957

Only thing to stress is it is "my" recovery, everyone's knee is different. However my story is pretty much a regular recovery of what's happened on these boards, especially for the UK on the National Health Service where they do seem to be a little more cautious than elsewhere. Overall, not too fast, not too slow, and I ended up with full recovery.

Stick to the basic rules of regular PT, regular "exercise" away from PT, stick with it, don't rush it, and listen to your knee.

I'm off for heart surgery on Mon 27th Jul, proper open heart stuff, and it made me think of this forum of where I got help and support over the recovery. Hopefully I'll get the same off the heart forum I'm on also 

Cheers,

Andy

[hersh12]

Hey everybody--I've been lurking here for about a year and decided it's time to reach out in hopes someone else is having the same experience as I. I've read many of your stories and they have all been fascinating and encouraging.  It's nice to find a place where people know the pain of hearing "oh my buddy did that, he walked out of surgery for his ACL...what's wrong with you??"

First, some background:

When I was 15 I ruptured my right patellar ligament playing basketball, either landing or jumping (can't remember) and it was the worst thing that had ever happened to me in my young naive life.  I never rehabbed hard, though was playing basketball again (albeit terribly) less than a year later.  I had issues with the knee buckling and muscles being weak for years due to the lack of focused rehab, though many years later I began lifting more seriously (finally realized that squats were indeed good for the knee, when done correctly) and my knee got back to just about full functionality.  However, I would literally have nightmares about the same happening to the left knee.

Fast forward 15 more years (and a year ago from this writing), my nightmare became a reality.  The real bummer is that shortly after I received word that I would be receiving a promotion which was contingent on a PT test that involved a sprint and 1.5 mile run.  I was devastated and the past year has definitely been the roughest of my life.  Despite a singular focus on rehab and getting back to where I was, I still am not close to 100%.  My mindset was that once I got the muscle back from atrophying that I would be back in the game.  However, the muscle is back and the functionality of the joint simply is not there.

I recently visited another doctor for a checkup (not thrilled with the operating doc, though he did a good job, he did not show a lot of interest in my goals for rehab) and he reported that while there was nothing structurally wrong, there was a lot of scar tissue and the patellar ligament itself was longer than normal due to the surgery.  This seems to explain the frequent buckling I experience and inability to really control the joint from -5 to 10 degrees of flexion.  Essentially, once the quad pulls as hard and far as it can on the patellar, there is still "slack" due to the elongation and I cannot fully raise my leg or straighten it past ~10 degrees to 0.

I went through the assigned PT regiment and the therapist had nothing spectacular to say and was happy when I returned to a normal enough walking gait. The second doctor's advice was patience and basically to be happy I can walk (with a limp) and run somewhat successfully.  I know that I am lucky to have use of the knee, though my career situation is still on hold due to my inability to get back to form and it's driving me nuts.

Has anyone experienced this "elongated" ligament post surgery? Or perhaps other reasons for the buckling? There is also pain and aching, though I can work through that and the doctors seem to think that's normal.  The catching, popping, and clicking is all due to the scar tissue inside and isn't anything remarkable. With time that will apparently work itself out...

"Mechanical disadvantage" is the term doc #2 told me I am dealing with, and it is infuriating to think that I simply have to let this dictate my abilities and can't do anything about it.  If anyone has any advice or experience, even if it is indeed to simply let nature take it's course, I would be very appreciative to hear.

Thanks, Hersh

[bryce73]

Hello hersh12,
From what I read, Drs would check the patella position when operating to set the right PT length... I'd say maybe try to see one or two knee specialist (even if you have to wait a few months to have an appointment) to confirm the first diagnosis and see if something can be done?
Good luck

[fishy]

Fishy here, and its 26 months since my surgery to repair RPT....I am a double (if I was only as lucky playing the lottery).  At 66 years old when I injured myself, I was fortunate that I was in relatively good health when I injured...  the bad news for me... well, I had to give up running.  The good news I now walk "normally" and I go up and down stairs without much concern.  My range of motion is normal, and the cottage cheese that was both my quads is less "large curd" and more "small".  A good attitude goes a long way during your recovery...don't expect a quick recovery, and ask a million questions.  This injury is a life time event so keep at it.... you will be amazed with what you can achieve.  Bob

[John42]

Hi Bob

Delighted to read your recent post - 26 months is a long time, but you have been rewarded with a renewed life nearly back to normal.   

However, keep an eye on the knees and take care.

Best

JohnK/ Manchester UK

[bballkingofnba]

bryce73,

from what my surgeon said is that all healed tendons heal a litle longer because the scar tissue has to stretch more than the normal tissues in our knee to obtain the same range of motion. That said, the goal of the surgeon is to minimize this elongation as much as possible by tensioning the tendon. They also leave a little slack because if they tension it too tight, the tendon can become shorter which is a lot worse than being a little longer. However, from what you are describing you tendon seems to have elongated a lot since you knee buckles. My repaired kneecap is slightly higher than my other one, but my knee doesnt buckle. Quad strength also goes a long way in bringing stability. Also, do you remember how long you were immobilised after surgery?

[hersh12]

bball--I think you meant me??- At about the 5 week mark I started trying to bend it.  I was a little slow on the mobility, but I eventually got to just about 100%.  I can squat deep now, though it does feel a bit tight at the bottom.  I also had to wait 9 days for surgery, whereas with my right one 15 years ago I was in the OR within 24 hours.  I'll copy and paste the notes I kept in a running doc file throughout my recovery:

July 6, snap
July 15, operation
July 25, post op, out of split into brace, shower and finally leave house

5 weeks -
August 22, follow up, bending starts, open brace to 20 degrees, no more crutches
August 26, 30 degrees

6 weeks
August 28, 40 degrees, first day of PT, first leg raise after
August 30, 50 degrees

7 weeks
September 10, 70 degrees

8 weeks
September 15, ready to walk without brace
September 16, 94 degrees

9 weeks
September 23, 104 degrees, learned to walk with minimal limp

10 weeks
September 30, 117

11 weeks
October 7,124 degrees

12 weeks
October 14, 136 degree

13 weeks
October 21, 141, last apt with doctor

17 weeks
November 20, first "sprint"

Since then I have focused on running a lot, which it seems was not the best course of action.  Recommendations from Dr and PT were, "sure, if you can do it, go ahead."  I'm still trying to walk in a way where I'm not throwing my leg forward and stacking the bones to create a stable leg, but when I try to activate the whole joint properly and take a step forward there is a lack of control.

[bryce73]

bryce73,

from what my surgeon said is that all healed tendons heal a litle longer because the scar tissue has to stretch more than the normal tissues in our knee to obtain the same range of motion. That said, the goal of the surgeon is to minimize this elongation as much as possible by tensioning the tendon. They also leave a little slack because if they tension it too tight, the tendon can become shorter which is a lot worse than being a little longer. However, from what you are describing you tendon seems to have elongated a lot since you knee buckles. My repaired kneecap is slightly higher than my other one, but my knee doesnt buckle. Quad strength also goes a long way in bringing stability. Also, do you remember how long you were immobilised after surgery?

Hello bballkingofnba,
I believed the scar tissue would be less elastic than the uninjuried tissue, somewhat like a scar within the surrounding skin feels more stiff.

[x7erra]

Hi everyone,

I've been lurking for a few months and have found this forum really helpful. I'm 33 years of age and ruptured my patellar tendon 10 months ago jumping during basketball. It was the most painful thing I've ever experienced. I workout regularly and have full ROM. I'm not back to playing basketball yet but I've regained my speed running and some of my vertical. However, I still have issues going down stairs or inclines. Is this normal and do you guys have any suggestions to help?

Thank you

[darrellb85]

Hi all, just wanted to check in and give a status update. I'm about 5.5 months post op from a complete tear in my right knee from basketball (last game of the darn regular season in my city league), and I've been cleared from PT this week. I've regained basically full ROM back, in comparison to my good knee, which I am ecstatic about. Strength is coming along, doctor still doesn't want me running or jumping until the 6 month mark, which I'm ok with. I have started jogging lightly on the treadmill, along with more advanced plyo moves.

x7erra, I'd say it sounds like you need to just focus on gaining back more of your quad and vmo strength, as it sounds like they're not contracting and stabilizing your leg while you bend, making it difficulty to stabilize yourself while you walk downhill and straighten your leg out? My strength has made leaps and bounds since injury and I found I'm able to get down stairs and downhill just fine, where it was trickier when that quad strength wasn't there yet...

Hope everyone is on the mends and keeping focused with your recovery!

Darrell

[bryce73]

Hi, hope anyone's doing well with their rehab

Just wanted also to add a little news as I saw for the last time my OS yesterday, at 3 months post op. Things are getting to take some good issue now.  I have almost completely regained full ROM (heel can touch butt when warmed up), and no problem with full extension, which I'm very glad of! Again, I really feel all the swimming/stretching sessions and the PT work helped a lot with it. (my Ptist worked a lot on the flexion)

On the down side, I still feel a jolt effect when my patella moves without effort which can be a bit unpleasant at times, but this is really a minor issue and hopefully it doesn't happen when I walk or bicycle. According to my OS, this is due to the oedema and may still last up to six months. The quad is also still quite weak (knee sometimes feels unstable), so I feel it's now time I move to more difficult and specific exercises in a gym to regain strength and rebuild muscular tissue, and also work on the tendon resistance, for which my Ptist advised me to do some excentric work.

@bballkingofnba : my OS told me that the tendon tissue is indeed more stiff where it has been injuried as it has lost its elastic properties, and the scar tissue will continue remodelling up to two years while not recovering entirely its initial properties. There might still be a rerupture risk on hard shock in the future, so one should be careful. Still, he wasn't very worried about MTB falls which for the most part preoccupies me.

@x7serra: As Darrell I suspect your quad might still be weak so that it's difficult to control the excentric motion of the leg when going down (actually this is what I feel when I go hiking, still having more difficulties on the descent part, beside the fact the injuried knee's still not as flexible as the uninjuried one)

[lamoncarter713]

*********Update************

Well I am at 8 weeks post op on my right knee ruptured patella tendon. Things are going great, I am getting around almost normal, sometimes I am reminded of I had surgery and I am not totally healed. I am walking everyday with my brace, but when I am at home I walk around the house without it. I am riding the exercise bike, getting the pool, but no strength training yet.

[madvillain]

I'm at 8 months now from the dual RPTs.   I can sprint close to 100% now but cutting is still a work in progress I've been in the gym constantly working on it and it gets better and better but still the power isn't really there.

Did my first real weighted squats yesterday at the gym 95lbs, halol.  For someone that used to load up the bar with a couple big plates on each side and go from there it's certainly humbling to see but also exciting as the ROM under load has increased and the pain and stiffness to get to 90 degrees on the squat has dissipated.

I also do a lot of negative work (research seems to indicate it's the best for healing tendons) and plyometrics.  Can jump on the 24" box now hoping to get up to the 36" one in another month or so.

I also do the "ski mogul" drill on the 12" box hopping like a skier over the moguls back and forth back and forth.  That one is a tough one and requires all my focus not to trip over the box.

But hell a couple months ago I couldn't even get on the box so progress is progress.

Ironically, I'm now slowed as much by mild tightness in my right calf (have a history of strains in it) as much as my knees.  Last thing I want to to is blow out my calf again and not be able to continue working in the gym, trail, court, etc.

My vertical is like 12 f***ing inches.   Oh well, probably won't ever play much basketball again.

Yesterday I ran a mile in 7:30, 8 months and 4 days from the ruptures.  Pretty excited about that as the strength needed to keep that pace just wasn't there previously for me.

There's so much rehab to do in this injury it really never ends but it seems like everyone is doing well.   That's very exciting as perhaps in the future this injury won't be seen as devastating as modern medicine and rehab improves outcomes.

[madvillain]

*********Update************

Well I am at 8 weeks post op on my right knee ruptured patella tendon. Things are going great, I am getting around almost normal, sometimes I am reminded of I had surgery and I am not totally healed. I am walking everyday with my brace, but when I am at home I walk around the house without it. I am riding the exercise bike, getting the pool, but no strength training yet.

Ah, the wonderful 8 week "I've worked really hard" mark!  Driving again, walking around the house without a brace, having eureka moments about previously natural movement (going up stairs!) and in general enjoying pain free movement.  Those are great days and congrats on the journey so far, excellent progress.

Not to be a downer but just know that (and John was there talking me down a few months ago) that you will probably plateau for the next month or so.  You'll make great progress and don't get me wrong keep busting ass in all your pt and rehab but for most people weeks 8-12 are sorta slow.

One thing that starts to happen (my surgeon scolded me on this well) is that the nerves are coming back, and you'll be feeling more sensation, and I don't say pain because "sensation" is more the word:  things just might feel a little "off" when you plant really hard or step off a curb.

Remember what even the most progressive  sports doc will tell you: 6 months to heal that repair, then you really test it.

But heck yea!  You are doing great.  If you read through the archive of this thread to be doing what you are doing at week 8 (and for that matter what many, including myself, are doing at all stages) it is truly a blessing of modern science and smartly applied hard work.

Very happy reading this thread lately just makes me want to work harder on my own recovery so many great rehabs at the moment.

And if you are struggling just know we have been there.  I had so many moments where I thought I'd never walk again.  It does get better just keep pushing everyone and let people help you!