Ruptured Patellar Tendon Surgery

[madvillain]

John, Alec and others; thanks for the responses.

Small update.  Last week Thursday I saw my PT and my new OS.   At PT, ROM hit 75 (10 weeks), which is a 20° improvement over 2 weeks.  Happy with that if it continues.

New OS asked me to perform a straight leg lift with brace off, which I could do with some pain.  She cleared me with instructions for PT to wean me from the Zimmer splint, and no restrictions as to PT protocol.  I guess anything goes going forward.

Question about straight leg lifts:  I can do them, but I have a sharp pain just under the skin where patellar tendon joins patella (site of my repair).  I have also noticed that the skin is "flat" in that area, and seems to be stuck to the tissue underneath.  It does not move freely along with the rest of the skin over the knee.  Is this cause for concern?  Is the repair causing pain, or is it more superficial?  Anybody else experience this, specifically pain during a straight leg lift in full extension, without a brace?

John, happy to hear that things are progressing well with you!  Walking without the brace on must have been phenomenal. 

Safe healing to all.

Terho

I'd back off some until the pain goes from sharp (6-8 on the scale) down to 2-4.  Sharp pain is a sign to back off usually.  There is a tremendous amount of scar tissue around your repairs at the moment and the healing is not even close to done.  Do ISO quad sets or assisted lifts using the strap until the pain subsides to maintain/increase your power in the mean time.

Try them again at 12 weeks see how it goes would be my advice.

Came on the forum to post that American football star here in Seattle Jimmy Graham tore his PT yesterday.  I knew immediately when I saw the amount of pain he was in and where his knee cap was that he had ruptured it.   There are pictures online where you can see his patella slid up his thigh as he's lying on the ground.  Tough rehab for him.

I got a big 1 year update coming for you guys next week!   One thing I'll tease is that even after almost one year there's still a long way to go towards a full recovery for athletics.  Everyday life has been normal for well over 8 months but my rehab is still constant and evolving.  Be well everyone and listen to your body.

[jhs0804]

Hi Josh, John and Terho -

Terho - On the straight leg lifts, sounds like it could be scar tissue and not sure if you're feeling stress in the repair or the skin/scar tissue sticking.  I had some success with the Graston Technique I mentioned earlier. 

My ROM this morning was 111 degrees which improved a couple of degrees and I might have been able to go further but thought better of it.  I'll take a couple degrees each PT visit and believe it is linked to the Graston.  So, maybe give Graston a try.  The guy I went to was a chiropractor.  BTW - I just searched your area and there is a Graston specialist near you. 

On the leg lift, you might want to do an assisted leg lift using your strap if you have one for heel slides, secure it around your foot and then pull the leg up keeping the leg straight until you feel comfortable.  I had some of that pain as well but have determined it is likely scar tissue but definitely want to err on the side of caution.  I also did a lot of leg lifts with the brace on until I got some strength.

Josh
Great work on the ROM - both measurements!  I hope to get there by 14 weeks.  I'm almost 12 weeks.  Not sure if your VMO is back in the game but that might be the ticket to getting your gate back so you're not guarding.  The one legged stand is a great exercise, there is also a balancing board I use at PT that basically pivots and can be used to go front to back and side to side.  The other thing that might be helpful is to put a ball or firm pillow between your knees and squeeze - 3 sets of 10.

There is a machine called AlterG anti-gravity treadmill where you can work on your gait without full weight bearing.  You dial in the percentage body weight you want to take on.  Maybe you can find one near you.

I have spent a lot of time in my brace trying to walk normally (heel to toe) so that when I transition I won't be learning a new technique and dealing with the anxiety of being out of the brace that I am sure will be there. 

On that, Terho, I was so fired up to walk without the brace even for the short time at PT and then cruising around the house this weekend.  I make sure to walk near something I can grab onto just in case.  My VMO needs more work before I get the final OK to ditch the brace I'm sure but will find out on Wednesday with my OS 12 week checkup.

I'm glad to see guys posting.  It was getting a little lonely in here!   

Have a great week!

[madvillain]

One year to the date for me.  Crazy how I now use the injury to mark time.  In many ways it's scary to me how quickly the year went by but also comforting to know that in this year I've come a very long way physically.

If you had asked me as I was laying in the hospital bed in the hours after the ruptures if I would accept this outcome one year later I'd have said, yes, 100% yes.  It took a skilled surgeon, 40k in medical debt and over 200 trips to the gym (I counted them up yesterday) but I've done it.  I have basically returned to 90% or so of pre-injury levels of athletic fitness and health within a year.  Year two is when I hope to exceed pre injury levels of fitness.

The toughest part:  without a doubt the first month.  Isolated from friends, unable to drive, trying to work through the pain when on duty at my business (not easy to be patient and kind to the customers when you are tired, in pain and can't walk five feet) and trying to stay positive while wondering if I'd ever walk (let alone play sports) normally again.  Just a lot of anxiety.

The best part(s):  the first time I took the braces off and walked 10 feet without them.  The first night I spent back in my apt.  The first time, somewhere around week 12, when I could "sprint".   The first time I was able to run for a bus around week 24.   First serious hike around 24 weeks to the top of the Oyster Dome.

The Future:  I still have issues doing deep squats, lunches, and other movements that put  stress on the knees while under load (jumping for example).  I hope to progress with my rehab in year two towards more "normal" feelings in the knees and legs.  My surgeon told me that year two is when I should really start to take off.  I feel good about what I've accomplished so far but there is still work to do.  I'm still about 20lbs higher than my goal weight and need to try and cut out my liquid carbs via beer.   I have found that I quite enjoy cycling now and will do a long 10+ mile ride twice a week at the gym.  It's easier on the knees then running but you still can be competitive with it and get a great sweat going.

I still haven't figured out what I'm going to do about my medical debt.  I have my health however so the money...eh it's just money.  I regret not having insurance but I try and not dwell on it.  At least my business provides me a living and cash flow.

All in all it's been a good year, despite the injury.   I didn't have any major setbacks recovery wise and everything seems to continue to progress.  I will say that progress seemed really slow around months 6-9 and that sometimes I feel I go backwards then forwards in fits and starts and that at times patience is required.

This post didn't turn out that insightful or great IMO but just wanted to post my thoughts at one year.  It's a s**t injury, but it can be rehabbed successfully and life does go on.

[jhs0804]

Good news Madvillain except for the debt of course!  But, as you said, health or money?  Take health.  Congratulations!

Update here.

Almost 13 weeks post op.  Out of the brace baby!  Been walking with/without cane for about 5 days.  I am so freakin pumped and starting the return to normal.  Still have a limp but that is smoothing out each day.  I am using a sleeve as a transition which has the dual role of pushing out the swelling I think.

We hit 120 degrees of ROM today which is almost 10 degrees better than last week.  Not sure what specifically to attribute that to but here is what I'm doing:

Floor cycle 10 - 15 mins per day.
Finally got the revolution on the Lifecycle so put in 5 mins yesterday.  This was after a week of going back and forth until I got it around.
1 minute on the Bowflex Max 5 trainer I have.  It's a combo stairmaster/elliptical.  I've had it for a while.
Going to the gym and doing leg presses on the lowest possible setting and then trying to transfer more effort to the repaired leg.  Helps with ROM too.
Graston technique.  I've had 2 or 3 treatments
Continuing the heel slides with the furniture coaster
Using my Kneehab daily for 20 minutes and pushing the exercise/yoga ball against the wall with each stim.  Like a leg press.  That has brought the VMO back to life which stabilizes the knee.  Still have skinny leg Peyton Manning going on the repaired leg but, yes, there is muscle life!
I scrape the knee with the gua sha tool frequently to align the collagen fibers

The swelling on the knee is down considerably since getting out of the brace.  As I think back, I should have been taking it off every time I sat for any period of time.  But, that's a lesson learned.  Let that puppy breathe.  Now combining heat and ice to flush out the crap (ice) and bring the blood back in (heat)

At PT, it took me a while to trust the process to push the knee for ROM.  I kept John42's words in the back of my mind until it felt right to step it up.  He was right and I am getting more confident but not pinning myself to a "number" rather pushing to enough pain to gain but no further.  Your knee will tell you what you can and can't do.  The longer you let it heal, the better.  I had in my mind 12 weeks and that has played out - at least for me and so far.

Funny how the incredible difficulty that this has been is already starting to fade as things get better.  I have prayed and prayed throughout this whole ordeal and every one has been answered.  From the beginning when I had trouble (and big time anxiety) getting from bed to chair, to getting to the kitchen, the bathroom and back, getting up and down stairs - you guys know the deal.  I could not have done this without my Faith and, of course, this discussion board.  That is for sure.

I hope all are well and wish you the joy that I feel in this very moment....

John

[carkeltom]

Wow, I had some serious catching up and reading to do.  So almost two and a half years since I did the double.  Finished my second season of coaching soccer since the injury in November.  Granted, I coach 5 and 6 year olds, but those kids are tough to keep up with.  Only fell once this year, walking backwards and got tangled up with one of the kids.  I felt pretty graceful falling and rolling, hoping not to squish them.  I take some solace in having a short sports break until softball kicks into gear in February.  I am still doing the pitching lessons, but feel much better know in taking the full stride when teaching.  Got some bad news this past week with my daughter, as she, as a 15 year old, suffered and ACL tear and a torn meniscus.  She get to have bone patellar tendon bone replacement for the ACL and feel for her, knowing what I know now, as she will have the graft and will probably have the same issues I have with kneeling on my knees.  Like all the progress everyone is having and hope everyone is doing well.  I hate the winter months and dread that first snow and ice event.  Hope everyone has a good Christmas.  Tom

[TH72]

Been a while since I have posted.  It was nice to read the positive posts by madvillain, John and Tom.

12 weeks came and went for me, and I have also ditched my brace.  John, like you mentioned, it is a great feeling and nice milestone.  I agree with you that I should have kept my leg out of the brace more often during the day.  My leg is not as stiff when I now start my exercises.  I do use a crutch when I am out of the house though. 

Strength is slowly coming back into my quads.  ROM is at 83 degrees currently.  Each week brings slow improvement, but improvement nonetheless.  Lots of cycling and heel slides at home, coupled with the same exercises at PT 3 times a week, with leg presses thrown into the mix.

Last Friday at PT I heard and felt a slight "pop" around the outside top of the knee.  PT claimed it was scar tissue letting go.  She related that a fellow PT had experienced a patient undergo manipulation under anesthesia to improve ROM, and it sounded like velcro being ripped apart.  Fortunately have not had to go down that road!

Wishing continued healing and good fortune to all as the holidays approach!  Winter has also been mild which helps buoy the spirits!

Terho

[TH72]

Brief update.  13 week anniversary this past Thursday.  ROM at 13 wks + 1 day is 96 degrees.  Gains seem to be coming a little faster now.  Heat pads seem to help loosen my knee, along with lots of cycling.

At PT, fellow patients ask what happened.  After I explain, they are sympathetic, but comment that I am probably thankful that it was not an ACL or TKR.  I bite my tongue. :-)

I am thankful that I have progressed safely though, and have not had any setbacks.  PT thinks that after about 100 degrees, my quad will be more of a limiter on my ROM than scar tissue in the knee.  I am starting to get tightness in the area around my quad tendon now. 

Terho

[jhs0804]

Hi Terho -

Great news on your progress!  It's great to hear.  I believe that's 10 degrees since your last update!

I completely understand the "bite the tongue" comment.  Sometimes, though, I can't help myself and show them the Henry Josey video and ask them to FF to 40 seconds... 

https://www.youtube.com/watch?v=C3fsbbWlO_c

Nobody wants to watch it twice.    If you watch the whole video, though, it is a great story and one that we all can relate to - from the initial comment of "not wanting to be on earth anymore" to the perseverance in rehab and then the incredible victory when he returned to competition.

While I wasn't playing football, that was a similar action that my leg went through when I fell down the stairs.  And, I suspect, the similar action that happened to many of us.  It reminds me too that mine could have been so much worse as his was.  I didn't have the other issues with the ACL, etc.  That is a miracle in itself.

Completely agree with your PT on the quad being the limiter past 100 degrees.  Mine is extremely tight. 

Someone on here I believe recommended getting on the full size bike if you're not there already.  I started with the rocking back and forth motion and then put the heel on the pedal to cheat the rotation and then gradually inching it to the toe as the knee warmed up.  Yesterday I road for 10 minutes - a new personal best post surgery.

Another thing I have heard is using a foam roller to break down scar tissue and loosening the hamstring and quads.  My massage therapist recommended pumping the leg while rolling the quad yesterday.  So, I'm going to try that.

I am also getting a massage each week with particular attention paid to the injured leg and a chunk of time on the good leg.  It has definitely helped.

Update here.  Coming up on 15 weeks this Wednesday. I reached 130 degrees passive.  When they flip me over on my stomach, I'm at about 110 and the quad is definitely the limiter.  PT told me to work on that at home by getting a band or belt, hooking it to the ankle and then pulling from over the shoulder while laying prone.  That, my friends, is not pleasant!  But it is necessary. 

Big issue for me is the swelling on the knee.  I spend a lot of time with it elevated and then doing the lymphatic drain procedure by gently pulling my hands across the knee and down the thigh to move the fluid to the groin.  I think the knee swelling is going to be the new normal at least for awhile.  Here is a link to something I found on that.  You can modify slightly and do it yourself.

https://www.youtube.com/watch?v=Q6bG-AsNVYU

So, that's it here.  I hope everyone has a Merry Christmas and a restful Holiday Season.

[jhs0804]

Hi All

I made a promise to JC55 that I would pay forward the use of the floor cycle he sent me right after my surgery. Now that I have transitioned to full size bikes I want to make good on that promise.

If you are reading this and are recently out of surgery and would like me to send you the floor cycle just send me a private message and we will work out the details.

JC55 thanks again for sending this along!  For those not familiar, the floor cycle will be really helpful getting those first 80-90 degrees of range of motion.  It's also helpful getting your mind into a positive frame as it begins the transition back to some sort of normal!

Look forward to sending it to the next warrior.

Merry Christmas.

[John42]

Hi jhs0804

Delighted that you are getting good use of the floor cycle - only $29 from Amazon -

Trust that you are making good progress.

JohnK/ Manchester UK

[jhs0804]

Thanks, John.

I should have been more clear.  The cycle is free and I'll even pay the shipping in the US up to $20 which should cover it.  JC55 gave me the unit and I paid the shipping so this is an even better deal than that.  Paying it forward....  I asked for a private message so people wouldn't have to put their address on this forum.

This is a link to the unit.

http://www.sears.com/sunny-health-fitness-mini-cycle/p-00632705000P?sid=IDx01192011x000001&gclid=CKyxue6o88kCFcETHwodm7gC_A

Cheers.

[John42]

SEASONS GREETINGS  to all my friends on this RPT thread - may you ll recover to good health -

Just remember

Avoid snow and ice
Sleep with a pillow/cushion between your knees
Don`t push it - PATIENCE

JohnK/ Manchester UK

[carkeltom]

Merry Christmas and Happy Holidays from the middle of America.  Hope everyone is getting to enjoy family, friends and health.  This past Tuesday, my 15 year old daughter had ACL reconstruction with a bone-patellar tendon-bone transfer, clean up and loss of about 25% of her medial meniscus and repair of the MCL.  This incident happened in late November (day before Thanksgiving) and the ortho allowed her to wait until now for surgery, which was ok with us and there was not going to be any long term harm.  She wanted to wait so she would not miss any school (she is quite intelligent).  But, my biggest point of pride was being able to listen and converse with the surgeon and staff, not as a rank amateur who had done a wiki search the night before, but as someone who knew knee anatomy and was able to explain to my child the surgery, process, recovery and healing process.  I will have to learn a little more about ACL rehab, as my personal experience is going to be much more different (I was able to utilize my college's PT/OT and football conditioning coaches) and she is younger, has the same scar as I do now (although I have matching ones on each knee) and her recovery and return to activity should be quicker than mine.  Again, best of wishes and recovery to all.

[TH72]

Happy New Year to all!!

Just finishing up the first PT appointment of the new year.  ROM is at 120° and walking is pretty normal now.  Can't go down stairs alternating steps, it is still a no go.  Going up stairs is not an issue.  Still very happy with my progress as it is consistent.

For those in winter climates, I highly recommend slip on crampons (metal spikes) for your boots.  They provide much needed extra traction on slippery surfaces.  Under $10 on sale.

Happy healing to all as we start this year!

Terho

[John42]

Hi Terho

Crampons a very good idea for walking on ice and snow - however we in Northern England, have not seen any snow in 2015, and still out of season very warm this week.

Keep up the good work.

JohnK/ Manchester UK