Ruptured Patellar Tendon Surgery

[terianne]

Hi Chiropractor2001, I have the same problem with my knee stiffening up right away. I am 6 weeks post op and got to 90 degrees at PT yesterday. I find that at the beginning of my stretching session, I feel tightness as early as 30 degrees and really have to slowly warm up to stretching it further and further. I am a PT myself and still find it very baffling how stiff I get...even 10 minutes after stretching....sigh!

TeriAnne

[Chiropractor2001]

Hi Teri Anne
I am 13 weeks post op.. the stiffness is still there. I am probably 130-135 when warming up and then Back to 125 in the morning.
I have started biking 30 min a day..and rowing 10 min a day. rom is improving slowly.
I believe we have 5 months to get most of it of not all of the rom  back.
How did your injury happens?
Do.they use wire or not?
Which part of bc you work.at?

[diane72]

Hello All,

Been reading the posts and just wanted to say it is quite normal to have more knee stiffness in the morning or after pushing it (I have found after a few days at Centerparcs the stiffness comes back).

It is one year ago today I had that moment's lapse of concentration and tripped on my 4 year old's scooter that led to the a complete rupture of my patellar tendon. I since discovered they had to use high strength cable (not made of wire) as it needed repair in a number of places, so Ii have been told that cable is like 'spaghetti' throughout my healed tendon so cannot be removed. I am pretty good on the flat but still struggle on stairs, which is tough as I am the type of person that has my kid strapped to her back climbing up a volcano only the November before the accident. I changed job as I used to drive a lot to and from my last job and I now catch the train, it turns out I love the new job. I still made it on my already planned trip to Vietnam but have found you just need to adapt and navigate things and also tell people (e.g. If you are trying to get a boat!) that you have mobility issues so need a bit more help. I still can't get out of a bath (so I shower) nor can I sit on the ground or get up from the ground. Part of this has been driven by my body deciding to 'fix' the cables and growing a weird bone that points out to my knee which feels like it will puncture the skin that also is preventing the tendon thickening as much as it could. I have more open surgery on 28 Feb to saw this strange bone off (John, Stuart not sure if this have come across this happening to anyone else). I remember someone in this forum saying this injury is like having kids, your life changes but you adapt and you just find new ways of doing things. This has certainly been true for me but the other thing I have learnt as the extent of injury can vary dramatically between people so don't compare yourself although we can learn from each other.

Sending best wishes to all on your recovery

Diane X

[Chiropractor2001]

Hi Diane
Thank you for your input. And sorry to hear that things have not returned to 90-100% normal.
I am a father of 4 youngsters... so I know having young kids makes this journey more difficult.  .
I hope that your next surgery on 28 Feb goes well.
I spoke to freind of mine who is a sports doc . His thoughts was why they did not remove the wire at 8 or 10 weeks.It was strange to him. He said unless the wire was set to 130 degrees. So more rom was allowed. Which is placed in a zigzag form. Anyway..  best of luck.
As for me.. I know I have alot to deal with since I need to get back to work soon. Meanwhile I am trying to rehab it as much as I can.
Things are improving however definitely slowly.
And rom when warmed up is nothing like one hour later..

[terianne]

Hi Chiropractor,

My injury was really stupid actually....my son's (15 yo) hockey game just finished and I was rushing down the steps to ask one of his teammates what one of the knuckle heads on the other team had said to him (turns out nothing...geez) and when I was on the bottom step (thank god!) I stepped to close to the edge putting my foot into plantar flexion causing it to slide down the edge of the step and and I lunged forward and I guess I flexed rapidly and knew right away that I had dislocated my patella and once I felt it in my thigh, I knew I had torn my patellar tendon 
They did not put wires in, so nothing to remove. He used Kevlar thread woven through the tendon and then up through the holes drilled distal to proximal patella.
My surgeon appears to be complete opposite of yours as he is very liberal! I saw him this morning (6 wk post op) and he told me to lose the brace and start active knee extension strengthening. Told me that I would probably need to go back to the crutches for a bit. Being a PT, I wasn't in complete agreement but did not voice this. I am going to leave the brace on and open it up to 30 degrees initially and progress from there. I'm not real comfortable with just LOSING the brace lol. Perhaps its a little psychological but I also want to proceed with a little caution.
I work in Kelowna which is in the interior aka the Okanagan, wine country. I work in the hospital here, so it can be a little heavy at times.

Teri Anne

[Chiropractor2001]

That is great.. listen to your ortho.  I went against my ortho and ditched the brace and crutches ( 80 % of the time)at 7 weeks and started going on vibe plate twice a week . Just to contract the quads . At 12 weeks , I was on a bike 30 min a day and 10 min rowing.
I am not saying to be aggressive, just a bit more than what my ortho was saying.
Stupid injury... however I am hoping that we all recover...

[Stuart Rulka]

TerriAnne. Welcome, from Vancouver. As a PT do you see more RPT or RQT ? Not sure in my own mind why one would rupture rather than the other. Any thoughts? Mine was RQT. Did you have surgery in Kelowna? I had mine in Duncan, on the Island and consider myself very fortunate. It seems some excellent Surgeons choose to practice in rural areas as a lifestyle choice.
My PT was Mark Rizzardo. Ring any bells?

[Chiropractor2001]

Hi Stuart
Do you still get any stiffness around the knee. I am almost 14 weeks. The rehab is coming along nicely however I have the knee heaviness almost all the time. I know it.is mostly inflammation however I wonder how long before it dissipates.. any thoughts on that??? My ROM is coming along... hopefully getting it back in 4-6 weeks fully..

[Stuart Rulka]

Hi Doc. In all honesty most of the time I don't even notice the knee. There are however days when that "heavy" feeling is there but it doesn't persist.
 I have never paid any attention to my ROM, in fact have no idea what it sits at. Don't much care as long as I have the range of movement I need. Do you have any answers to the question I posed TerriAnne re quad vis a  vis patellar tendon tears?

[Chiropractor2001]

Hi Stuart
The difference between the quad versus patella is the load. The load before the pulley or after the pulley .
The younger you are and more active you are , your quad are very strong and speed is high. When there are little Micro tears or tendinitis in the patella tendon, the quads pull very hard ( almost 17 times your body wight and tear the tendon). It is harder to rehab since it is tendon compare to a muscle which heals alot quicker.
The older we get, the muscles are not the same strength and load applied is usually through the distal quads ( before the pulley) so the risk increases. The rule of thumb is before 40 patella and after 40 quad.
Not sure if I made proper sense. ..
Rom is important in recovery because as we get older we loose some rom naturally so if there are other injuries and arthritis then we want to keep as much rom before any other injuries.  Strengh usually comes back after 6-8 months with proper rehab. However once the rom is done and scar tissue has formed fully it is almost impossible to break.
The hardest part of the rehab is Rom and then trying to fire lower quads ( almost goes hand in hand) To decrease alot of muscle inhibition.
I have dealt with acl tears and sport medicine for the past 16 years. And treated athletes  at provential and national level. However I had never dealt with a patellar tear ( so very new to me).
I am on rehab at 1 hour a day and two 30 minutes rom exercises a day. I am hoping to recover at least 90 percent .. ( hopefully).
I hope I made sense ...

[Stuart Rulka]

Thanks Doc. The leverage issue does make sense, and I thought improved vascularity was probably the reason the Quad heals faster; still unclear as to why the quad after forty, as surely any micro-tears in the patellar would be exacerbated with the passage of time?
 It also makes sense that the patellar, with little or no stretch would be the determining factor in ROM. My PT put me on a bike at my first visit ( two weeks ) and said see how far you can go, back and forth. A week later, three sessions a week, I achieved a full revolution , and I was on my way. He never thereafter made an issue of ROM.
I was 65 at the time, but very active. My Surgeon felt that my rupture was the result of very powerful quads trying to get my leg under me as I fell. I used to leg press 630lbs with little strain (10) reps, but had An innate reluctance go higher because of concern for the loads I would place on the tendons. Seems I was right!

[Chiropractor2001]

You had a good pt without a doubt.  Most people recover to 80% within the first year.  However if one does all the work and stays active. (Proper rehab).  I find that most people that have become 100% don't post on this forum as much. Which they should since it gives alot of people better hope and guidance.
I have 2 patients on the clinic who had a patellar rupture many years ago. ( they did not see me for rehab) and both are very active without any issues.  However they are in their early 30s now. So there is hope for everybody. As you mentioned many times, the research shows that we need to be a bit more aggressive on rehab and earlier unless there are specific reasons...
I am in toronto.. and I can tell you that there are not that many pt or chiro that have dealt with this injury as much... 

[Chiropractor2001]

So finally I got to 140 assisted ( after warming up the knee for 10 min) at 14 weeks... then 2 hours later I was at 130.. long road ahead to build  muscle ...
This injury plays mind game...

[madvillain]

You had a good pt without a doubt.  Most people recover to 80% within the first year.  However if one does all the work and stays active. (Proper rehab).  I find that most people that have become 100% don't post on this forum as much. Which they should since it gives alot of people better hope and guidance.
I have 2 patients on the clinic who had a patellar rupture many years ago. ( they did not see me for rehab) and both are very active without any issues.  However they are in their early 30s now. So there is hope for everybody. As you mentioned many times, the research shows that we need to be a bit more aggressive on rehab and earlier unless there are specific reasons...
I am in toronto.. and I can tell you that there are not that many pt or chiro that have dealt with this injury as much...

Good post all around.  I remember very specifically calling a well reviewed PT around week 6 of my injury and I asked right way "does anyone...on your staff...have any experience with this injury, a ruptured patella tendon [of which I have two!] and when I got the boilerplate "well, all of our staff are professionals with a wide variety of experience" I said thanks but no thanks, hung up and dedicated myself to learning everything I could about the rehab procedure and to just do it myself. 

Not saying everybody should do that but it's certainly an option and shouldn't be dismissed out of hand.  The Internet is a great resource and those confident enough in their research ability can use it well.

As for your thoughts about posting frequency going down as a function of recovery I agree.  I check in here once and awhile to give some advice or post my recovery details but I'm 100% back in everyday activity and have been for about a year now now (2.2 years since injury).  Most of the last 12 months have been focused on regaining power and pre-injury levels of cutting and jumping, and while they remain probably 80-90% of pre injury levels they are still improving with work and hopefully by the third year anniversary closer to 100%.  I can say that everytime I bang out another squat or 8 minute mile I kinda smile.  It's a blessing!

For your particular rehab it seems like you are quite aggressive in your approach and it's certainly one I agree with.  The rowing machine and bike and step ups were the first exercises I really started to feel great progress with from weeks 6-18 and then progressing from there.

Of course heel slides and quad iso sets should also be done daily, if not multiple times per day, if not every other hour, during this time.  You said you have the wire repair?  That seems to be a bit of a slower rehab so obviously modify your plan according to what your needs are.

I found it interesting that the poster that had the same kevlar threaded repair I did also had an aggressive approach to rehab like mine.  I had a younger guy who was part of a sports medicine team here in Seattle and I'm glad he supported me in my early efforts.  I was (locked in braces of course) walking without the walker by week two and I attribute much of my rehab success to the early efforts to just MOVE as much as I could during the day.

I also remember times of incredible fatique and frustration, when I'd be at work and simply rising and sitting in my chair required me to plan my day around it.  Or trying to take a s**t.  Or a sponge bath.  There's a lot about the first few weeks that are really awful, especially if you like some of us here you got a "two for the price of one" (not on the hospital bill tho) rupture.

From appearances, it seems like most here are doing well.  Good to see!  Hang in there Johanna you seem like a particularly hard case and my thoughts go out to you.  I'm the last person to lecture on weight and what it does to our knees (it got me into this mess, a long with pounding the hell out of them in athletics) but if you can just try and maintain your weight while you are stuck with limited options for exercise.

Finally I just want to post what I use to "loosen up" my knees, still to this day in fact, before I do any intense work in the gym:  first I bike 5-10 minutes, then I do patella manipulations and heel slides, then I do the "butt kick drill" and then finally I do unweighted squats on the bolsa ball.  At this point I then start doing heavy squats or other leg work.  I've found that even to his day my knees are stiff and take a good while to warm up for proper, as pain free as possible, squatting and other leg work.

[Chiropractor2001]

Hi Madvillan
Thanks for the info..
A quick question for you? I after warming up I get about 140- 142 rom at 15 weeks.however 2 hours later it is back to 130 or so. Does this ever end. Also the heaviness in the knee... I know alot of it is still inflammation. I have seen it in acl repairs.. does the heaviness go away at one point.
And I am sure once the inflammation goes down , the rom increases by few degrees (5-7 maximum).
Any thoughts on that?
Other than that... I still have problem firing my lower quads... well I guess eventually...
I have 2 patients in the clinic that had their patella repaired many years ago.. and both have recovered fully.. no issues for years now. ( they are in their mid 30s) hopefully we will be there sooner than that..