Patellar Tendon Rupture.....

[Unregistered]

Brian:
You are fortunate to have surgery so quickly following the injury - which generally improves the odds of a good outcome and reduces the atrophy time for your quad. It took me a couple of weeks to mentally understand the scope and severity of the injury. I suggest that you concentrate on passive range of motion exercises- these are crucial (as per your physio), RICE (rest, ice, compression, elevation), and not doing anything to tear the fine work of your surgeon. You will be in a very fragile state for at least the first 10 to 12 weeks and need to lie low on resistance training until your surgeon says that the tendon has fully healed (probably start low resistance cycling around week 11 - buy a stationary bike).

Life improves substantially after that point when you can crank the resistance on the bike, (should be walking without a device), head to the gym & physio and start seated squat/hamstring, straight leg pully, and other resistance exercises (as well as full body weight exercises). I have had my first week of resistance training and have already improved to about 3X the initial first day weight (e.g. 90lbs one leg seated squat). I will probably start road riding in another week.

In your current circumstance I suggest the following: keep a positive attitude - take a shower every day (change dressings daily- no infection) after the surgeon okays it - make sure you have help to get in and out of the shower, for meals, etc - keep the crutches near your bed in case you head to the washroom overnight (night light helps) - have access to the maximum TV-movie-sodoku/Xword/book selection. You will likely be off work for 3-to 4 months. Use the time to mentally recharge as recommended by Ernie Els (Golfer) who tore his ACL boating last August and was back golfing in Dec. Lay off the beer and colas (and overeating vs activity ratio) to minimize the coach potato weight gain (e.g.Diet Pepsi, water) and overnight trips to the washroom. Also use extreme care on stairways. I used the crutches to climb them with someone right behind me going up, and felt the safest sliding down on my back side step to step going down until I could weight bear 100% and go down standing up. Crutches going down narrow stairs seem really risk to me. Be careful with your uninjured leg. You will be putting a lot of pressure on it until your weight bearing improves.
Rob

[asad]

hey guys, reading your posts has given me some outlook on how things will go. i am a medical student at msu and ruptured my patellar tendon this last week while playing kickball. i know....kickball. it was a med school student event so i was surrounded by my classmates, which was nice and not so nice. i didnt think the intial pain was that bad. i mean it hurt, but maybe i blocked it out in hopes of not looking like a punk. we have been studying the nuero-muscular-skeletal system this summer so we all had an idea of what happened. i was hoping it was just dislocated, but then one of our drs was playing with us and he ran up and was like get him to er. he explained to me what had happened and all i remember was dreading the rehab. er confirmed what i was already told. my family came and picked me up and now im near home. we have a family friend orthopod who got me in today for an office visit. the injury was friday. the surgery is scheduled for tomorrow at 3. im hoping things go well and scarring is minimal. i will keep you guys posted. please continue writing as well, its encouraging to see others going thru your hell. it helps make you realize, it will be ok. good luck to all of you and lets hope for a speedy recovery for all!!!!

[Unregistered]

ASAD:
I hope your surgery went well. You guys in the states seem to get the fast surgery (things are not as quick here in Canada). Try to make the most of the rehab time in terms of spending time with family and friends, mentally recharging, etc. After four months of rehab time, I've had my second day on the road bike and enjoyed it immensely (a lot better than the stationary bike). I passed a deer on the side of the road yesterday that came to watch the spectacle of the rehab rider whizzing by.

I averaged 27 kph for a 30km ride today on moderate rolling terrain (between 32-34 kph preinjury -I'm definitely to stay away from the hills for now, but completely flat terrain is hard to find - pat tendon is holding up well so far). Since I am embedded on my seat and can't push it by standing on my pedals yet, it was a pretty good ride. It can be a bit of a task to get on the road bike. I clip in with my rehab leg and then push off with the other to get going. I had a doctor recommended biodex test last week which indicated that I had only 30% on leg extensions and 55% on ham contractions compared to my non-rehab leg. My rehab didn't think much of the test since the ACL protocols recommend staying away from this type of open chain leg extension exercise until your leg gets stronger. The test at least gives a baseline to measure improvements.

But I am pushing 110 lbs with my rehab leg alone on the seated leg press (230lbs both legs), 50-60lbs one leg seated hamstring machine and 135 on the squat rack, so my strength is improving on the closed chain exercises. 10lbs on the rehab leg seems heavy right now on the open chain leg extension machine. That will need a lot more time to come around. I can climb stairs okay, but I need big wide non-steep stairs with a good railing to practice going down stairs. I will work on that at the Y again tomorrow since they have 6 flights of good stairs to practice on. I am pleased that the intent of all is to get my leg back to full strength. I have extra work to do since I had a long layoff period and consequently substantial atrophy. Most of the rehab work (90%) is up to you to do on your own. The physio just lays out the exercises. I recommend documenting your rehab (date, activity, sets, # of reps) and make sure you don't leave physio until receiving and writing down the list of exercises, sets and # of reps per day that match the changing limits your orthopod gives you as you progress through the rehab period.

As for your circumstance now, I needed the painkillers every four hours for the first four days post surgery and then I was fine without them. They probably will have you take some sort of aspirin once a day for 3 weeks to prevent clots. Keep that knee from getting jostled around or hanging unnecessarily (the weight of the leg will bother you for a while if it hangs off the floor). The first change of the dressing can be tricky since some blood may dry to the dressing. Soaking the dressing repeatedly with a wet (warm water) face cloth and gradually peeling back the dressing as it softens worked well for me. I only had to do that once.

After your wound has completely healed, a punctured vitamin E gel capsule spread on top of the seam once per day with a bit of moisturizing cream has worked well to make the scar fade. Range of motion is key so work hard on your physio. I hope all goes well for you.
Rob

[Unregistered]

Hello everyone!

This was a good site for me to read. I ruptured my tendon three months ago, and then i did it once again after two months when the worst part of the recovery was over. I managed to fall on a wet spot, of course it had a really big impact for my motivation to recover. The surgery I had was similar to what many of you other have described, and the rehabilitation training as well. I live in Norway by the way, make my living as a proffesional handballplayer so an injuery of this magnitude has of course a big impact on my life. My fysio tells me that if I do my training, I will probaby recover and be able to play handball again, at proffesional level.
Anyway as I wrote in the beginning it was very comforting to hear that the injury existed somewhere else and that it is possible to get back to an active lifestyle again.
Hopefully Im can write again in a few months and give some pointers to a fast and full recovery.

[bum knee]

I ruptured my PT while playing basketball on May 25 of this year. I had surgery a week later, and had a follow up exam a week after that. At the follow up I was told to keep the leg straight, and the knee brace locked for 1 month. I read of others on this site beginning rehab much earlier. Is it normal to begin rehab a month after surgery? I'm curious to know, since I'm worried about loss of motion in this knee. Also does anyone know about bromalene, and it's ability to breakdown scar tissue. This is my first venture at any sort of rehab, so I don't know what to expect. Will a CPM be used in rehab, or will I be forced to bend the knee on my own? I have so many questions, and not many answers. Can someone help me to understand how big this battle will be?

[Unregistered]

I would suggest that you talk to your orthopod about starting some passive physio earlier than waiting one month (no longer than 2 weeks). As I mentioned to Dee on page 1, first 10 days I stayed off the leg entirely. Next three weeks very passive physio you do on your own moving your leg with your hands while sitting to 45 degree ROM (supported underneath by a board with a slidy surface) and feather weight on left leg. I left my leg in a bent 45 degree position with a soft roll underneath the knee for 45 minute periods, 3X per day (did a few hamstring stretches). No active quad exercises.

The following four weeks involved more passive physio with leg bend to 90 degree ROM and 25% weight bearing on. My doc set my leg in surgery to give me at least 90 degrees, and then you work on getting more as healing permits.
Next 6 weeks (weight bearing as tolerated) and hopefully range of motion as tolerated.

It is quite a battle (more of patience and caution then anything else), but you can win it in time. It will be difficult for your friends to understand just how out of commission you are for the first few months, but then life brightens up considerably.

Rob

[Unregistered]

I thought it might be useful if I lay out in detail the physio that I did after the first 10 days post-op (pretty conservative physio regime).

3 weeks max flex 45 degrees - Repeat below 3 X per day
-Leg/Ankle flex (3x20reps) - Sit on couch with leg level and straight out on bench/ottoman with slidy board underneath. Use belt or hand to pull upper leg up to 45 degree mark. Use other hand to allow release back to straight position.
-straighten leg (contract toes toward you with straight leg to tighten quad) and hold for 5 seconds. Release and repeat 3X10
-Leg Roll- Sit on couch with leg level and straight out on bench/otto and place a soft roll under your knee that lifts it to 45 degrees. Watch TV with leg in bent position for 45 mins.
Calf stretch - after a week or so, use belt to stretch toes back toward you to stretch the calf.

Next 4 weeks max flex 90 degrees. Same as above to 90 degrees.

Next 6 Weeks - Started electronic quad stimulation at physio (cycling/spinning no resistance half way through this period for range of motion improvement). Started moving to one crutch(2 weeks), cane (1 week), and then walking with brace after that.
-Leg/Ankle flex (3x20reps) - Sit on couch with leg level and straight out on bench/ottoman with slidy board underneath. Use other hand to allow release back to straight position. Going for max flexion as tolerated hopefully by this point.

-Can Lift- (3X10)- Large can with towel around it. Sitting with leg level. Put can under the knee. Lever your lower leg off the can to raise it to a straight position. Release and repeat. Your knee will be sore and weak during the first attempts at this one. Gradually add weight on foot (1 to 3lbs - hero biscuit when you reach 5 lbs). Crucial exercise.

-Straighten leg (contract toes toward you with straight leg to tighten quad) and lift leg up about 8 inches, then lower. Repeat 3X10. (Same 1 to 3lb gradual resistance lifts).
-Calf lift (stand on toes and lower to ground 3X10) -Calf press - move foot to 45 degree flexion against an object and lean forward for calf stretch.
-Patella shift - when your physio says its okay, start to gently move the patella between your thumbs (alternating gentle side pressure) to make sure it doesn't lock up. Also gently rub the surface of the healed area horizontally across to make sure the skin doesn't stick to underlying tissue.
-Late in th 6 week period. Lift leg when laying on chest in bed with partial flexion straight up for rear muscles 3X10. Then some side straight leg lifts while standing, back step & return, lift flexed leg up to waist and return gently to ground. Yes, that really is your leg moving.

After surgeon says tendon is healed- Resistance training (weights/bike), wean yourself off the brace. Walk with the locals as much as possible.

Seated squats, seated hamstring machine, straight leg pulley exercises, road bike riding, stair climbing and (uugh descending), hamstring exercises using stretchy cord, toe touch & calf stretchs, squat rack with weights, etc. Don't forget to exercise the rest of your body. Recovering from the overall atrophy is the goal now. No pivoting for a couple of months at least.
Rob

[Unregistered]

Jonaton:

I'm really sorry to hear that you re-injured your knee after the initial surgery. Hopefully you will have a slip free rehab this time around. Just keep your chin up and work on your recovery. We don't have much choice but to stick to the recovery program and hope for the best. Your a brave guy to deal with the adversity you have encountered. It's a good thing you are athletic since that should help you recover better.

Rob (Canada)

[asad]

hey guys, thats awesome that you guys were able to do passive motions within the first 4 weeks. my orthopod told me, prior to surgery, i had to keep the leg in extension for 6 weeks before we did anything. im a little worried about the ease of getting it functioning again. i am going to see him today, so i will probably bring up some of the ideas that were mentioned on here.
as for those who have already undergone rehab.......how long would you say it took you to get back to normal form, as far as daily activities go and as far as working out or playing sports? do you feel like it affects your daily life now, any seasonal or occasional pain? are you hesitant to do any physical activities?
im just worried that this injury will always linger in the back of my head and cause me to be less active. prior to the injury, i was very active as far as working out goes(3-5 times weekly) and played sports whenever possible. but i dont know how forth coming i will be to do something like jump roping or some odd cardio routine after this is all said and done. any thoughts out there?

thanks again for the input guys, talk to you soon.
asad

[asad]

hey, i forgot to talk about the surgery. if youre like me, you like hearing about other's experience to help gauge how your outcome will be. my sugery went well, it was 4 days after the injury. the orthopod was actually a physician i shadowed while i was in college and he ended up writing my rec. letters for med school. it was kind of cool, but so much different actually being the patient. he did a clean job, i wasnt bruised or anything and when i went to change the dressings for the first time, there was no blood or other fluid leakage.

the day of surgery, i felt awesome.....must have been the morphine. as for the next day, i just remember waking up and it felt like someone was stretching the hell out of something inside my knee....maybe my patellar tendon?? well i took vicodenn and 2 ibuprofens that day and the pain cleared up. i have since taken about 5 vicodenns total, but used about 2 ibuoprofens a day for about a week. i am saving those suckers...vicodenns, for rehab.

i would say the worst thing about this whole injury is the lack of independence, at least for me. which brings up a question for everyone, how do you get around? getting in and out of chairs/bed, showering, even the bathroom? i have a chair set up in my shower along with a releasable head to make things easier, but taking a shower is a still a big event. how soon will this not be an issue for those of you who have gone thru this? how soon were you guys able to drive? unfortunately for me, this happened to my dominate/ right leg so i dont anticipate driving for at least 6 weeks if not more.

id say the first 2 weeks went well, about a week after surgery i started studying for a final which was last friday. my time was consumed studying which was also a pain in this state of immobilization. this week, we had the week off school and depression kind of set in. i had planned on doing all of these outdoor activities and seeing a bunch of friends who i havent seen in a while due to being away/busy for school. i was still able to see close friends, but it wasnt the same. it helped cheer me up, but overall i would say the last few days have been rough. i want to be out on a lake, playing golf,...i dont know, i just hate being blah. i started working out at home on monday. i have a bench that adjusts to different heights, mainly for abs. i just went thru some upper body exercises and it helped me feel somewhat better. this brings me to another question.........do you guys have trouble sleeping? i cant get to bed at night, i thought it may have to do with the lack of activity in my life. we are all use to doing so much more, that i was thinking maybe this much rest requires us to get less sleep? just a thought. ok, well i think i have written a novel here, so i shall stop. talk to you guys soon and any input is greatly appreciatied. good luck to all of you!!!!!!!!!!!