Ruptured Patellar Tendon Surgery

[TH72]

John, glad to hear you are making progress each week.  Very encouraging when each week brings incremental achievements!

I had my 5 week post op visit last week Thursday with the PT and OS.  ROM had improved from 20 to 30 in that time frame, and OS wants me to keep ROM at 30 until 7 weeks post op due to my poor tissue quality.  I am fine with that, and this past Saturday, my knee recovery took a back seat...

Saturday night I woke up with chest pain and shortness of breath.  My wife took me to ER, and they admitted me with low oxygen saturation, high pulse, low blood pressure and the above symptoms.  A CT scan show that I had a sub-massive saddle embolism in the artery from my heart to lungs, and several smaller blood clots in both lungs.  Apparently, due to having to keep my leg immobilized, my femoral vein suffered many blood clots (DVT) which broke away and traveled to my lungs.  Very scary time, but am finally home recovering.  It baffles me that after surgery, it is not standard procedure to prescribe blood thinners to prevent clots from forming.

So, a short derailment.  Even while in hospital, I was able to work on ROM and do quad sets.  After week 7 I will be allowed to push my knee past 30 towards 90 degrees, so can't wait for that. 

Learning to walk and breathe again.  Never expected this, but life does not always go how we expect it to go, as all of you on this forum have experienced.  Will continue posting and reading here, great source of info and support.

Terho

[jhs0804]

Terho -

Holy cow!  Thank God you are OK.  Did you have any warning or suspicion beforehand?

On the blood thinners, my doc told me 2 baby aspirin - 1 in the morning and 1 at night.  He took me off of those at my 6 week check up.  Not sure if they even gave you that direction.  Early on, he told me to crank on the ankle pumps.  I've seen some people say 20 per hour. 

PT in the hospital!  Love it.  Can't keep a good man down.  That's impressive.

If you ever want to talk and just get some stuff off your chest or share ideas, send me a private message.  I had an awesome talk with one of the guys on this forum that was like therapy.  Only those of us who have gone or are going through this get it.

I started to pedal the floor cycle today.  That felt awesome.  I was much better going backward than forward but I've on a mission this weekend to get that going.  Keep in mind, awesome is about a revolution each 10 seconds.  But, even the smallest bit of normal is a huge emotional lift.

Hope you get feeling much better soon.

John

[JoshD]

Hi folks - although I have been a regular reader of this forum during my recovery process, I have yet to post.  I am a 43 y/old firefighter, (previously) very physically active and fit.  I am ten weeks out from patella tendon repair of my left knee.  Recovery has been unremarkable, but my mental game is starting to lag.   I am at 125degrees ROM, and have just began light body weight exercises.  I am wanting to do much more than i can - and am cautious about any re-rupture risk.  I can sorta walk around, but with a terrible limp.  Still in my brace at all times minus sleeping - brace opened to 40degrees. 

I am wondering if there is a 'breakthrough' wherein I will feel like myself (or some version) again.  I am hoping to get back to my normal job as a firefighter at the 6 month mark...  Any experiences or pep-talks appreciated.  Thanks.   

[John42]

Hi JoshD

Welcome to the RPT thread on KneeGuru -

My goodness - 125ROM at ten weeks - that`s far too much bearing in mind that it takes about 10/14 weeks for the tendon to heal and then starts the PT.  Are you visiting a PT who understands your injury?

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

Suggest that you ask your PT " have you seen this type of injury before?

Read the undermentioned thread - give you a full insight to your injury and the rehab process.

At six months, should see you back at work with limitations, depends what activity is involved, ( but not climbing a ladder fighting fires. )

Keep reading previous posts - ASK questions and remember PATIENCE

JohnK/ Manchester UK

https://www.facebook.com/QuadricepsPatellarTendonRupture

[JoshD]

John42 -  Thanks for the response!  More injury Detail...  Although embarrassing, I was at a punk music concert (in Denver) and was helping lift another concert-goer to their feet when the whole crowd shifted into me as i was mid-lift.   Instantaneous rupture.  This was August 20, late in the evening.  Surgery occurred on August 25.  Obviously out and away from work - I am back now, though in the office and not on my fire truck.   
I have been following the prescribed week-to-week rehab protocol to the letter (the surgeon provides the protocol, the PT interprets...)  My PASSIVE ROM has been right at the top end each week, which i guess is good - i haven't had to push too much to get there.  My surgeon and my PT are both very versed with this injury, including working with folks in my occupation (and professional athletes - I got a lucky referral!).   
My injury has been described as a complete rupture of the PT below my patella and the medial and lateral retinaculum.  Also as a 'clean' rupture with a good repair.  I have no other knee injury history.
Hope this adds some insight into my current status.  Tomorrow is actually the exact 10week post op mark.   I have read in these forums that the recovery between weeks 8-12 can take on a 'stalled out' feel.  For sure, I feel like I am stalled out this last 10 days, and am hoping to get through this and on to feeling like recovery is happening again.  I am an avid rock climber and mountain biker outside of work and can't wait until those sports are back in the picture... 
Thanks again for your continued response.     

[TH72]

Hey John,

In hindsight, knowing what to look for now, I did have some symptoms of a PE.  The biggest symptom being major shortness of breath.  At the time, I thought it was my physical conditioning going downhill from not being active, and I remember telling my wife numerous times that I was shocked how out of shape I had become in such a short time.  Regarding DVT symptoms, only thing that comes to mind is one day about 3 weeks ago where my leg felt swollen and sore.  Other than that it has been fine.  I was not instructed to take aspirin or any blood thinners after surgery, and I had done ankle pumps pretty actively.  If I ever need surgery again, I will be sure to ask for blood thinners to avoid future clots.

Have been keeping up with knee exercises, and ROM is at approximately 45 degrees currently.  OS did not want me much past 30 until week 7 which is this Thursday.  I can start pushing it a little harder over the weekend.

Nice to hear that you have started cycling!  It sure is nice when "normal" starts to creep back into our lives!

I will take you up on your offer and will try to figure out how to PM you.  Right now I still have a persistent dry cough that makes it difficult to talk, but that should improve as time goes by. 

Take care and hope your recovery continues on it's course!

Terho

[JoshD]

TH72 - Hey man, I'm new to the forum as of today.  VERY scary re. your PE, and awesome that you got through it...   Often people don't.   
My surgeon has repeatedly warned me about the risks - but only 'prescribes' moving my foot around a bunch (ankle pumps, etc.).  I'm not on any blood thinners, but still in my brace.  (As stated before, I'm 10 weeks out) 
I remove my brace as often as possible, when I'm sedentary in my chair, with the hopes of equalizing my circulation.   

Good luck and safe continued healing!
JoshD

[TH72]

Josh, welcome to the forum!  Yeah, it was scary indeed.  I'm sure as a firefighter you have seen your share of people who have not survived a PE.

Shame that you had such bad luck with your injury.  Talk about a freak accident! 

In your experience, was there a certain degree of ROM that was hard to break through?  I am currently around 45-50 degrees at 7 weeks out, and have pain on the medial side of the knee above the kneecap (around where the VMO is), which seems to not budge at all.  I will keep working heel slides at least 3 times a day in the hopes of wearing through that spot!

Good luck with your recovery, and hope you break out of your slump soon!

Terho

[madvillain]

John, glad to hear you are making progress each week.  Very encouraging when each week brings incremental achievements!

I had my 5 week post op visit last week Thursday with the PT and OS.  ROM had improved from 20 to 30 in that time frame, and OS wants me to keep ROM at 30 until 7 weeks post op due to my poor tissue quality.  I am fine with that, and this past Saturday, my knee recovery took a back seat...

Saturday night I woke up with chest pain and shortness of breath.  My wife took me to ER, and they admitted me with low oxygen saturation, high pulse, low blood pressure and the above symptoms.  A CT scan show that I had a sub-massive saddle embolism in the artery from my heart to lungs, and several smaller blood clots in both lungs.  Apparently, due to having to keep my leg immobilized, my femoral vein suffered many blood clots (DVT) which broke away and traveled to my lungs.  Very scary time, but am finally home recovering.  It baffles me that after surgery, it is not standard procedure to prescribe blood thinners to prevent clots from forming.

So, a short derailment.  Even while in hospital, I was able to work on ROM and do quad sets.  After week 7 I will be allowed to push my knee past 30 towards 90 degrees, so can't wait for that. 

Learning to walk and breathe again.  Never expected this, but life does not always go how we expect it to go, as all of you on this forum have experienced.  Will continue posting and reading here, great source of info and support.

Terho

Damn that is very scary.  My surgeon had me on a daily aspirin regime for two weeks after surgery in order to prevent clots.  I honestly never even really thought it was necessary but in retrospect I'm glad he prescribed it and I was blessed to have my mother around to insist I took them.

______________

On ROM:  it's tough.   There is a massive amount of scar tissue to break up.  Try Gua Sha scraping around the kneecap and also try a rowing machine or exercise bike.  Once you get get one revolution done on the bike (even if you have to lift your but out of the seat some like I did, ha) then you can do that same motion thousands of times over the next month (I usually tried to ride 2-3 miles a few times a week at the gym) and every time you do it the knee will get a little less stiff.

Every single one of my workouts post surgery now starts with 5 minutes on the exercise bike.  It's a great, safe way to warm up the knees. 

"Butt kick" drill is another thing you can do to to help your ROM.  Basically you just try and kick yourself in the butt with your heel.  You probably won't get there until around week 12-16 but you can safely work on it all the while.

In general I like to try and train 4-5 days a week and just give myself 2-3 days at most off and never two in a row unless I really have swelling in the knees, which still happens from time to time after a really good workout. 

I've found that after 2 days with no real activity other than walking my knees get quite tight.  I've also found that the knees do respond well to rest, that is, even if they are stiff after 2 days off, that the exercise session post rest will be strong and go well.

There's def not linear progress coming back from this injury.  There were  days at 8 months where I felt better than at 10 months.   That said, there are now days at 11 months where I have never felt better.  I just like the new "high water" marks and try and just ignore the inevitable bad days or even weeks that do occur from time to time.

[Stuart Rulka]

Terho, first of all, it's good to have you still with us. I was warned aboutDVT but not prescribed anything, just concentrated on motion.
  For once I find myself somewhat at odds with madvillain, somewhat strangely as I had probably the most aggressive rehab on the board. My PT put me on the bike at two weeks to see what I could do. A week later I achieved a full revolution and three weeks after that was hiking, uphill only!
 Don't really care for the idea of butt kicks though; any kicking motion has a degree of explosiveness to it, and I think at this stage any motion should be slower and more deliberate. Aside from that, go for it. I am a big believer in listening to your PT rather than your Surgeon. The former wants to get you back in action as soon as possible and the latter, with all due respect, wants his surgery to be a success!

Good luck, you have a lot of silent supporters out here cheering you on.

[jhs0804]

Hi Everyone -

First, Terho, I sent you a private message with my phone number.  Look forward to catching up!

Secondly, for the veterans, I am stuck at around 87 degrees ROM. I am 8 weeks today.  Great progress over the last couple weeks but, again, stuck.  I am doing the floor cycle and heal slides.  Lots of icing.  There is still some swelling which I get is going to be there for a while and may be impeding progress but not sure.  I'm using the gua sha tool as suggested to try to break things up but there seems to be some persistent fluid on the knee - particularly below the repair and wrapping part way around the back of the knee on the lower side.

I'm wondering if introducing heat is an idea to loosen things up.  Couldn't find anything definitive so hoping someone can weigh in on this.

Another development is I am going to switch PT companies.  Early on, I thought these guys were OK.  But, as I've progressed and learned, the fact is that the current group has not seen this repair and instead of listening to what I've learned and studying themselves, I get the "I have a doctorate" speech.  I reminded them that I have this on my mind 24/7 and have been really educated by you guys. Of course, I'm told that I'm "spending too much time on the discussion boards." 

An example of incorrect PT technique is I have one guy wants to grab under the knee while I'm laying flat and then starts yanking it up for ROM.  We had a little semi-heated discussion on Monday during which I politely and then not so politely told him we were not going to do it his way.  My opinion is this has to be gradual and intentional and you push to discomfort slowly.  Sudden movements aren't the ticket.

To sum it up, I feel like I'm bringing the information to the table based on what I've learned here when my expectation is to have them to tell me exactly what to expect from an expert point of view.  The other thing is that I'm with the therapist for about 15 - 20 minutes and then passed off to the "techs" which are bachelor degreed PT's.  It's been frustrating and I hit the wall today.

So, I called my OS and he is going to hook me up with someone else tomorrow.  I guess the learning here is what has been said before - question your PT group and make absolutely sure they know what the heck they are doing and have direct experience on this repair.  We get one shot at getting this right.

A bit of a rant but hopefully helpful if you're in a similar situation.

John

[TH72]

Everyone, thanks for the continued support!  It means a lot!

madvillain, I have a Gua Sha scraper, and have used it a handful of times early on.  Did not seem to do a whole lot.  Could be due to my technique, or perhaps the large amount of swelling that I had early on.  Will have to revisit this.

Stuart, I also think sudden, quick motions may be a little drastic, at least this early in the game.  I am however looking forward to that full revolution on a floor cycle or exercise bike!  That and rowing have been my two favourite cardios in the gym.

John, I got your message, thanks!  Will try calling you tomorrow evening to chat.  Too bad about your current PT not working out.  Based on the information you shared, it sounds like you are doing the right thing.  I am sure you will move on and progress; you're attitude is good and your reasoning is solid.  Talk to you soon.

Terho

[John42]

Hi John

Interesting comments - as I have mentioned many times - ask your PT " have you seen this injury before?"

Keep asking

JohnK/ Manchester UK

[JC55]

Wow, lots of activity on the board. Regarding PE, I was not prescribed aspirin just told to do calf pumps all the time. May have something to do with surgery site needing to heal without all the excess fluid that would probably accompany taking aspirin. Regarding plateaus, they happen along the way. I would take a couple days off to allow my body to rest then continue on with PT. it seemed to work for me...I happen to think body rest is underrated.  Try not to compare yourself with any one in particular (especially if they have a different injury or one that caused less damage) but rather the average of the group keeping in mind that you will be above average in some areas and maybe below the average in others. Not all RPTs are the same.  For instance, my injury had substantial damage to the medial and lateral retinaculum...my OS decided not to use wire...my reattachment site was mid-tendon...etc. To summarize: you will get there, have faith and don't despair! Work through the pain little by little everyday. Do your at home PT and listen to YOUR body.  Recovery comes exponentially once you start returning to your everyday life.  For me, it started around week 12 once ROM was getting more fluid and then later on when my strength came back.  All of this resulted in my knee getting back in balance and soon after that I hardly thought about my knee. Good luck to you all...I wish you some peace of mind.

[jhs0804]

Hi Everyone -

Some tough days and a great day!

First, I started some new exercises on Monday at PT and wound up tweaking my back.  Best I can tell it was the L5 and after 3 chiropractic adjustments and PT digging in to release some things in my back, I'm on the mend.  I read that there would be times of discouragement and setback and this was definitely one of those times.  I kept my head up and kept my eye on the prize but this was probably the closest to inventing a few new words I've been in the 9 weeks since surgery.

My patience was rewarded today when I got another therapist by chance.  By the way, I stayed with the same place but asked to work with a specific therapist.  She was out today and her replacement was phenomenal. 

One HUGE thing to note.  There is a muscle just above the patella whose name escapes me (Vastus Lateralis?) that was really bound up and she dug in and released it which immediately added 10 degrees of ROM.  I knew something was holding things up and that was it.  My symptoms were that the patella was really tight when trying to increase my ROM and really hard to progress through.  Of course, major caution that it may not be your issue but it is certainly a question to ask your therapist if you are stuck.  She had a couple other techniques which involved opening the knee joint by pulling the lower leg down and then into the ROM motion.  The combination of things really helped.

So, we got to 104 degrees of ROM today - 9 weeks and 1 day after surgery.  I am super pleased with that victory.  Then, to top it off, we walked with my brace unlocked to 30 degrees and I was able to fairly well normalize my gate which was another victory so a 2 star day.

Things added to PT are now they are putting me on a stationary bike to gently rock backwards and forwards to continue to get more ROM.  I haven't made a full revolution but definitely seeing progress.  The other thing is they are putting me on a Total Gym to do leg presses.  It's just body weight and the other leg is there for stability but it just feels good to start to return to anything resembling normal.  I came home after PT and have been walking in circles in the family room!

So, a step back and 2 steps forward.  Amazing how the attitude can change in a one hour PT session.

Hope everyone is doing well.

John