Ruptured Patellar Tendon Surgery

[John42]

Hi Lairy75

Welcome to KneeGuru - you have found the best webpage for advice  covering all aspects of a RPT injury.

Yes, it`s a very rare and serious injury with a long rehab process - read as many previous posts on this thread - ASK questions - remember PATIENCE is required - Driving is a no for quite some time - you must have clearance from your OS, otherwise you will invalidate your insurance cover.

Where do you live?

Keep posting
JohnK/ Manchester UK

[Lairy75]

Thanks John.   I live in Durham.  Was hoping to get back to work once I could bend the leg enough to sit down properly.    How long is that likely to be?

[John42]

Hi Lairy75

10/12 weeks  and the ROM   Range of movement should be about 60 by then, but then starts the hard slog to reach the next milestone of 90ROM, which can be up to 4 months - in otherwords
you should be in the region of 100ROM after 4/6 months - get your good leg measured for a long term indication

JohnK/ Manchester UK

[Jola]

Hi, I am 4 weeks post surgery for ruptured patella tendon of the right knee. Currently wearing a hinged brace set to 60 deg but I'm getting very little bend in the knee - maybe 30 degrees, it's so tight. I am still icing it regularly and I have a lot of swelling in my ankle & foot which doesn't help. Any advice greatly appreciated.

[John42]

Hi Jola

As we have stated many times - PATIENCE - The tendon has still not healed and you will be in a brace for a minimum of six weeks - having removed the brace or plastercast, you should reach a minimum of 30ROM - at 12 weeks, you will be working up to the next mile stone of 60 ROM with lots of PT and patience.

( don`t attempt to drive until you have clearance from your PT -  sleep with a cushion/pillow between your knees.    ASK questions - read some  of the previous threads on this post.

Keep posting

JohnK/ Manchester UK 

[Lairy75]

John,

What do you mean about measuring my good leg?
Also, has this injury occurred because my tendons are weak? Should I be working to strengthen my good leg with calf raises?

Also, I wondered if anyone else had returned to Crossfit after this injury?  It involves a lot of squats which I'm now wary of.

[John42]

Hi Lairy75

Your good leg should have a 140/150 ROM, so you should try and achieve 135 plus ROM within 12 months.

I would avoid crossfits as this would place a strain on the tendon.

Best/ JohnK/ Manchester UK

[Alkotter]

How's everyone doing? 6+ months post op.  Walking normalized, ROM back and doing well.  Was given clearance to begin lightly jogging.  It's like learning how to walk again but I'm embracing the challenge.  Best of luck to all.

[madvillain]

John,

What do you mean about measuring my good leg?
Also, has this injury occurred because my tendons are weak? Should I be working to strengthen my good leg with calf raises?

Also, I wondered if anyone else had returned to Crossfit after this injury?  It involves a lot of squats which I'm now wary of.

One day at a time.  Don't worry about cross fit for awhile.  I worked my ass off, had a great surgeon, and it took me about a year to get back on the squat rack and it was at about 25-50% of the weight I'd have done before.  I just did leg day this Sunday (god my legs are f***ing sore, but it's DOMS sore!) and I finished my squat session with 235x5 and 235x3.   Before the injuries I'd have been finishing with 325x5 and starting with 225lbs x10

The way my surgeon explained it to me is that the tendons, especially in middle aged men, get micro tears, which usually results in pain over the top of the patella itself and tendonitus -- both things I had for at least a decade before my ruptures.  I had patella pain on and off throughout my athletic career, including low level college baseball and then through hiking in my late 20s before I had dual ruptures playing tennis.  Being 40-50lbs overweight didn't help my cause, and lose any extra weight you have as soon as you can.  I'm still about 20lbs heavier than I should be, but I'm at 185lbs now and was at 225lbs when I did the ruptures, now, boy, 34 months ago.  Time flies.

Anyways, enough about me. 

What you want to be doing at 4-6 weeks are heel slides, iso sets (just try and flex your quad muscle and hold it for 10 seconds, do this 3-5 times a day for a couple minutes) and then straight leg raises (side and front) WITH the straps as soon as you can do so without sharp, acute pain.  If you are unsure, don't do them.  I believe I was at about 3 weeks when I started them but I was super aggressive and I'm not sure that's the best route for everybody.

Also, situps!  Situps will help, you'll feel your quad helping you and you can work it safely and avoid some of the muscle atrophy.

At about 6 weeks you might find the rowing machine helpful to gain ROM,  and then as soon as you can, try the exercise bike.  It will be hard but it will help our ROM a lot.

Be patient.  You still have a TON of scar tissue and nerve damage at week 4.  You might consider buying a "gua sha" scraping tool and watching some of the videos online of scraping after patella tendon repair.  Basically you just want to try and scrape around your scar in a downward motion for a few minutes every day.  It will help break up the scar tissue and help ROM.

It's a long road of recovery but you'll start seeing good progress soon, the key is around week 12 you'll stall, and progress won't be so linear anymore.  Just keep pushing.  This was around the time I started doing light hiking around town and I remember vividly crying after a completed a short 2 mile loop trail, as it was something, frankly, I thought I might never be able to do.

Of course now I've long returned to full activity and in many ways I'm as fit and athletic as I've been since college, which is great, but I still have some moments, mostly going down steep ass mountains, where I can feel the tendons just aren't quite what they were.

But in everyday life, if you work hard and are patient, you should return to 100% function within 18 months.  Practice makes perfect, especially on stairs.  And Heel Slides.  My god, do as many heel slides as you can.  Keep your toes pointed at your belly button.  Watch youtube videos of recoveries, theres' some good ones out there.

Heck, even go through my post history I posted a ton of rehab protocol stuff back a couple years ago and my recovery, (not so humble brag) has been pretty damn good.

[Lairy75]

Thanks Madvillain

Well done on your recovery man. 

It's really great to get an idea of some of the exercises I can start getting on with.   It blows my mind that this is going to take 18 months to recover from but I'm trying to stay positive. And patient.   My first target is to get enough ROM so that I can sit in the front passenger seat of car.  😀

[John42]

Hi Lairy75

Your PT will measure your good leg.

Don`t drive until you receive clearance from your OS.

JohnK/ Manchester UK

[Primetime_21]

Currently at 15 weeks post op. I am at around 120 degrees ROM. moving fine, with no pain or limp. My quad is still very weak, so an athletic knee brace when I'm out and about. My os and pt have been pretty cautious with my rehab as I guess my damage was pretty severe. but all in all everything is moving pretty smoothly. the main thing for me was making sure to consistently perform stretches and exercises recommended to you by your PT. I also own a recumbent bike, which helped a lot. I still have a decent amount of scar tissue which seems to lead to some occasional crackling in my knee (nothing that hurts), but I have been told by numerous people that will likely subside as I regain quad strength. For all those going through the grind, stay positive and keep working at it!

[AroohArooh!!]

hey everyone....i have now got back on my road bike and started biking roughly 6 miles to the gym and 6 miles back 3x a day. I keep a fairly intense pace because city traffic in los angeles does not care about injury or not ahahaha.

Lairy it's a tough road but everyone is making progress...you will too. My brace was taken off by my PT at the very first session and I am so grateful that she was aggressive with that. I'm almost 7 months now and i bike and walk around but have not made it to a jog yet. I will be there soon shortly.

Positive vibes to everyone here!!

[Johanna]

Hi RPTers,

I'm back and my news isn't good.  I had planned on posting here to bring you up to date about things, but not like this.  My surgeon felt my left leg was strong enough to withstand my TKR for my right knee a year or so after I had the achilles cadaver transplant.  With my right knee in bad shape time was of the essence.  I think I posted a while back that my right knee cap had attached itself to scar tissue and was resting up and to the right of the normal location.  It's a wonder that the joint didn't give out as structurally unsound as it was.  I had the knee replaced on 5/2/17.  My surgeon reinforced the patella tendon to avoid a repeat of the rupture on my left.  He also used a much more powerfully designed implant as well for this one.

The surgery wasn't without some complications.  While I was off blood thinners for the five days prior to the operation, it appears that is when a DVT developed.  I admit I took a risk, because I felt compelled to wear my knee brace 24/7.  My right knee had begun to shift around much like the left one had and I was afraid if it gave out I'd do
irreputable damage to cadaver graft on my left leg.  Thus, the recovery period including some weird cramping and a lengthier time to achieve acceptable ROM.  I lucked out and have about 140 degrees ROM on the left leg.

On to the disturbing development.  With my replaced right knee I truly for the first time in my life had an idea what a normal movement of my knee cap should feel like.  With that understanding, it became more than obvious how loose yet the patella felt on my left knee.  While it doesn't sublux like it had done prior to my knee replacement and transplant, it does move up and down in a pronounced fashion and feels quite wiggly, if you will.  I find it unnerving.  I checked with my home therapist, and then my out patient therapist and asked what they'd do about it.  They both mentioned the need for a brace.  I thought OMG...I so hoped I was beyond that, at last.  I had discussed this only a little with the surgeon prior, but as I became more fully recovered with the right knee it just seemed quite obvious the degree of disfunction still left in the left.  He had stated something about limited ability to treat loose ligaments.  So, today, I wanted to really address this more fully when I visited him.

It seems that the lag has increased when I try to fully extend my left leg.  It was about 10 degrees shortly after the surgery.  That has increased to about 20 degrees or so and the doctor explained that after my own tissue had encapsulated the cadaver tendon and also the build up of scar tissue it had elongated the tendon some.  He explained that in my right knee when I contract the quad the patella tendon responds almost instantly.  In my left knee, I'll contract what quad I have, which I had posted here recently was damaged and would not ever be as strong as normal, it brings my knee up high...alta position almost, and then that movement starts up the attachment to the lower tendon, the replaced patella tendon.  The up shot of the whole thing as best as I can explain it, is that the leg has weakened some and he recommended that I begin to wear that shin brace I had prior to the the graft once again.  (The custom brace sits in a shoe and keeps my leg from buckling backwards as a consequence of a lack of tendon function.)

A couple of other factors have played into all of this.  My crappy insurance plan made it difficult to secure regular PT sessions.  It seems to be resolved for now.  But in the interim, I lost strength particularly in my left quad by the delays.  So, the prognosis might be less grim, once I can rehab my leg properly again.  However the left kneecap instability seems to have returned as a permanent characteristic.  I had already gone and obtained a brace to help stabilize that part of my knee, not expecting to have to wear the other brace again (the one that rests against my front shin bone up to just under my knee).  This also means using my walker at least for the time being, all in an attempt to keep me from falling.  My surgeon was quite emphatic how he never wanted to attempt a surgical task again with that knee.  (I had posted this was the only RPT transplant he'd had to do in 32 years of practice.)

As you might imagine, I was reeling after this news.  I thought I might have to adjust to wearing a PTO brace the rest of my life, but I wasn't at all reconciled to having to use a walker, and the lower leg brace again.  As I was reviewing the outcome with my best friend, she felt I ought to again, obtain a second opinion and further see if I can find a 'bionic' brace if that is the only fix open to me at this point.  I must admit the lower leg brace seems cumbersome, a bit crude, bulky and quite unusual in design.  My surgeon had resorted to what he had deemed the approach used to stabilize polio patients.  Perhaps he is not aware of current methods and materials.  Surely there must be lighter braces incorporating the latest technology out there.  I'll have to start searching them out.  I'd post a pic of the brace here if I knew how to do so.

Sending out healing thoughts to you all and I hope your recovery is more successful than mine.  (Trying to look for any silver lining in all of this...at least I have a much stronger right leg now, which couldn't have been possible without having something done on the left to support me while the right leg was treated.)

I've not kept up with the posters here...I appreciate being able to return to this thread...

~ Johanna ~

[Johanna]

I guess I killed the thread...