Ruptured Patellar Tendon Surgery

[jhs0804]

Hi Everyone -

A quick update on the week's activities.

I am 4 1/2 weeks post op.  Reminder - rupture below the knee.

Here's the current PT protocol.

Knee massage to remove fluid.  Swelling is coming down by the way.
30 ankle pumps
30 glute squeezes
30 calf raises
30 leg straight leg kick backs, out to the side and across the front
5 mins of ROM to max point of comfort
Weight transfers - 4 mins side to side and front to back (each)
Side steps back and forth along PT table - 3 mins
One leg balance on square foam block - 3 sets of 30 seconds
Side to side and front to back on balance board - 3 sets of 30 seconds each way

New in the last week
On back
Heel slides - 3 sets of 5 using exercise band
Leg Lift - 3 sets of 5 using exercise band.  I bend opposite leg to about 90 degrees and then lift injured leg parallel with opposite thigh.

On stomach
Opposite leg lifts

Also, took my first extended walk without the single crutch (about 30 yards total) with my PT right by me of course. 

ROM hit 70 degrees assisted and about 65 during the heel slides!  I need to be at 90 by a week from this coming Wednesday which will be 6 weeks post op.  I won't do anything stupid to get there but I really want to make it happen.

My work let me use one of our sitting chairs (not desk chair) and they bought me an ottoman which is just above the chair so slight elevation.  Conducted 2 client meetings with no pain and actually worked about 6 or 7 hours one day.  So, that's a huge improvement.

The shower is getting better - I'm just about self sufficient (interpreted as confident!) but do have help watching over me for an hour each day to make sure I'm safe.

Getting up and down stairs sideways and slowly but I can get to the car, laundry, etc.

Still battling anxiety particularly walking any prolonged distance.  I get a little light headed or just plain scared so have just learned to confess to my co-workers who have been extremely gracious in helping me through those moments.

We all get the questions of how it happened, etc.  I'm having fun with it and have added a new story that this was a result of a hard landing while I was wing suiting.  Clearly I have too much time on my hands to watch stuff on youtube but it's producing great material!  And, as expected, the consistent response it "no, seriously, what happened?"

Biggest thing in all of this is that few people get what this is.  Hard for them to understand how long this process is and how big this injury is. 

Best advice I can give that has helped me through this is to spend zero time lamenting what happened and be thankful for what didn't happen and have a positive attitude.  In my case, I was carrying tools, could have landed on them, could have hurt both legs (props to the guys who have this by the way), could have hurt my back, etc.

I definitely have some down moments but staying there isn't helping anything so I try to recover quickly.

I hope everyone is doing well and making good progress at YOUR pace!

[John42]

Hi jhs0804

Interesting update, however 90 ROM at six weeks post op is pushing it - just take care - listen to your knee - the tendon has not healed.

Keep posting

JohnK/ Manchester UK

[jhs0804]

Thanks, John42

Your counsel is on my mind at each PT session.  So, as you said, if the knee doesn't want to go further, I'll slow it down.  I've not had any pain at all during PT, just tightness which we very patiently let relax before going another degree. 

Not sure if I've shared this yet, but as I read through the posts I see different types of repair.  What I understand about mine is that the OS drilled holes in the patella, sutured the torn patellar tendon and also had to repair some tears to the muscle on either side.  Kind of a grid.  I'm told the sutures will remain for the rest of my life.  So, not sure if that makes a difference.

As I read through the protocols, they seem to agree with the 90 degrees by week 6 so I am balancing that with your counsel as you've been there.  I am attaching two I've found that seem to agree.  But, again, I'd appreciate hearing more detail about your concern.  A wise man has many counselors!

I have not done any quadricep setting as the OS did not approve that yet so I'm waiting until the follow up appointment to discuss.  That seems to conflict with these as well so it's confusing sometimes how different protocols are which I mentioned in an earlier post.

On a separate subject, I am reading about the importance of aligning the collagen fibers and supplements people are taking to help with that and promoting healing of the tendon in general.  Can you give me some suggestions?  I see Cissus on several posts.  Is there anything else?

Thank you for sticking close to all of us.

[JC55]

Hey guys,
Looking back on my recovery I was at 60 degrees week 6 and released to 90 degrees at beginning of week 7.  ROM came rapidly after that but I didn't push it. Lots of massaging knee, quad sets, electro-stim and heel slides.  Good luck to all.

[buckwild]

Just a quick update at week 6 post op

Had my first adjustment of the brace to 30 degrees. Knee feels really tight and I've only been able to bend it to 10-15 degs. Any tips on how to loosen it more or do I just play the waiting game and keep bending it daily?!?

Cheers
Col

[jhs0804]

Good Morning...

JC55 - Can you add more detail on what you did for the quad sets and stim?  I have stim 3 times a week at PT for 15 mins.  2 pads above the knee and 2 below.  Were you doing something at home in addition?  As mentioned, I haven't been cleared for quad sets yet so wondering how you did those and kept the pressure off of the repair.

Col - Couple of questions
1 - Are you working with a physical therapist?
2 - Are they/you moving the patella at all? 
3 - What did the OS say about the ROM?

Hope everyone has a great week.

[buckwild]

Hi jhs0804

I'm not working with a PT just yet.

I'm in Australia and am going through their public health system. This means going to the hospital every 2 weeks and being seen by a registrar (who is just an OS in training), which subsequently means no specialised care. I'm not paying for any of this so I really can't complain!

My treatment protocol at the moment is:

Weeks 1- 6: 0 deg in ROM brace (Full weight bearing as tolerated)
Weeks 6- 8: 0-30 deg ROM
Weeks 8-10: 0-60 deg ROM
Weeks 10 -12: 0-90 deg ROM
Week 12+: Brace is removed, and PT sessions commence which will also be done at the hospital.

The knee is still feeling tight today but I have managed to bend it at 30 deg, though I have to straighten it again every 10mins or so.

Cheers
Col

[JC55]

JHS maybe we are having semantics issue.  Quad sets is where your leg is flat and all you are doing is tightening quad to force knee down against surface. My PT said there is no strain on your patella tendon.  What you should NOT be doing are short arc quads where your knee is bent over a towel and you try to raise your foot off the surface. This does put pressure on the patella tendon.  I do know others on this board did quad sets early like me and I believe it represented all types of repairs, with and without wires. PLEASE follow your PT, but ask her about it.  My PT sent me home with an electro-stim machine so I used it two-three times a day in addition to doing patella massages, quad sets, calf pumps, and heel slides.  As I progressed we added in leg raises, cycling, etc.  Feel free to message me if you need more specifics. Good luck.

[TH72]

Hi all,

had my first PT session at 4 weeks post-op.  Knee feels really tight, especially on the lateral side.  Two exercises that I am cleared for are heel slides to 30 degrees and quad sets.  ROM on good leg is at 150, and the injured leg (left) got to 20 degrees.  I asked my PT about quad sets, and she confirmed that it does not put pressure on the tendon (per the post by JC55).  I asked my PT about the differences in protocol from person to person, and she thinks a lot comes down to where the OS was educated and the protocol that they learned there.  My OS's  approach seems middle of the road in terms of aggressiveness, and is definitely somewhat conservative compared to some others that I have seen on this board.  Just interesting to note that.

Per John42's suggestion, I did ask her if they have treated RPT patients in the past.  Apparently they are quite rare.  For the past two years they didn't have any, and they currently have 3.

These next six days I will be performing heel slides and quad sets at home, and will see the PT and OS next Thursday for followup.  I also have the floor cycle for upper body cardio workouts, which has been nice.

I am currently in a Zimmer splint which puts a lot of pressure on my patella from above as it slides down.  It seems like others have hinged braces, which I imagine have more space around the patella. Question for  fellow members:  What brand/model of hinged brace do you use, and are you happy with it?  I would really like to purchase one as my ROM comes back, as I don't currently fit in the front seat of my vehicle.  I will bring this up with my OS next week as well, and will obviously wait for clearance from him before driving.

I am very excited about having started PT now.  It sure beats sitting around and doing nothing, even though I understand the necessity of immobilizing the repair to let it heal. 

To the others on the road to recovery, I hope things are going well!

[jhs0804]

Hi TH72

Great news on the PT!  Glad things are underway.

The quad thing has been perplexing - lots of differing views but more power to you if you're cleared to go!  I'll find out Wednesday if I'm cleared to start quad work - my 6 week post op check in.

On the brace, I have a Donjoy T-ROM.  I've been happy with it once I figured out how to properly strap it.

There are several versions online so check with a specialist so you get the right fit.  I am uploading pictures of mine just for reference.  I like the sleeves that wrap the upper and lower leg - adds stability.

I've been doing the heel slides for probably a week to week and a half.  Make sure you have something under your ankle that allows it to slide easily.  I was cleared yesterday by PT to do the slides in a chair versus on a PT table or my bed.  They recommended one of those coasters you put under the furniture when you're moving it.  They had one at PT and it worked great.

Sounds like you are in good spirits and that is great to hear.  Have a great Saturday.  Big game here in Michigan today!  We'll see the true test of where the Wolverines are.  Great to have 2 ranked teams in the state.

Best,  John

[TH72]

Hey John, thanks for posting the pics.  I will ask my PT and OS this thursday about adjustable braces.

Heel slides are not very pleasant!  I hit about 30-35 degrees on Sunday.  There is a lot of tightness on the lateral side of the knee, otherwise it feels good.  This is most likely scar tissue, but will ask the OS about it this week to make sure.

Tough ending to Saturday's game for Michigan!

Terho

[madvillain]

Hey John, thanks for posting the pics.  I will ask my PT and OS this thursday about adjustable braces.

Heel slides are not very pleasant!  I hit about 30-35 degrees on Sunday.  There is a lot of tightness on the lateral side of the knee, otherwise it feels good.  This is most likely scar tissue, but will ask the OS about it this week to make sure.

Tough ending to Saturday's game for Michigan!

Terho

It sucked.   Ha, I've been trying to do a media blackout.  Never figured I'd see a UM post on KneeGura RPT thread but then again world's largest alumni group and all that! 

Ok, on to RPT rehab.

I'm at 10.5 months now from the dual RPT.  Time does fly.  I remember my doc saying "6 months no restrictions, 9 months you'll feel good enough for sports and 12 months you should start to feel "normal" again. 

Well, his timeline has pretty much been correct.  My right knee feels pretty much normal.  My left one has some tracking issues from time to time and occasionally aches at night after a tough workout but no real setbacks at all. 

Some of you are wondering what the best PT stuff do do in weeks 1-8 is and I thought I'd lay it out once again even though I've posted it before it's buried pages back on this thread:

Week 1: try and get on your feet any way possible for small stretches.  Try and walk to the bathroom for example using your crutches and/or walker.  I did a lot of practicing just with the walker the first week.  I had duals so if you have single you'll probably just have a crutch so no excuses!  It's important during this phase to try and arrest the muscle atrophy.  It will come no matter what you you do but the more you can prevent the better.

That leads me into: quad iso sets ("dancing kneecaps" although at week 1-4 they ain't gonna be dancing too much!) and situps.  My routine was usually iso set, 50 situps, iso set 50 situps, iso set 50 situps.  I would do that 2-4 times a day.

Weeks 2-6: HEEL SLIDES.  Maybe the single most important thing you can do for ROM.  Keep your toes "pointed" towards your nose so you activate the quad.  Continue to shuffle around (safely of course) as much as possible and continue iso sets and core (situps) work.

Weeks 6-8: ooh, starting to make some real progress on ROM aren't we?  Time to try the bike/rowing maching.  Rowing machine was critical for me at this stage as it allowed me to safely work the ROM.  Around week 6 I was able to do a full revolution on the bike with only a little pain so I started that.  That was a huge milestone as well.  Also was walking in the braces as much as possible on the treadmill at 5% incline or so just trying to keep that muscle strong.

The most important thing is to BE SAFE.  You will not have much feeling in your knees until around 6 months.  Lack of pain is not necessary lack of injury or a sign of complete healing.  It's more a sign of you have no nerves right now around the injury.   Wise words from my surgeon and John always emphasizes safety first, as he should.

Avoid situations where you are around crowds and/or pets and kids.  It stinks but you have to really avoid situations where you might get bumped.  Your balance and quickness isn't there so if you get hit you might crumple and be back at square one on the operating table.

Don't let that happen.

At week 8 you'll probably meet with your surgeon and maybe he'll clear you to remove the big braces if you have made enough progress.  That was always a goal of mine and I met it actually at week 6.

Work works. 

_____________

Small update for me:

10.5 months now.  Right knee pretty much feels 100% normal.  Left knee has some issues with kneecap alignment (patella tracking) from time to time (the dreaded "creaking") but heck I had that before the ruptures anyways.  Left knee occasionally aches after a hard workout or hike or tennis session but nothing above a 2-3 on the pain scale.  Nothing an ice wrap won't cure.

I do cold plunges after working out whenever I can that really seems to help with inflammation.   I'm still at like 18-20% body fat which is just too much.  I dropped about 40 lbs since the injuries working on dropping another 20.  Being overweight is not good for the knees, but you knew that.

As always, good luck everyone and work works.  Have faith in the process and let yourself enjoy the help and company of those around you.

[TH72]

madvillain, big thanks for the very informative post!

I am currently 5 weeks post-op, and am finally able to somewhat consistently make my kneecap "dance".  The previous two weeks it was next to impossible.  I have thought about doing sit-ups but have not, reason being that I am worried about it putting strain on the repair.  Will make a careful attempt at sit-ups later today.

Thanks for the tip about pointing toes up during heel slides.  I have been doing the exact opposite, lol!  Will definitely modify my technique on this.

Sounds like your rehab has been going well!  Keep it going; hopefully you have a "full" recovery ahead of you.  For those of us in the beginning stages, it is very beneficial and uplifting when the "veterans" chime in with their experiences and tips.  Much appreciated!

Terho

[jhs0804]

Hi Everyone -

6 week post op check in with this OS.  Great news!  Repair is solid and he wants me to start to kick it in gear.

I was 72 degrees ROM this morning at PT which is my highest yet but a little short of the 90 degrees we were looking for.  He's prescribing a flexinator for my PT sessions.

Big miss on my part was not firing the quad sooner.  He thought I was already down that road.  Having said that, I have been doing assisted leg lifts so was doing some quad work but he wants me now to start the floor cycle carefully and even do some light leg presses (like 5 pounds) and get the ROM as far as I can in the next 6 weeks.  He also endorses the Kneehab unit I've mentioned in previous posts so I just finished two 20 minute sessions on that.He also opened the brace full but only for exercises, heel slides, etc.  When walking he wants it locked.  Important thing is that I've got to hit the 12 weeks with a strong quad to jettison the brace so I am motivated.

We tested the ability to lift the leg with the tendon and it worked!  So, that's a huge relief and one of those near tears moments.  Other one was a full on tears moment when I walked with one crutch about 3 - 4 weeks ago.  It's funny, sometimes you don't know how much this is wearing on you until those unexpected moments happen and you start to see a glimpse of returning to the "normal" you once knew.

So, in good spirits and ready to keep progressing.  John42 - I know, I know....carefully!!!

Hope you all are doing well.

John

[jhs0804]

Good Morning, Everyone -

7 weeks post op.

At PT yesterday, achieve 84 degrees ROM!  So, getting better!

PT is more aggressive now but not overly so.  It's exciting to see progress.

Haven't started the leg presses yet, but I'm hoping that happens tomorrow.

Also started doing my Kneehab unit for quad stim.  This is in addition to what they call "Russian Stim" at PT.  The quad is coming back to life.  No longer looking at a thigh that looks like mashed potatoes!  Well, kind of.  It's still pretty atrophied, but starting to see visible signs of muscle returning.

Starting to use the floor cycle as well though haven't been able to complete a rotation due to ROM, but gently working it back and forth.  I'm hoping to get over the hump this weekend.

Hope everyone is doing well.