Ruptured Patellar Tendon Surgery

[Johanna]

Oh wow...Sue, I forgot to scroll up...oops...I keep this site open displaying the latest post (usually mine...guess folks are better, I hope...and/or less new RPT casualties...lucky devils). Sent you an email.  Thanks for your post and patience...

Hope members here are enjoying their Saturday...as for me, I'm on the umpteenth TV re-run...sure wish Mad Men, Downton Abby and The Good Wife series were still active. 

~ Johanna ~

[madvillain]

Don't doubt that. Lack of joined  up thinking is frustrating.  No reason to doubt the OS as is part of a specialist team and believe is headed by a good senior surgeon. There seems to be failing in communication as part of the system and the PT has been understandably cautious. Lack of movement that could of been done as guided excercise at an earlier stage has not helped and now recovery will be slightly harder.Getting to the stage where I can do even normal every day things will take longer. Particularly so as I don't have a good leg to work from. Thats not 'disrespecting' the injury. Every case is individual and think I have every right to be frustrated. J

In some ways the bilateral is better as it will force you to build up both legs again and not over rely on a good one.

You're still only at weeks 6-12 and those are tough weeks but you should start to see progress with ROM if you're doing heel slides 2-3 times a day and supplement that with some sort of gentle motion -- can you make a revolution on a stationary bike?  Do you have access to a rowing machine?  Those were my two go to exercises for ROM at that point.  Also should be doing assisted straight leg raises with the straps after week 6 as tolerated.  Pain beyond a 3-4 on the scale or a sharp pain that increases is a sign to stop but you have to push through a little discomfort.  I know that feeling of "tightness" on the knee caps but the only thing that will break up that scar tissue is gentle movement.  Get a gua sha scraping device and watch videos online on how to use it to help break up the scar tissue.

Take charge of your recovery, as John said frankly most PTs don't have experience with this injury and spending an hour on this thread, reading all the past posts, and then another hour or so researching PT guides (I've posted at least a couple here) will give you more confidence in your recovery and in the PT sessions.

There's a long road ahead of you but you have a couple things good going for you and that is that you haven't had any post op complications with infection or blood flow and you also had surgery right away.  The time from injury to surgery is a key predictor of recovery and you had it the day after that's great.

Oh, you can also do straight leg deadlifts at this point and those will do you immense good.
___________________________

Squat routine yesterday at exactly 1 year, 6 months and 16 days from the ruptures:

5 sets 135x10
3 sets 185x7
2 sets 235x3 (box squats so not quite full rom)

Certainly the most powerful day I've had yet.   Did a very thorough warmup including knee cap manipulations and a very thorough soft tissue session afterwords on the foam roller and in the sauna. 

Feels good today, sore in all the right places.

I'm almost at the point where if I want to squat down to look at something during my day I can get into a full catcher's crouch without thinking about it too much.  That's amazing to me.

I'm still struggling to lose the last 15-20 lbs, been stuck at 175-180 for about 6 months now.  Lost 50lbs right away after the ruptures with my athletic future in doubt it was easy but now that I'm healthier the motivation isn't always there.  That said, weight maintenance and loss is critical part of rehab if like myself you were overweight at time of rupture.

[Bascat]

Thanks for the encouragement mad villain...two is better than one ☺
I'm doing some basic excercise can only heel slide a bit as quads are weak and very tight at the kneecap. I I'm also sitting in  wheelchair and holding the flexation with feet on the ground for a bit. I'm finding things are loosening up but soon tighten and stiffen up once I return to my legs out position.  All feels like it's moving in the right direction and pain not too bad. Most discomfort is in the morning when I wake up. Don't havever rom for a bike just yet but rowing machine sounds a really good idea and give some cardiof work out too. I'm aiming too get in to work soon even if for a few hours. Logistical are difficult as can't get on car but could maybe walk for train and use taxi with wheelchair. No strength in quads for legal raises just yet and am focusing on quad setting. Walking about a fair bit too.

Weight is a concern. I'm a big lad 6ft 6 and 18 -19 stone. Trying to keep it healthy but difficult not to comfort eat. My Mrs went mad the other day because I ate a bag of nuts 😈😲🙃 . Good to see someone ahead who has proguessed and thanks again for the help. Please excuse any typos too...pesky tablet device Cheers J

[Bascat]

I doubt you'll be back on here much mad villain  but have looked through your past posts. The thing I'm curios is how you got to being able to sit in a car (don't worry others not to drive) and get down to sit on a rowing  machine ?? Perhaps more difficult with my heigh. Don't know if anyone else has ideas or if anyone has an email address for mad villain.  Thanks J

[Downstairs]

Big Day!

Had the courage to stand in shower without brace on.   First real shower in 7 1/2 weeks

Also.....I was able to cut my toenails!   All by myself.   I think I have about 100 degrees of flexion.  I see PT again tomorrow.

I am pleased with progress.   I can't wait to start rebuilding my quad.

Knee feels stiff with movement but no pain. Quad is jelly like. 

[quickrecovery]

Congrats on taking your first shower since surgery.  I know the feeling.  I was ecstatic I could do it myself. 

[John42]

Hi everybody

Reminding you that PATIENCE is important and you will be rewarded with a better and sustaining ROM


JohnK/ Manchester UK

[jpwooding]

Hi folks,
Found this thread after reading up on everything associated with my injury and felt it was time to jump (I don't think so) on it! I was 40 when I slipped playing football at the end of March this year. I felt something was wrong and as I lay on the floor I saw my kneecap had shifted up my thigh and my right leg locked at 90 degrees. It didn't hurt that much,  just a bad ache really. Once I was at hospital the kneecap was put back in place (this was more to do with the horrific cramp I had in my thigh and calve!) An x-ray showed nothing so I went home in a velcro sprint with crutches. At work a couple days later hospital rang and said I should go n for urgent scan? I just thought it was a dislocation and would need physio, nothing more. Of course a scan, and the fact I couldn't lift my leg off the bed, revealed a total rupture of the patella tendon, with an operation later that afternoon. Following a 4 1/2 hrs op (told I shredded it, torn in a v shape that also needed sutures all over and on the tibia as well as usual threading through knee) I was in cast for 8 weeks. Brace was locked at 0-30 for 2 weeks, then bypassed 45 and went to 60 for two more, then finally 90. My last consultation, last week (week 13 post op) I was told no longer need brace as reasonable strength- I put some of this down to to doing a few leg raises in cast to encourage quads, and the fact I have been on my feet (crutches!) at work since week 2 post op. I am still wearing brace at work for reassurance but not at home. Abandoned crutches once 2nd physio session restored a more natural gait this week (was locking leg to prevent buckling) R.o.m is 90, perhaps 95 at a push. I am on my feet at work for most of day, causes bit of stiffness but no significant pain, off which I've had very little on the whole: (Day one after op was a killer, but dropped all medication, bar anti-clot injections, after week 2 or 3 I think. I also had an electric shock in the garden which lifted me up and brought me down full weight on it. That hurt more than anything but fortunately didn't Re rupture it). I feel so much more confident now I know it won't buckle and am more concerned about rom than strength. I am aiming for a natural gait within a couple more weeks and total non reliance of brace. Total R.O.M, I suspect, will be a different matter!

[Bascat]

Morning .

Hope all is well with everyone (as well as can be).

JPwooding sounds like you are one the road to recovery....electric shock!

Nearly 9 weeks post op. Looking over the past week realised I'm progressing a lot.
Managed to get to  work for an afternoon. Boarding the bus was not too bad as floor lowered and could perch on the high seafood behind the driver. Corners a bit hairy. Overall took a long time to get there though as walking at snails pace.

ROM is about 80ish in left leg and 70ish in right.

Starting to sit in chair more often too now and pulling my self up with upper body allows me to manage this. Think this is helping to loosen my legs as feeling less stiff at lower Rom and in general. Upper leg muscles are relaxing more too when doing flexion which is helping. Nice not to be so confined to the bed and legs in extension.

Next goal will be trying to get in and out of car. Will be visiting swimming pool for a shower today too 1st in about 2 months.

Helps to be determined and set goals and targets but agree patience is important.

Good luck everyone with recovery. Also so happy with the mighty Wales doing so well in the footy.

Cheers J

[John42]

Welcome to JP Wooding - another member of this exclusive club.

 Important that you read some of the prvious postings on this thread.

ASK questions - keep posting - where do you live?

Take care
JohnK/ Manchester UK

[jpwooding]

Thanks for the welcome guys. JohnK- I live in Northants.

[Johanna]

Checking in with you fellow RPTers...

Finally worked out the home services debacle a bit with my ins. co. and the VNA (Visiting Nurses Association).  After almost a two-week break in PT visits, I had an evaluation of progress last Wednesday.  I've had my brace set at 90 degrees, but I could see that my actual bend was a bit short of it.  He measured my ROM and at just beginning 8 weeks out I'm at 80 degrees.  I see my OS this Thursday.  I don't know if he'll measure it again, but I'd like to be at 90 degrees in 10 weeks, if I can do so safely.

I am looking forward to hearing more about what's next from this visit.  I'd like to know if he found much scar tissue (I'd forgotten to ask) inasmuch as my tendon tear was diagnosed months after the fact.  Further, I'd like to know the progression of weaning off my brace.  I am wearing it locked while fully weight bearing, and trying to unlock it regularly while sitting.  And, of course, it is unlocked while doing heel slides.  My PT has me do them on my bed and then again while sitting too.  BTW, when the PT asked about putting down some paper on the carpet to do the slides or some plastic, I found something handy...I'm employing an unused trash can liner, which works pretty well.

A couple of times, I actually forgot to lock the brace when I was up walking.  It kind of freaked me out, since I didn't discover it until I was back seated.  I told myself that at least I seem to have some strength building since nothing felt out of the ordinary, other than a bit of an unusual sensation when I did a pivot with my walker going back to my recliner.  My PT explained that my OS might have me begin to wear the brace unlocked as I move towards less brace use.  I'm willing to wear a smaller brace on the way to being brace free, if necessary.  He assured me, that should I wear the brace unlocked for awhile, it would still prevent me from a fall in the event my quad is weak and my leg begins to buckle.  I was glad to hear of that option.

It dawned on me, that with an achilles tendon graft, which I've read is the strongest of the tendons, that it is possible that I have greater stability than I ever would have achieved should my original patella tendon had been possible to repair.  If true, I am greatly comforted by that...especially as I make my way through the incredible tedium of this recovery.  (And, with my right knee TKR to go + the likelihood that the same early 70s surgery means my patella tendon was split on it too, I recognize I may have a RPT graft on that one as well.)

Hi to the new posters, including JP Wooding. 

There's some lovely warm weather out here these days - I do enjoy hot temps (I live just about 1/2 hour from Palm Springs).  I hope the lift for our out door pool will be fixed, and that I'll be allowed in the pool after the wire is removed during the first week of August, before summer's end.  That will be such a terrific reward for getting through this ordeal.

At least I can be entertained by our ever so nutty presidential election conventions coming up, and then the Olympics.  Go Phelps!

Sending you all best wishes on the mobility journey...

~ Johanna ~

[Norene]

Hi all.   Have been reading and thought it would be good to post my experiences.

I live in the US - Maryland.   I am 61 years old and prior to my injury I walked up to 7 miles a day.   Slipped on ice January 28, 2016 and went down on my knee.  Broke my left patella into multiple pieces.  One large piece ended up in my thigh.   Had surgery on February 2, 2016.  Hope was to pin & wire the two larger pieces together but the one piece was too small.  OS had to attach my patellar tendons to the largest piece of kneecap and remove all the other pieces.   

Was in a straight brace for 10 days (used a walker to get around putting slight weight on my leg) until the staples were taken out.   In a full leg cylindrical cast for 4 weeks but was able to be full weight bearing on my leg.  Cast removed and put into a hinged brace for 7 weeks.  Started at 10 degrees and worked up to 90 degrees by week 7.   At that point my OS said I could go without the brace and start PT.   Took two weeks to get an appointment for PT and during that time I worked on some quad strengthening exercises on my own at home.

I am now 5 months from surgery and starting my 8th week of PT.  I go to PT twice a week - exercises, ultra sound and using the Graston technique to break up scar tissue.  Because of the kneecap ending up in my thigh I have an excessive amount of scar tissue that has to be broken up.   My ROM is about 134.

I am walking 4 miles/5 days a week.   Some days are good days, other days my knee aches constantly.  I walk very slowly compared to my pre-accident time.   I am sometimes able to do stairs the "normal" way.  I have more pain in my knee going up stairs rather than down stairs.

A couple of observations/comments after reading many of the posts.

Even though we all have suffered a ruptured patellar tendon there are differences to our injuries.   We were at different levels of quad strength prior to our injuries.   We will all heal at a different rate.

My OS did not want me doing any PT until 3 months after my surgery.   He said that I needed to be sure my tendons had healed properly.  I wore my brace to bed that entire time. 

I ice my knee 4-5 times a day.   I find it helps that tight band feeling that I have above my knee. 

I find sitting for an extended time without elevating my leg causes pain/aches.   

The best thing I have learned from reading all the posts is PATIENCE.   One day at a time and baby steps. 

[John42]

Hi Norene

WElcome to the RPT thread on KneeGuru - Youhave done well to read many of the previous posts and have made very valid points   " PATIENCE " .

I also slipped on black ice and ended up with 115 ROM, but with that I can do most things in life.

Have a look at getting a floor cycle on Amazon - about $50, but worth while.

Keep posting - ask questions.

JohnK/ Manchester UK

[Norene]

John - Sorry about only 115 ROM.   How are stairs for you?

It was black ice that did me in also.  Was certainly not the way I planned on spending my winter.   

Will look into the floor cycle.  It is going to start getting very hot & humid here so my walks will not be much fun.

It is the ups & downs that do me in.   One day I will feel pretty good, the next day my knee aches so bad that it drives me crazy.

It certainly is an interesting injury and one that I would not wish on anyone!