Patellar Tendon Rupture.....

[Rob N]

Steve:
You should also think about the leg extension machine. I would not recommend using this machine until you have some professional advice about when you are physically strong/healed enough to start using it (always adjust the resistance pad as high up on your leg as possible to minimize strain). The leg extension machine certainly isolates your quad and helps build your stubborn vastus medialas (vmo), however, it is a high risk machine since it places a lot of stress on your knee and patellar tendon. I didn't get the green light to start using the machine more aggressively until about 8.5 months post-op. I started very gently (one leg) with about 10-12 pounds (single plate) and stayed there for quite a while. I have been told to use the weight that I can move for sets of 10 while being able to release the weight down very, very slowly for every rep. After a month, I still start with a set of 10 at 10 lbs, and then a set of 10 at 30 lbs, a third set of 10 at 40-45lbs - followed by one set of 2 leg at 90lbs. I then head off and do a pile of other weights and return at the end of the workout to do another three sets of 10 (one leg), one at 10 lbs, 1 at 30 lbs and 1 set at 45 lbs.
The type of machine, seat position, resistance angles are all key in the level of weight I can move. It's different on every machine. Use extreme caution. I am always relieved when I successfully get the sets in, and then I scamper away for 30 minutes on the ellipitical to finish off the workout.
Rob N

[FINFAN3DP]

This past Thursday, 12/14, I fell down 4 steps and landed on my knee. Was taken to hospital by ambulance. They did xrays and say that i Ruptured my Patellar, but each time they came in to look at it they said it was strange that it didn't look that much different from my other leg. They sent me home that night and scheduled a MRI for the next day. I went and did the MRI but they didn't tell me anything, they said they were going to send it to the Ortho guy that afternoon. I have an appointment in the morning on Monday at 8:15 then they say surgery at 12 noon. I am in extreme pain when either putting weight at all on that leg or taking weight off. I've found the best position is to have my leg straight out and up on the couch along side of me. I cannot bend the leg at all and the doc sent me home with one of those foam/velcro braces, but told me I didn't have to wear it unless i was up with my crutches.

I guess my questions are 1) What did everyone's knee look like?? I mean did you have bruising or swelling or blood under the skin? I have some swelling, but I'm a 350lb guy so that's not abnormal. I have no bruising or anyother indication, other then extreme pain that says something is wrong.

2) I work as a police clerk and sit at a desk all day. How soon can I get back to work?

3) Can I drive considering it's my left leg not my gas pedal leg?

I'm sure I will have more questions but that's enough for now. This was in one way a great site to find, but in the other way it sucks that we all have to endure this pain.

[Rob N]

FinFan:
Best to assume that you have torn your patellar tendon (the MRI may or may not confirm it - sometimes the radiologist report may come back as a possible partial or full tear). Typically from my experience, I had considerable swelling, a flatish look to the front of the knee (and initial immediate post injury I had the tell tale horizontal crease across the middle of the knee and an immediate spasm of the knee that I was able to fortunately put in a straightened position). Your patella will likely be high riding (up possibly several inches above where it sits on your non-injured leg). You likely will have considerable swelling that does not fade quickly. My leg was most comfortable in a straight position. You are fortunate to have had an MRI and the option of surgery quickly (the studies suggest that immediate repair gives the best outcome). I could not straighten my leg the last 15 to 20 degrees slowly when seated and hold it (which confirmed for my surgeon that the tendon was completely done in). I could swing it up there straight, but that was due to other muscles compensating. I could not lift my leg straight up while laying on my back in bed for 4.5 weeks post-injury. Then I started to be able to do it, but with a partially bent leg. Pain killers, regular icing and elevation of your leg to chest level should help at this stage. You will likely have a very swollen left ankle.

I was off work for 4 months post surgery(3 months to get the tendon healed, learn to walk again- and I took another 3 weeks to get some strength back into the leg resistance training. While the tendon/graft are healing, it is not worth a re-rupture working unless you have no other choice. Your future mobility is on the line. They will likely opt for a hamstring graft (or possibly use the wire which requires a second surgery to remove). The hamstring graft worked for me (must be careful that you don't tear it). An allograft (cadeaver) may be a possibility, but there is the risk that your body rejects the foreign tissue. I injured the same leg as you did. I drove my car pre-op - but post-op I didn't start driving until I was at the cane stage of recovery (9-11 weeks post-op). Please read my other threads at this site. They will help you. Be confident that you can recover. I recommend that you put the cause of the injury behind you and focus your attention on a gradual recovery.
Rob N.

[Steve in NH]

FINFAN......I also injured the same leg if you read back my first entry back in June.
So it is now been 6 months and I can only advise if you can flex your left lower leg
toward you but not back out away from you and if your knee cap is depressed like a
golf divit.....you need the surgery ASAP. Regular X-rays will not show this patella tendon.
That is the first thing my Ortho told me in the operating room. I was lucky and had good Dr. and surgery same day of injury. The surgery should go well with very little scaring.......
However it is so important to get good PT after initial healing at around 3-4 weeks or
as your Dr gives you OK. Like Rob and others said......it does get better and for now
keep leg elavated up on couch or coffee table. After surgery you will have brace on for
about 6-7 weeks......I was able to get behind wheel of mini van and drive at 4-5 weeks.
You will need help every day but should be able to get around on crouthes...very careful
with stairs. You will have lots of questions and hope we can help. This website was a lot
of help to me over the first 2-3 months post opt.............Good Luck, Steve C/NH

[Norbert]

I only found this site today, and what a great read it has been for me - it's somehow comforting to know that others have been there before you.

Here's my story ...

I am a 38 year old guy and was very active. I played 5 a side soccer once a week and 11 a side soccer on Sundays with training once a week.

I also ran - I completed the 10 mile Great South Run this year for charity and considered my self quite fit.

I have Crohn's disease (which I have had for 20 odd years) and take a multitude of pills for on a daily basis - including steroids and AZT, an immunosuppressant. One flip of this is that it denudes your vitamin B12 absorption and for which I receive quarterly injections. The reason I mention this is that one of the symptoms of B12 deficiency is aching muscles.

Playing as much sport as I did, my knees always seemed to ache, and I put to down to my advancing age and the B12 issue.

Anyway, on to the injury.

On 22nd October I ran the Great South Run in 1hr 42mins and felt fine afterwards. I played my 5 a side and 11 a side and trained for soccer as usual for the next four weeks. The training took place on hard astro turf and my knees always ached after training - I put it down to the surface.

In early November I played a full 90 minutes of soccer on astro turf and had my left knee strapped as it hurt more than normal.

On 21st November I was playing 5 a side soccer on a good artificial surface.

After about 23 minutes of play, I was sprinting to get the ball shoulder to shoulder with another player and when I felt my left knee give.

I looked down and saw my left kneecap about two-three inches above where it ought to be.

I collapsed screaming and holding my knee, but after about a minute, I realised it didn't hurt at all, provided I kept still.

An ambulance was called and arrived eight minutes later.

I was taken to A&E, the initial thoughts being that I had dislocated my kneecap.

I had two X rays and then the A&E Consultant told me that I had ruptured my Patellar tendon.

This was deemed unusual enough for seven (yes, seven) junior doctors to have a go at guessing the injury - only two were right, so top marks to the Consultant!

I was kept in overnight and had surgery at 3pm the next day.

I had no pain at all until I left hospital and walked on the leg. I now walk without crutches and find no difficulty with stairs. The biggest bummer is that I can't drive the car! It may be a different case once the cast comes off!

I am now told that i had an "avulsion of the distal pole patella", in short, I yanked the tendon off the kneecap.

The surgery re-attached the tendon and four screws now help it stay where it should be.

I was allowed home the next day and had a back-cast on for the first week.

A full cast replaced that for week two and now I have another full cast (hip to ankle) with no flexion until 17th January.

I am told that this will then come off and a knee brace will go on for at least 4 weeks, with increasing knee flexion and Physio.

I'll keep this updated with how things go.

Two things to say.

The cause.

The surgeon thought initially that the steroids had a major part to play. Having done some research, I am convinced that I had Patellar Tendonitis, and that the aching, hurting knees were the warning signs that the patellar tendon was starting to rupture/detach. The previous four weeks to the injury, I had the classic signs of PT, and had I known ...

The result.

I know that I am in for the long haul here. I am not the youngest patient and I want to get to a stage where I can resume sports.

At the moment, I have days where I am quite positive, and days where I feel very down.

Having read other posts on here, I realise that things could have been so much worse - both legs at the same time? That does my head in and the guys on here with that injury have the utmost respect from me.

So, I must try and look on the positive side here and set myself realistic goals which I can achieve to get me back to some sort of activity level.

For my own part, I feel that the fact that I had little pain may be a good sign and the consultant says that the repair he did is excellent.

One last thing - there are lots of people who criticise the NHS in the UK. I had surgery on my knee within 20 hours of the injury, free of charge.

I read with horror the accounts from guys in the US waiting upwards of 5 days for surgery.

One thing I have noted, is that early surgery significantly increases the chances of a full repair, so I'm hopeful of a positive outsome.

Anyway - thought I'd share my experiences with you all.

Nick

[Rob N]

Nick:
5 days is a fast repair. I had to wait 5.5 weeks. Anyways, you certainly did well getting an immediate repair. Your age shouldn't be a problem for the recovery. Your willingness to do the rehab and recovery is the bigger factor. I would be a bit concerned about being in a cast for an extended period since you can't do any passive rehab to gradually build your range of motion (ROM) until the cast is off. Definitely focus on building your ROM when you get the chance. I didn't have a lot of pain either beyond the initial incident (that is likely because the tendon was completely severed - likely more painful if only a partial tear). It sounds like things are going well for you and hopefully you will have an easier time rebuilding your quad than I have experience since you received your surgery so quickly. Be especially careful when you come out of the cast. That tendon is fragile. Did you have a hamstring graft or are you using the wire (I'm guessing that you are using the wire)?
Rob N.

[Norbert]

Rob

Thanks for the reply.

I'm not sure what you mean when you say 5 days is a fast repair. I had the surgery within 24 hours!

I too am a little concerned about the cast being on for 8 weeks in total, however, I am reassured by the fact that my Consultant Orthopaedic Surgeon is one of the best around and comes highly recommended. I know quite a few in the local medical profession, and they all say he's a top bloke and the best guy to tinker with knees! I'm working on the basis that he knows what he's doing.

As to grafts and wires - neither. My surgeon was going to wire the repair, but said that as it was a detachment rather than a tear the wire wouldn't be required. Also, he said that having another op. to remove the wire in a few weeks would have been an unnecessary bout of further surgery. The repair has been strengthened with four screws into the patella.

I am hopeful on a number of fronts:-

1. I got surgery lightning quick and from a top bloke who says that I should be fine;

2. I have no pain and I am up and about without crutches at just 4 weeks;

3. My leg is actually feeling quite good - I know when the cast comes off, that that's when the real hard work starts, but hey,no pain, no gain, eh?

Nick

[Steve in NH]

Rob...The one exercise you reccomend with leg extention machine is the one machine my
PT has told me to avoid due to possible re-injure. How about your #2 best exercise or
health club machine to best build up quad???? I've got to get leg muscels in left leg stronger but with work schedule cannot really get to gym everyday. If I get there 2-3
times a week what 2-3 workouts do think is best???
Steve in NH

[FINFAN3DP]

Just got back from the hospital. They had me stay over night. I cannot believe the amount of pain I was in and how it is still very painfull. Can anyone tell me how long the burning pain lasts? Thanks.

[silerlock]

I'm a 30 year old that tore my Petella tendon mid structure. I was playing basketball and one of the players fell on me. When I tried to get back up I noticed that my leg didn't work. I didn't feel any pain, but my knee cap was three inches higher than it should have been. After a ride in an ambulance, I was in surgery a couple of hours after the injury. The ortho said it was the worse one he has ever seen. The tendon completely ruptured in the middle and it shredded like spaghetti at the ends. He put it back together the best he could and held everything together with a circulage of wire around the knee cap and through the tibia tubular. It's been seven months and i'm walking normal and riding a bike. I can single leg press over 80 pounds and can do walking lunges. My trouble is with leg extensions. It is really sore trying to extend leg with any weight on my ankle. Has anybody else experience this? I try to talk to the doc about it but he just shrugs his shoulders and won't give me a answer.
Thanks,
Chris

I just wish I could wake up and this nightmare would be over