Quad Tendon Rupture/Rehab
I read with interest IDG and Vsoldier's progress. Perhaps I can give you some ideas with my experience.
56 yo male. Runner, now forced to treadmill due to knee pain, highly active outdoors.
On Oct 27, 2007, I was visiting friends in the mountains of NM. Just having arrived, I brought my suitcase to their 2nd floor bedroom. On the way down in leather -soled shoes, I started to "slide/ski" down the last 4 wooden stairs. When I stopped, I thought I had broken my leg. Realizing I didnt, but in tremendous pain, I noticed a gap above my right kneecap. I spent the next 3 days on 16 Advil a day (4 at a time) and wine! Returning to MN (tough trip thru airports) the following Tuesday I tried to get an appt with Ortho surgeon. When none was available for weeks, I scheduled an appt with an intern for Wed (Halloween). I knew I needed an MRI and that was my goal. She "diagnosed" ACL and meniscus tears/ruptures and scheduled an MRI. I coulda have had one Friday Nov 2 but business took me to PA Thurs, returning Friday, tough trip. MRI Mon Nov 5 showed Quad Tendon Rupture (rt leg). I managed to get into my surgeon of choice Friday Nov 9. He said classic QTR, have you eaten today? We can do surgery this afternoon, or Monday afternoon, your choice. I selected Monday as he said outcome would not be different and I had to reschedule work.
I had surgery Mon Nov 12, about 2pm. I was lucky, the surgeon could perform tendon-tendon sutures so I did not have to have my kneecap drilled. In the recovery room the nurse kept asking my pain level and administering morphine, 3 doses, then to Percocet. I was immobilized in surgery and finally sent home at 7:30 that nite. I had been told by Physician's Assistant I would be on crutches 4-6 weeks but I (and I asked) was told I didnt need them. I took last of Percocet the following Saturday. During this initial period, I was given 2 exercises, quad flex and leg raises. I couldn't do a leg raise until Saturday, unless I used my good leg.
I returned to Dr. (actually PA) Nov 26 and had the stitches out. He asked where are your crutches? ! He asked where are you doing your rehab? So I was a little disappointed in the communication end!
I began PT Monday Dec 3, 3 weeks post-surgery. I still was immobilized, only taking it off to shower every other day or every 3rd day (the first time I took it off, I almost passed out trying to maneuver into the shower!). Initial PT existed of isometric exercises (immobilizer on) which I did 3x/day at home, in between visits. December 10 the PT took my brace off and did electro-stimulation of quad while I flexed, and I did my isometrics with the brace off. I also had begun heel slides to regain flexion, not to exceed 45 deg. My first visit back I could do 54 deg, and the PT said great, but follow the protocol! I stuck with the 45 deg. I was highly motivated and determined to do what I was told to return to "normal". i continued with home exercises and PT e-stim/isometrics. On Dec 20 I received a hinged brace! Christmas! On about Dec 27 I achieved 90 deg (doing this from memory).
I returned to work on Jan 2, 2008. On Jan 17 I reached 120 deg flexion, but my quad strength was still very poor. I saw my surgeon on Jan 18, he was pleased with my progress, and explained that the inner most quad muscle "turns to mush" in this type of injury and takes time to come back. He told me to anticipate minimum 6 months to recover and more liely 12 months. At this time I was experiencing pain on the inside portion of my right leg, explained by the weakness of my interior quad muscle which helps keep the patella from staying properly in place. I used Aleve, 2x/day and watched my exercises to reduce the pain.
On Jan 23 I had my last PT, 124 deg. Stationary bike was most helpful to get there. I was on vacation the last week in Jan and spent 1 hr 2x/day in the gym, mostly on stationary bike.
On Feb 6 I began PT at our local retirment complex for the primary purpose of gaining quad strength. I did therapy pool (98F) exercises, warm pool exercises, some limited weights (curls, leg presses) and still on home isometrics. I had my last PT there on Mar 6, was evaluated as 80% strength of myleft leg, and 130 deg flexion.
Today i continue to do circuit training at a local club where a program was set for me. I do 10# leg extensions, 15# leg curls, elliptical 10 min, Wave 5 min, and 10 min treadmill. I have tried to eliminate Aleve twice. Last Thurs - Sun I went to the club each day. Monday I had pretty good swelling on the outside of my knee, and interior pain. I am now back on Aleve 1/day and have backed off leg exercises at the club until Fri of this week.
I must say that therapists have been tremendous. I am not a patient person, I want results, and as you know, they don't necessarily come quickly with this rehab. I am told all along I am progressing fine, be patient, it will come back.
Today, if my leg is rested, not sore, I can walk normally to an outside observer. To me, I feel a "hitch". My knee feels "full" which I attribute to remaining inflammation, primarily at the suture site. This past Monday I was 17 weeks post surgery.
My Ortho Rhab protocol calls for "light running" beginning week 16. I cannot run on the treadmill without a serious hitch in my gait, a severe limp. My PT recommended I do not run until I can do so with a normal gait. I continue to do pool therapy (walking/"running") post circuit training.
I can now begin to see the return of some definition of my right quad muscles. When I do leg extensions, I do them 1 leg at a time, and I see significant difference in quad definition between the 2 legs, but I see progress.
I too have a long icy driveway and until about Feb 23 used my brace to walk outside. I no longer wear the brace.
I am encouraged by all those health care workers who tell me I will "get there, be patient". But I am on my own to judge how to progress, and will use pain/swelling/fatigue to judge.
Best of luck to you who are going thru this!
Bulldog
