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Quadriceps Tendon Rupture, Repair and Rehab - Page 136

post #4051 of 10804

8 months post injury

7 months post first surgery

3 months post second surgery

51 yr old male

complete quad tendon tear


Quick Update - I hit 136 degrees ROM this week (my good leg is 142). Stationary bike really helping, I do 30 minutes at the lowest seat setting a couple times per week. Am doing strength building exercises now too. I can go downstairs in a reciprocating gait but it is still difficult. My second surgery was to remove scar tissue via three arthroscopic portals and then a manipulation. Before that procedure I was stuck for a couple months at 68 degrees.

post #4052 of 10804

Just an update:






Was able to easily hit 60 degrees range of motion which I guess puts me on normal course, a first good feeling over the past month.  Have lost over 2 inches from quad but I know its normal and will come back.  Able to weight bear and walk with minimal discomfort utilizing the crutches.  Working with what I have been told is a conservative protocol but seem to be doing fine.  Went back to work after two weeks being new in a position and have been ok, tired and some swelling at the end of the day.  Able to elevate but started bring ice packs to work the past few days to try and minimize the swelling.  Going to be a long road, but one day at time....no matter how frustrating.

post #4053 of 10804

Hey StevieP,

I feel for you. You are clearly stuck in a bad state. I don't know how it would cost you financially, but my humble opinion is that you should get a private consultant to assess your situation and consider MUA. I personally could not imagine being in your situation possibly for the long haul. Good luck.

post #4054 of 10804

Hi Frank - Inpatient guy here. Saw your comment about the bump on your knee where it was reattached.. I am 23 months out from surgery, and still have my "bump". It is in a place that keeps me from kneeling because it still hurts when I kneel on a hard surface. If I put a towel down or wear a kneepad, it is fine.


Anyway, to get to the point, my OS told me that it is where the wire used to pull everything back together is knotted, and that if it was a "problem" he could easily remove it since healing is complete. I think I will just put up with it, as I really don't care to ever have another procedure performed on that leg smile.gif Good luck.

Inpatient guy,


post #4055 of 10804

NYYankee - I'm about a week behind you, but I'll give you my progress as a point of reference.  I just got moved to 45 degrees ROM in my brace this week (at 4 weeks PO) and I'm finding that it is a little more painful than the 30 degree setting but can "walk" a little better.  I'm also moving around well on crutches, sometimes just 1, and can pretty much fully weight bear.  Occasionally even take a few steps without the crutches.   I commute into NYC and have been taking train and walking 5 blocks to work.  I'm finding that the trip home is tiring and I too have  a lot of swelling at the end of the day.  But considering where I was 3 weeks ago, it seems like slow and steady progress.  That's all I'm going for.  Good luck,



post #4056 of 10804

Hi guys!

I hope everybody moving in right direction -  toward complete healing

Can somebody provide timeline for you recovery.

Particularly what you were able to do after 3.5 months postop

Have a good weekend.


post #4057 of 10804

Update here: Had my 2-week post OP appointment with the surgeon last Thursday. Was told to stay in the brace (straight-leg) until December 10th at which time I could begin some heel slide exercises on my own; up to 30-degrees the 1st week; 60 degrees the 2nd week and 90-degrees the 3rd week. At this time all he says I can do are some quad squeezes and straight leg lifts in the brace, if I can manage them.


He doesn't want to see me again until the first part of January, at which time he said he will prescribe some PT. At this point he said they wouldn't be able to do much for me and would be a waste of time. I understand from reading through the forum that there are conservative and progressive approaches to this injury, but this seems to be ultra-conservative......and against my nature. I did talk him into letting me get into some pool work, but only after December 10th. I guess I would like some feedback from others as to this approach. Seems a little too conservative to me, I am afraid of scar tissue build-up and difficulty in regaining ROM.




post #4058 of 10804

mdciggy - your treatment does sound conservative, but your doc knows best and he saw the damage.   For what its worth, I started PT at 2 weeks and have not done much more than quad squeezes and leg lifts since then - I'm at 4 weeks now.  PT does do some massage and a little passive ROM, but your doc is not too wrong - I could do almost all of it at home and do on the non-PT days.   I've read a lot on this forum and while there is concern about scar tissue, the overriding theme in the early going is patience - let it heal.  Your are not going to get too far behind by waiting til 6 weeks to begin really working on it.  I crutched into the gym today and did 30 minutes on the hand cycle and some upper body weight work and felt almost human.  Maybe that will make you feel better.  Be careful.

post #4059 of 10804

Estearn and mdciggy,


My brace is now open as well to 45 degrees.  My OS stated that I could now (going onto 5 weeks) get around with either one crutch or switch to a cane.  However, when I went to PT later in the day, his recommendation was to stay with crutches a little longer as switching right now will delay bringing back some of the walking motion...just food for thought.


 I started PT at week 3.  I agree that a lot could be done at home but the leg compression boot they use literally moves all the swelling out of the knee (very temporary of course), but, it allows the PT to massage and manipulate the kneecap which will definitely help with stiffness and scar tissue, also I am on what the PT said was a conservative protocol but I think most call to get 90 degrees ROM by 6 weeks which is going to be hard the later you start, getting in now they can slowly start helping you get there...if co-pays or limited visits are not an issue, I would take advantage.


 I do ice and electric stimulation and the PT has ordered one for me to take home...this will assist along with the quad squeezes to bring back some of the muscle above the knee cap.  Just another thing to think of...regarding quad squeezes...I have been a gym rat most of my life...I was squeezing my quad and getting a lot of motion in the upper quad forming a muscle again.  Well, showed the PT what I was doing...and I was not doing them right...what he was looking for was squeezing of the lower and outer portion of the muscle...closer to the knee cap, you should see your knee cap slide up if your doing them right.  At the risk of sounding like an idiot...I thought I'd share that so you don't waste a few days like I did.  I am happy with the progress to date as was the doctor.  He was able to bend me 90 degrees and actually doesn't want me going anymore until after 6 weeks so concentrating on those squeezes and I believe some calf raises this week as my calf has also turned to mush.  Sorry for getting wordy...just sharing.

post #4060 of 10804

7+ months


Improvement seems to plateau out at intervals. I haven't been able to kneel, or walk down hills/steps very comfortably, without much improvement for quite a long time.

I've hit on a new exercise which seems to be making a big difference quite quickly.

I've had my bike on a turbo trainer for some time and it was really good at the beginning, just for loosening up etc. What I'm doing now is pedalling standing up (holding the bars) as if honking up a hill. I put the bike in top gear and set the trainer for max load to make it feel even steeper.

First attempt I could barely get my bad knee past top dead centre. But this improved quite quickly. I can now do it very slowly for 2 minutes max. But I can really feel the benefit. The pains below the knee are easing off and the leg feels stronger.

I'm really pleased with this. 

I couldn't have done it at all only a few weeks back, so if you try this don't over-do it too soon!

On the road I haven't tried honking up a real hill yet but I'm going OK in the saddle.

post #4061 of 10804



I'm the same age as you. When it happened Doctors told me I was young to have the injury. I tore my Right Quad on the third of oct. A week and a half before you. I am only at 40%ROM. I dont use my crutches at all around the house only when I am going out. They havent even started me on PT yet.  Anyhow, did you have pain trying to get to 60%? I guess everyone heals differently. I seem to be on a fairly conservative regiment.

post #4062 of 10804

Hi Theaetetus,


My PT said that my OS protocol is pretty conservative, for whatever reason thus far, I just haven't tightened up.  60 deg was pain free, can hang from a table 90 deg and feel a good stretch in the upper quad but not painful.  Not going past 90 until hit 6weeks.  I started at week 3 doing heel slides to bend the knee and did them as frequently as possible, I think that probably helped.  


Heard the age thing too, not common for people under 40, however if the impact is traumatic enough, its going to happen.  Had knee issues previous to this put took a fall and came straight down on the right leg.


Interested to keep hearing your progress...I have gotten great tips here.  Will let you know if I come across anything interesting...

post #4063 of 10804

Just back from PT this morning and had an interesting "breakthrough."  After the stim and squeeze routine, PT had me work on heel toe walking between two parallel bars, gradually decreasing the reliance on the bars.  After a few minutes, I found that I could take small steps without using the bars with a normal gait, and subsequently walked across the gym without crutches and without the gimp limp.  Slowly, small steps, but equal weight on both feet and no limp.  My brace is set at 45, so I'm not going very far like this, but it was real progress.  I also think that I had a mental block based on expectation that the knee would give and it would be painful and when it was not, I got a little confidence.   I'm still going to use 2 crutches for any kind of distance, but this was pretty encouraging.  PT stressed same thing NYYankee said - more important to focus on quality of walk than on reducing the number of crutches you are using.  


One more thing that may make MDCiggy feel better - My ROM is nowhere near 90 degrees at 4.5 weeks.  I'm maybe at 50 degrees and PT is not pushing it.  They are much more focused on my ability to extend the leg straight, as failure to get that right is apparently harder to remedy later.  I'm told the ROM will come when the healing is done and to focus on the quad squeezes and leg extension exercises. 

post #4064 of 10804

From Active Padre


Update at seven months post op.


69 years old; male; active cyclist, hiker; sometime skiier; reading and photography hobbies; fairly sedentary work (pastor of large parish).


Full QTR right leg; spontaneous injury while hiking in Utah desert near The Wave April 19, 2012.

Surgery three days later at Mayo Clinic, Rochester, Minnesota.

Full cast for one month.

Split cast for one month to allow some knee movement.

Soft, adjustable brace for one month.

After three months began PT twice a week for 6 weeks.

Worked on ROM, muscle rehab, softening scar tissue; used cold laser treatments as well.

Current ROM: 130 degrees, compared to good leg at 145 degrees.

Bicycle flat road/paved trail every other day for 1-2 hours. Flat single track alternate days for one hour.

Try to walk in evening, but still get quite sore doing so.

Workout upper body at gym; some eliptical work as well.

Restrictions: running; anything that would require foot plant with quick change of direction (soccer move); squatting to lift anything.

Have soreness and stiffness after standing, walking or sitting for moderate length of time.

Most days don't think about having injury other than when standing up from chair or sitting down or walking down hill.

Take acetaminophin 500 mg. x 2 at bedtime if soreness or any pain felt.

Residual issues: muscle tone and strength in injured leg still lacking, but getting better; soreness in uninjured knee; general lack of stamina; get tired very easily; evening meetings hard to take (but that's nothing new!)


For newbies: Mayo Clinic conservative recovery process: 3 months for healing; no agressive PT, only simple leg lifts, quad, glut sets, etc. 6 weeks PT with therapist experienced in this particular injury; ROM goals: one degree per day post op (e.g., 90 degrees at 90 days); use ice pack after any workout, or for any swelling, which is expected; full recovery possible, but most outcomes are short of returning to pre-injury level of activity. However, it depends on letting tendon fully heal (three months), physical condition, age (older tendons more brittle, harder to heal); pre-injury level of activity (athelete vs. couch potato). My surgeon expects near full recovery for me, but will be 12-18 months post op.

I'm looking forward to retiring this summer at 70, and hope to increase the time I spend hiking, biking, traveling and continuing an active lifestyle. For you younger QTRs: if I can recover you can as well. Be patient, let tendon heal, slowly things will come around. Expect setbacks and plateaus. Don't overdo it at any point in time. Find more sedentary activities while recovering: reading, crosswords, watching TV, gaming, fantasy sports, etc.

Thanks to all who helped me along the way with their comments.

Keep the faith


post #4065 of 10804

StevieP,  Are you doing wall slides?  That was the single best exercise for my ROM and should be something you do multiple times per day until it's where you need it to be.



For those commenting on the eccentric phase of exercise that I mentioned, I agree that it needs to be done with care.  I'm not suggesting that someone still in their brace do full bodyweight squats with one leg.  I'm suggesting that in all of the exercises you do, really concentrate on the the eccentric phase.  If you are doing a leg extension with no weight to contract the muscle, don't just let it fall back down, take it down easily to a count of 10.  If your PT has you doing step ups to increase your strength, really concentrate on doing step downs as well in a slow controlled fashion to help.  When doing this, make sure your non-injured leg has the toe up so you aren't lowering yourself into a position where that toe and your calf help you on the way down.


For those complaining about knee pain, I think it's because your quad isn't strong enough to help with the tracking of your kneecap.  The weakness of the muscle had mine tracking in a way that it moved ok until about 45 degrees and then had a "catch" where it hurt like an SOB until I got passed about 50 degrees and then it was fine.  What I learned was that might patella wasn't tracking normally due to the weakness in my quad.  Knee pain continued until the leg strengthened to a point that it tracked as it should.

post #4066 of 10804

anyone know if they had an oblique tear or a tear off the bone? mine  was an oblique tear so the doc had to sew mop-ends together. anybody else have that. most tears are off the bone.

post #4067 of 10804

Mine was mid-muscle where there were "mop ends" he trimmed up and reattached.

post #4068 of 10804



Yes i've tried wall slides but they give me too much pain and as yet i've not found a pain killer that will cover up that kind of pain, i've been taking anti-inflammatory drug for arthritis for about 24 years now so i have developed a high resistance to many pain killers. Apart from the pain the main problem i have is that when i get my knee to 98 degrees it just comes to a stop, almost as though a leather belt was attached to my upper leg and my shin which is stretched to the limit when the knee is bent, i put this down to scar tissue build up, well at least i should find out this friday as i am going to see my surgeon......fingers crossed!

post #4069 of 10804
Good luck brother!!! I hope they can massage that shit out or something.
post #4070 of 10804
Originally Posted by oldbumper View Post

Brad J,

Ironically, it looks like you and I are two of the only skiers currently posting on this forum. I am only at 14 weeks post-op, so I would also love to hear others' experiences with skiing after this injury. I will be at about 8-9 months post-op by the spring season, and I'm hoping and planning to ski groomers with my kids at that time. I generally ski very aggressively, mainly bumps and powder (when I can find it, of course), but I'm not expecting to do that level of skiing until the 2013-2014 season, unfortunately.


BTW, my original quad rupture happened at a summer ski camp, tho I was on a trampoline when the injury occured...

oldbumper, skied on sat for the first time since april 6 date of my injury, took it easy felt good, not pain just a little stiff, am ging this sat and will ski at least one day a week during the season, planning on no bumps this season, and not sure about powder, lots of groomers ,not my favorite but thats where I am. will post as I get into shape. brad

post #4071 of 10804
Originally Posted by StevieP View Post

when i get my knee to 98 degrees it just comes to a stop, almost as though a leather belt was attached to my upper leg and my shin which is stretched to the limit when the knee is bent, i

put this down to scar tissue build up


My injury was minor compared to what you all are talking about ... a fracture of the proximal tibia and some ACL damage.  But I had similar problems with heel slides.  The cause of mine was knots in the IT band, which were massaged out.  The deep tissue massage wasn't fun either, but it took care of the problem.


Good luck on Friday!

post #4072 of 10804

oldbumper, skied on sat for the first time since april 6 date of my injury, took it easy felt good, not pain just a little stiff, am ging this sat and will ski at least one day a week during the season, planning on no bumps this season, and not sure about powder, lots of groomers ,not my favorite but thats where I am. will post as I get into shape. brad


That's awesome! I guess that means at about 7 months post-op, you're out on the slopes. Something to look forward to! Keep us posted on the skiing!

post #4073 of 10804



Just checking in for a rehab update. Im 9 months post op. Im 43 years old and very active. Im a police officer and in the army reserves. Its been a test of my character and heart to get back to my previous form. Not there yet though. Here is just a bit of my current rehab.


warmup with 5 mins on eliptical

run on treadmill for 15 mins level 5-6

agility drills simular to football drills

step ups and downs off of a 2 foot step (hard)

lunges onto a bosu ball (hard)

jumping drills through a laddar (fun but hard)

leg presses isolated injured leg

leg extension (I know its bad but only doing 20 pounds supervised by PT)

wall sits 3 sets of 1 min

trampoline drills

windsprints in the hospital hallway (seriously lol)

suicides in the hospital hallway (seriously)

squats while standing on bosu ball( hard)

running with sport band attached to waist (fun and hard)


I leave PT dripping wet shirt completely soaked.. My PT is a small petite young lady and  she had a big smile everyday.. She was awesome and she got me back on duty full time and back to my military training. Im still carful when stepping down stairs BUT as the quad gets stronger its becoming less of an issue. What a journey.. This site was the only thing i found that helped me research and assist in my recovery.. My PT was awesome and a cutie pie lol.. All the hours of stretching the knee from 0 to 130 was worth the pain.. Everyone was a motivator on this blog.. I will check back in in a few to see how everybody is doing and hopefuly to give a 100% report..lol Keep pushing!!!

post #4074 of 10804

It has been a while since I last read the posts on this site.  It is very helpful.  49 yrs old, full Left QTR, surgery 5/3/12.  Still have daily nagging pain and swelling, but back to mormal in terms of dialy routine.  I cycle a 10 mile loop 3-4 times a week which has been very helpful. One observation that may help is that many people have pain or trouble with stairs.  I worked very hard at the gym with the aerobic stairs first one level high then increased to 3 levels high.  I worked on the downward movement leading with the good leg and slowing bending the bad leg, just working on that motion. I did this early in rehab, maybe starting at about the 8-10 week mark.  Consequently, I mastered stairs up and down without pain or use of the rail at proably the 3.5-4 month mark. I am still lacking full Quad strength and continue to work on this aspect.

post #4075 of 10804

Hi Quad Rippers,


I am at 10 weeks post-op. 77 yrs. old - active - carpenter. Today the Doc removed my brace for good. Moved me to 170 lbs. weight bearing - in 7 more days i will be at full weight bearing and then the walker is gone too. (Can use a cane as needed.) Now my ROM is 87 degrees - Doc says he wants 110 degrees ROM in next 7 - 10 days and 120 degrees ROM in an additional 10 - 14 days.


I will be in Outpatient PT 3 x per week for next 4 weeks.


I really have a big job ahead of me - but I've been asking for it and now I have it.

post #4076 of 10804

Hi Old Runner Guy,


I had a serious setback last Friday.  I was jogging and walking and during my last jog before going to work I heard and felt a loud pop in my left knee.  I had no idea what happened so I just went to work.  By the time I got to work it really hurt so I called the orthopedic.  After an examination and confirming xray it was determined I had fractured my kneecap, left side vertically top to bottom.  The surgeon said he has done 750 quad tendon repairs in his career and never saw this happen.  So here I am back in a leg brace waiting for an MRI on Friday and consultation with the surgeon next Wednesday.  Surgery will follow ASAP. The fix is two screws horizontally in the kneecap to hold the pieces together.  They also cut tissue to the left of the knee cap to relieve tension. 


The explanation is there was a pressure tension point was in and under my kneecap probably caused by the quad tendon repair and there was degeneration of bone on top.  The weakness was a fault line that caused the kneecap to flex back and forth and over time it snapped in two.  Initially they told me 4-6 weeks in a brace and then rehab.  I asked how we could be more aggressive and he described the procedure first developed in Japan. 


The only good news is I can move around weight bearing and once the screws are in the healing process should go pretty quickly.  As bad as this is it is nothing compared to the original injury.  I have always thought a broken bone would be better than torn muscle and tendons.  Now I get to put that theory to the test.


Anyway, that's my update.  No 4 minute miles in my immediate future!


Happy Thanksgiving to all!


All the best,



post #4077 of 10804

wow sorry to hear that Dan.. my question is, was there anything you could have done to prevent this? more stretching or warm up activities?

post #4078 of 10804

Distressed to hear about Will Run Again's setback. Hope all goes well for your surgery. I am coming up to 12 weeks post op (16 weeks post injury). Have 110 ROM. Physio has given me exercise to to in the gym where I use a light gym ball behind me on the wall to give back support and then doing squats- have to try and stop the good leg taking all the weight. Have continued with reverse direction on the X trainer, the horozontal bike and walking in the pool. Still using the brace but with no ROM restrictions. Physio has explained that there is more stress on the knee because weak quads give less support- so brace allows exercise to strengthen quads without overstressing the knee. However full recovery seems about 9 months away.

post #4079 of 10804

Hi Bikerboyz,


The natural reaction to what happened to me is to ask did I do too much too soon.  I don't think so.  There was a tension stress point under the kneecap and some degeneration of bone on top.  The situation allowed the kneecap to flex slightly and it progressed to eventually snapping in two.  If I did less I think the kneecap would have eventually snapped anyway.  In any event, it is what it is.  There was a weak point that was going to cause problems sooner or later and it turned out to be sooner.


The surgeon described the fix as two screws horizontally in the kneecap to lock the pieces in place.  Then they cut some of the connective tissue on the left side of the kneecap to relieve some of the tension.  The screws don't bother me but cutting tissue does.  I have my MRI tomorrow morning and see the surgeon Wednesday.  I assume surgery will be scheduled the following week.


I guess all any of us can do is get up after we've been knocked down.  A complete quadriceps rupture is a serious injury and full recovery takes a long time.  At least a year.


Happy Thanksgiving to all!



post #4080 of 10804



SO SORRY to hear about your kneecap......you are probably correct in that it would have eventually happened as you have done all the correct rehab. With the long rehab from the quad this is a tough setback. But ...you have the drive, desire, and mindset to overcome this and go forward. You will be back running this summer. Good Luck and we all will be thinking about you and wishing and praying for your best.

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