Full-thickness re-tear 1.3 cm 14 wk after quad tendon surgery

[PeterSp]

I slipped on wet grass and ruptured my quadriceps tendon in late July this tear and had surgery 4 days later (3 holes in kneecap drilled and tendon reattached via sutures which I believe is standard approach). I went though a “normal protocol” with immobilizer/brace as directed by surgeon and started physical therapy (twice weekly) at his direction after 2 weeks and over time my ROM has increased to about 105 degrees. Also started full weight bearing after 12 weeks and was allowed to remove brace. So far, so good. About 2 weeks ago I felt that there was something wrong with knee - my straight leg lifts started to become painful particularly if had walked a mile or so the day before. (This was in addition to the stiffness and some swelling which I have assumed to be par for the course given scar tissue etc). I saw my surgeon last week (14 weeks post surgery for my 2nd follow up visit) and discussed with him. He said this was normal, said he was pleased to hear about ROM and felt my knee with his hand and said all was OK. I asked him why he had never taken an MRI and he said “it would not affect the course of action I was on so & he didn’t feel it was necessary”. I pushed back and got him to agree and had one 3 days ago. You know where this goes … I got results 2 days ago and the radiologist report indicated a 1.3 cm re-tear. I spoke to the surgeon, he said he was shocked when he saw the report (and was very apologetic). He said that the 1.3 cm is because the tendon is not attached to the patella and that the 3 sutures are keeping the attachment of the tendon to patella intact (i.e. 1.3 cm gap). He indicated options are (a) do nothing for time being, keep going with PT and exercises (but stop any exercise causing pain) and he and I will revisit in a month since other option is (b) re do surgery and he would use “regenerative patch” as part of repair (I believe this helps the tendon attach to patella more effectively) but he indicated that there was no guarantee this would work better. Since I don't think I could stomach another surgery for a while (I am 69) I am thinking option (a) but I would really appreciate any advice or experiences other have had with something like this. I did ask him whether sutures were intended to be “standalone” links in the chain between tendon and patella but never really got a definitive answer Thank you in advance for any help or guidance (and yes, I am trying to get a 2nd opinion from another knee doctor).

[John42]

Welcome to the RPT page on KneeGuru, I hope that somebody will pick up your post to give you some positive response - Which part of the UK do you live in?.

Two immediate tips - sleep with a pillow or cushion between your knees, this will take the weight of the pain area away. Also if you drive, get your application in to apply for a blue badge-( good for parking outside Tesco`s.

I assume that you had your knee fixed in a NHS hospital, which has a good Orthopedic - consultant- Keep posting and watch those wet leaves or in my case, slipped on black ice, some 20 years ago. JohnK4221

[PeterSp]

Hi John

Thanks for the reply. Actually I live in NY/USA (though I am originally from UK) and I had my knee fixed in a New York City hospital. Thanks for the tips which I had already followed (though the color of the badge is different over here). It gives pause for thought that something as seemingly innocuous as slipping on wet grass (or in your case back ice) can lead to such a debilitating injury. In facts friends who have seen what the last few months have been like for me always end up saying " you slipped on wet grass and ended up like this ?? ". I probably should invent a better back story.

Anyway, good to be part of this community and hopefully someone can provide some thoughts on the choices I have in front of me. Cheers, Peter

[The_KNEEguru]

I'm going to link you to a couple of published papers which may be of interest in your decision-making.

This first paper is about technical options for repair - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5709721/ and the authors note "Traditional repair included running-locking sutures in the quadriceps tendon passed through transosseous tunnels in the patella and tied over the inferior pole. However, clinical studies demonstrate the continued functional deficits in patients who undergo quadriceps tendon repair."

The other one is about a person who re-ruptured BOTH quads after a bone-anchor repair - in which Table 1 interested me and shows that this problem is often associated with other health issues such as kidney problems or diabetes https://www.ncbi.nlm.nih.gov/pmc/articl ... /table/T1/. That may be something you want to check out... The full article is here if you want to read it https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5958582/.

[PeterSp]

Many thanks for this - I will be reading these. Peter