Ruptured Patellar Tendon Surgery

[John42]

Hi Quickrecovery   

There is no quick recovery for this rare injury - you are in for a long haul to a reasonable recovery.  Suggest that you read some of the previous posts on this thread and click on the undermentioned  thread as it contains a number of documents which describes your injury and the rehab process.

  Where do you live?   ASK questions - keep posting - It takes about 12/14 weeks from surgery to reach 90ROM   - PATIENCE is required.
\take care
JohnK/ Manchester UK

https://www.facebook.com/QuadricepsPatellarTendonRupture

[diane72]

Hi Quickrecovery,

Welcome!You are over the worst of it and now each week it will get better! I'm just past 12 weeks post-surgery. I am now without a brace but using crutches to walk. My physio wants me to focus on 'form' and see me walk 'normally' without a limp before getting rid of the crutches.

On your questions:
-  How do you manage to go down stairs?  When were you able to do that comfortably?
No, not comfortable at all! We have fairly narrow, steep stairs with no handrails, so my physio didn't let me attempt stairs until my leg was strong enough to hold me if one of the crutches slipped . So I only started going up & down stairs about a week and a half ago (I was allowed to do my front doorstep about 3 weeks ago-its a big step but at least there is only one so less for the crutches to go wrong on). If I had a handrail on one side of my stairs they would have let me do them much sooner though I think. Now I am quite happy going up them with the crutches (good or bad leg) but I've really had to work hard on coming down them with the two cructhes safely. Two crutches down, then bad leg down with foot very slightly angled so that the foot is firmly all on the stair, then good leg down.

-  How long did it take for you to get to 90 degrees? 
My OS basically upped it by 30 degrees and told me to spend the next fortnight increasing the ROM every 2-3 weeks. So week 2: unlocked to 30; week 4: unlocked to 60; week 8 unlocked to 90; week 10: take the brace off and go as far as you can. Although I seem to have hit a complete block at 90, where it has been for about  3weeks now. 
 
- When were you able to drive?
Not driving yet, good question. I certainly woudn't do it prior to being able to walk unassisted as you risk not only your own life but others too if you aren't strong enough to react in a potential accident situation. My best friend was hit & killed at 15 by a lady that shouldn't have been driving due to a medical condition and despite her son saying how awful she felt and how she was on anti-depressants as a consequence etc. the truth is nothing compared to how it was for my friend's Mum & Dad and brother, they never truly recovered and even now nearly 3 decades on I can see how their heart breaks every time they look at me and think of what could have been.

- When were you able to do single leg raises?
About where you are now. But the trick with this is to focus on each step. Step 1: Get that quad muscle just above the knee really contracting strongly Step 2: Put a towel under your knee and do the half leg lifts first, start with a really big bath towel folded twice over length wise and then rolled up Step3:Gradually make that towal smaller and smaller by not folding it so much and then switching to a smaller towel Step 4: Then straight leg lifts will come. I will warn you those towel ones absolutely killed me at first, painful! But the move to SLRs were relatively easy once those were easy. The other thing I did was while sitting on the couch lift the leg out straight from bent position (I'm working online from home just now so do these alot while working).
 
- How long did you need physio for?
Again. I'm still very much in the world of physio, I guess it will vary person by person and based on their progress

Update from me: I'm now doing 30 seconds standing on the bad leg alone while using the wall to balance myself, feels a bit like when first trying to do those SLRs but getting easier each day.   I've just started practising on an aerobic step going down with the good leg first, while holding on to rails/table either side. OMG I feel my lack of ROM in the bad leg when doing that-it just seem to stick behind me! Waaaaagh will this leg ever move past 90 degrees it seems to have just got 'stuck'!

How is everyone else doing?

Diane

[Johanna]

Hi everyone.  I thought I'd update you on the latest and also ask for your advice. 

Contrary to most who post here who are quite a bit younger and athletic, I am a female - turning 70 on 5/3 (while I am in rehab) and I sustained a completely ruptured patella tendon in a mysterious fashion, post my knee replacement in 12/14.  Neither my surgeon, nor I, know how/when it happened.  As I mentioned in a previously post, I have lived with birth defects in both of my knees, and it seems for some reason that the tendon was considerably shorter (less than half) of a normal one.

Moving forward, I obtained a second opinion consultation with a respected orthopedic specialist and he concurred with my original surgeon that a cadaver graft was my only option to restore minimal function. (Since my diagnosis last fall, I've been wearing a brace and using a walker everywhere.)  Further, this doctor affirmed my take on things, that the sooner I address it the better the prognosis.  Who knows how much scar tissue and quad atrophy has already set in.

So, my surgery is scheduled for the end of this month, 4/27/16.  My surgeon will be joined with his personal mentor in the operating room.  I find that reassuring.  I have been told I can expect to be in rehab at least a couple of weeks.  The last rehab facility was the world's worst nursing home (no expertise whatsoever...it was to put it mildly, a warehouse for the infirm.)  This time, i am suppose to be admitted to the rehab facility offered by the hospital, inasmuch as this is such a rare surgery.  Both the consulting doctor and my surgeon felt the knee implant itself seems solid, so I've been told the procedure will be to suture in the cadaver tendon by drilling holes both in the knee cap and attach it the same way to the tibia. 

Since I live alone, I may need to be in rehab an extra week.  I am going to be fitted for an immobilizer this Tuesday.  I see my surgeon tomorrow for a pre-op review.  I welcome any advice about additional questions I should pose to him and thoughts about which braces have been effective.  Also, I have read posts by many of you making mention of use of crutches.  At my age, and weight (too much) and lack of fitness, I am sure hoping that I will be OK using a walker instead.  My surgeon did mention I can be weight bearing, but I won't be bending the knee for six weeks.

Should I ask for a wheelchair?  I do plan on getting a hospital bed for use in my living room, since it will be awhile before I can sit in my recliner, I imagine, and I don't want to be confined to my bedroom for weeks on end.

I guess it will be unavoidable to have sponge baths for several weeks, and I am sure not looking forward to navigating my way to use the toilet. 

I appreciate all you share here.  This site is just about the only place where I feel there's actual experience with recovery from such an issue/injury. 

I am heartened by how many of you have achieved a return to mobility and function.

~ Johanna ~

[quickrecovery]

Hi Quickrecovery,

Welcome!You are over the worst of it and now each week it will get better! I'm just past 12 weeks post-surgery. I am now without a brace but using crutches to walk. My physio wants me to focus on 'form' and see me walk 'normally' without a limp before getting rid of the crutches.

On your questions:
-  How do you manage to go down stairs?  When were you able to do that comfortably?
No, not comfortable at all! We have fairly narrow, steep stairs with no handrails, so my physio didn't let me attempt stairs until my leg was strong enough to hold me if one of the crutches slipped . So I only started going up & down stairs about a week and a half ago (I was allowed to do my front doorstep about 3 weeks ago-its a big step but at least there is only one so less for the crutches to go wrong on). If I had a handrail on one side of my stairs they would have let me do them much sooner though I think. Now I am quite happy going up them with the crutches (good or bad leg) but I've really had to work hard on coming down them with the two cructhes safely. Two crutches down, then bad leg down with foot very slightly angled so that the foot is firmly all on the stair, then good leg down.

-  How long did it take for you to get to 90 degrees? 
My OS basically upped it by 30 degrees and told me to spend the next fortnight increasing the ROM every 2-3 weeks. So week 2: unlocked to 30; week 4: unlocked to 60; week 8 unlocked to 90; week 10: take the brace off and go as far as you can. Although I seem to have hit a complete block at 90, where it has been for about  3weeks now. 
 
- When were you able to drive?
Not driving yet, good question. I certainly woudn't do it prior to being able to walk unassisted as you risk not only your own life but others too if you aren't strong enough to react in a potential accident situation. My best friend was hit & killed at 15 by a lady that shouldn't have been driving due to a medical condition and despite her son saying how awful she felt and how she was on anti-depressants as a consequence etc. the truth is nothing compared to how it was for my friend's Mum & Dad and brother, they never truly recovered and even now nearly 3 decades on I can see how their heart breaks every time they look at me and think of what could have been.

- When were you able to do single leg raises?
About where you are now. But the trick with this is to focus on each step. Step 1: Get that quad muscle just above the knee really contracting strongly Step 2: Put a towel under your knee and do the half leg lifts first, start with a really big bath towel folded twice over length wise and then rolled up Step3:Gradually make that towal smaller and smaller by not folding it so much and then switching to a smaller towel Step 4: Then straight leg lifts will come. I will warn you those towel ones absolutely killed me at first, painful! But the move to SLRs were relatively easy once those were easy. The other thing I did was while sitting on the couch lift the leg out straight from bent position (I'm working online from home just now so do these alot while working).
 
- How long did you need physio for?
Again. I'm still very much in the world of physio, I guess it will vary person by person and based on their progress

Update from me: I'm now doing 30 seconds standing on the bad leg alone while using the wall to balance myself, feels a bit like when first trying to do those SLRs but getting easier each day.   I've just started practising on an aerobic step going down with the good leg first, while holding on to rails/table either side. OMG I feel my lack of ROM in the bad leg when doing that-it just seem to stick behind me! Waaaaagh will this leg ever move past 90 degrees it seems to have just got 'stuck'!

How is everyone else doing?

Diane

OMG Thank you Diane for your post.

That information helped me a TON.  I just did a partial leg lift.  It hurts a bit in the knee and I can barely do it, but it's still progress.

Thanks so much for the info.  Hope your recovery goes well.

[diane72]

Quickrecovery, great news! I found even after a week of those half leg lifts they get less painful / easier and by a couple of weeks they are the route to your straight leg lifts, good luck!

Johanna, I'm 43, I do have strong arms and I still did really need the wheelchair at first as I couldn't lift my leg at all and it was super painful when the foot touched anything let alone the ground and it was hard enough getting from the wheelchair to the toilet on the crutches. I actually had a commode next to the sofa bed for the first fortnight which in the first few days post op was critical and then after that it was good in case you needed to go in the night. I did do washing out the sink for several weeks but once my leg was strong enough to do straight leg lifts I got one of those electric bath chairs that have suckers on the bottom to put in the bath. They are great as it means you sit onto them from the side of the bath while you get your leg in there and then press of a button and it lowers you into the bath, but if you gave a step in shower you probably don't need it (I don't have a step in shower in my house, only a shower upstairs that is in a bath that is very raised as it sits above the pump!).

Brett, are you walking more confidently now?

Sending recovery vibes to everyone out there!

Diane

[Saskman]

Hey all

When did you guys start sleeping without the brace on?

[Johanna]

Thanks Diane for sharing from your experience.  I really appreciate the feedback.

I went in for my pre-op appointment today.  My surgeon explained that he will be using an achillles tendon for the graft.  He mentioned there are a few small bones at the end of the achilles tendon which he plans on attaching to the tibia via a few screws.  He had already described how he'll drill some holes into my patella and secure the other end of the tendon with sutures.  Further, he will be using some wire from the bottom of the tendon up and around the perimeter of the patella.  He stated that he'll leave the wire in anywhere from 3 to 6 months and that it, in his words, wouldn't be a big deal to remove it then. He expected I'll be in the hospital just a couple of days.  I'll then go on to the rehab facility and stay there until I am able to sufficiently independent to go home.  He did agree to a wheelchair for me, and a hospital bed too.  I asked again about getting around and he said he expected I'll be using a walker for that. 

I love baths however it has been a long time since I've been able to safely lift myself up from a tub.  I do have a step in shower and it has a seat in it, which has turned out to be impractical because it is part of a fiberglass shell and it is too low and slippery to sit on it.  Additionally, it doesn't have armrests either.  When I was recovering from my knee replacement, we managed to get in a shower chair (it is part of the 3 in 1 commode) for me to sit while a home health aide helped me bathe.  One problem with the chair is that it won't fit very far back and I don't know if I'll be able to bend my leg enough to use it any time soon.  I probably will remove the doors to the toilet area of my bathroom (it is in a separate enclosure) and also the door to the laundry room, by which I exit to the garage.  I imagine I will have to slide backwards into the back seat of my mini SUV to get around for awhile.  I sold my very low '91 Acura Legend and leased a Toyotal Rav4 so that I wouldn't re-injure my knee trying to maneuver in and out of a vehicle.

I also saw my primary doc today and he reassured me that he'll come on by and check on me this time at the hospital.  I think he will be able to persuade TPTB to allow me to join the rehab unit right there, thank goodness.

Tomorrow, I go in for my hospital pre-admitting appointment and my brace fitting.  So things are moving along, at last.  BTW:  the suggestion for a small pillow between the legs makes sense to me...I am trying to recall if that applies even while the brace is still on? 

I'll be shopping this weekend to try and stock up on things before I begin round 2 trying to get my left knee/leg to function.  At least I've saved up up streaming netflix and especially look forward to viewing the entire House of Cards seasons.  My brother says I'll love the British version even more than the one with Kevin Spacey.  I'm also saving up another reward for myself after dealing with this daunting surgery.  Out here in California, uke parties are the latest thing.  Back in the 60s, I taught myself to play the guitar.  It should be fun joining up with others to make music.  Reminds me of my hootenanny days...lol.  I really, really hope this surgery works, so that I can safely resume playing the piano.  I've got to move a chair with armrests over to it and play while I can still use the pedals a bit.  For the time being, the piano bench is out...can't get up from it.  Ugh!

[madvillain]

Works works everyone.  In general I'd be aggressive in your rehab.  15 months now for me.  Recovery goes up and down.  Losing weight helps, big time.  So does busting ass.

[madvillain]

duplicate.

[madvillain]

Hey all

When did you guys start sleeping without the brace on?

I was paranoid about somehow waking up in the middle of the night and sleepwalking (even though I haven't done any of that since childhood) and ripping out the surgeon's work so for me it was about 6 weeks.  I think most people here took it off after a couple weeks.

Make sure you are trying to do your quad iso sets and strap assisted raises as much as you can tolerate.  It's a very critical time in your recovery to try and arrest as much muscle loss as possible.  It is absolutely insane how much of your quad, and specifically the VMO, you will lose despite best efforts.  I'm a bit of a nutter and attacked my rehab like nothing I've done since college athletics and I am still only now at 15 months starting to squat and deadlift heavy weights again.  I still have stiffness when squating and I am just now starting to get that ROM back under load for quick changes of direction in athletics.

A few things I said I'd never do again I'm doing however and that is fun.  I'm jumping down hiking trails Barry Sanders style again

One thing to keep in mind is that progress, especially the first year, is not always linear.  At week 16 you might feel better than week 24.  Around six months the nerves start to regain feeling and with that will come soreness and aching.  The best solution I have found for stiffness and aches is to either row or bike to gently increase blood flow into the knee.  My knees always feel better after getting activity. 

You might find that compression sleeves and a supplement called "cissus" help with the stiffness and aches.  I try and avoid NSAIDs as much as possible but YMMV.  Certainly throw those opioids away as soon as possible.

Another common question is "when will I be able to go down stairs"?  For me, without the brace, it took me a good 6-8 months to really start to feel "normal" again going down.  Going up is the easy part!  I will say that even at 15 months, with all the weight I've lost and work I've done in the gym that some mornings I am still pretty damn stiff on the the stairs.  However, there are days when I feel pre injury levels of normality on the stairs.  It comes with rebuilding your ROM and rebuilding your muscle.

On pain versus injury:  it's important to note that my surgeon told me that it takes a full six months for the repairs to heal and until that time you need to be very careful as not only are the repairs still healing, the nerves are not yet functioning and you will not have proper pain feedback.  That said, pain is normal and not always an indication of something being "wrong" in the knee(s).

There have been many times I have slightly "tweaked" my knees during rehab and felt that perhaps I had done something bad.  However, with rest and ice and time those have passed.  In general, at six months, you can start going as "full bore" as you can tolerate.  Frankly, you probably won't have the muscle necessary to generate the forces needed for a re rupture anyways.  Be careful if you experience any sharp pain above a 3-4 on the scale.  That is a sign to dial back.  In general however pain around a 1-3 on the scale is normal and something you will need to push past in order to recovery properly.

Good luck everyone!

[Johanna]

Thanks for sharing your recovery experience in such detail madvillian.  Your discussion of responding to pain was especially helpful to me.  Frankly, with all the knee surgeries, and other surgeries in my past, I have had more of a concern about pain management this time around.  I suppose it is natural, considering the unusual nature of this procedure/rehab.  Your post also was reassuring about the issue of re-injury too.  I expect to be posting more frequently at this site after my surgery next Wednesday.  I've been told the surgery will take about 2 hours and I'll leave the hospital for rehab within 2 days or so.  I keeping my laptop at home, will keep my Kindle fire with me to stay connected with cyberspace.

Take care, everyone.

[diane72]

Hi All,

Madvillain, thanks so much for the detailed feedback it is incrdibly helpful to know what to expect and what is 'normal'. I did wonder if and when the numbness to the right of my scar would get smaller over time and it sounds like that may well take some time to know the final outcome on that. At the moment I can't imagine going downstairs without at least one crutch or a handrail to hold onto at least, but hopefully that will come with time. The lack of linearity is good to know too as I was making great progress on my ROM week by week but post-90 it has hit a huge block On the weight loss side I managed to get on the scales for the first time the other day and I have increased more than a stone since surgery, so my first milestone is to at least get back to my pre-accident weight!. Hopefully now I can walk better on the crutches I can start building up distance and I am now able to stand well enough unaided to cook (much as I appreciate my husband having cooked for the whole family the last 3 months, his dislike of salad & veg, has come through in his cooking style ha ha ha).

Saskman, I basically started taking the brace off in bed when I reached 90 degrees ROM, as I thought I wouldn't bend it too far if I was already at that.

Johanna, keping everything crossed for a smooth surgery for you and a quick recovery. It sounds like you have planned really well for everything

So my mini-breakthough at physio today is now walking with just one crutch (no brace). I have now to start using just one crutch while going around the house (apart from stairs where I am to stick to two as we have no handrail) and building up my distance using two cructhes to support my balance/'normal walking form' outside, working up to 20 minutes. I can do very short distances without crutches but I do limp if I do that and they want to ensure that I am walking'normally' before removing the crutches completely. I feel the strength will get there, although my leg is very achey after my first day with one crutch around the house, We have booked to go to the forest the weekend after next so that will be good incentive to build up my distance. My worry is the ROM I have taken 3 weeks to go from 90 to 95 degrees so it is moving very slowly. 

Best Wishes to all,

Diane

[Bmcnamara417]

Hello all,

A quick update. Now 9 weeks post surgery.  I have full 130 degree range of motion (since last week). No brace.  Played golf on Monday, mowed my grass yesterday.  Still a little gimpy with a limp, but as the muscle strengthens that will go away.  For those of you that have been told that it takes for ever to get back on your feet....don't believe it.  I will be back to work as a firefighter on June 5.  That's just over 3 months from surgery.  Think I'm crazy?  I'm not...I did the exact same thing to my other knee in 2012 and was back to work in 3 months.  The trick is to be aggressive.  Not passive!  The harder you work the faster you will recover.....do not let your surgeon wait 4 weeks to start Physical Therapy.  You will have to work a lot harder if you wait that long!

[quickrecovery]

Hi everyone,

Just thought I'd give everyone an update.  Since my surgery on February 26th, I am approximately 9 weeks post surgery.  I've definitely made progress.  I am currently just under 90 degrees range of motion (passive). 

Two days ago I went to my OS for my 8 week checkup.  He told me that I am now clear for full range of motion and I can start closed chain strengthining exercises. 

I currently go to physio three times a week.  Here is my current exercise regimen:
Heel slides with a utility belt - Twice a day, 2x10 reps, hold 5 seconds
Lying on my stomach and bending my knee towards my buttocks - 20 reps, 2-3 times a day, hold 30 secs
Knee dangling over bed - bend and hold 5 secs
Single leg raises - 100 a day
standing on one leg - balance for 60 seconds
calf stretch - 20 seconds x 5 reps, 3-5 times  a day
toe raises - 30 reps, 1-2 times a day.

Just bought a floor cycle from amazon as I'm supposed to start biking late this week/next week.

Hope everyone is doing well.

[quickrecovery]

Hey all

When did you guys start sleeping without the brace on?

For me, it was at 8 weeks.