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Quadriceps Tendon Rupture, Repair and Rehab - Page 141

post #4201 of 6376

Hey everyone I am a 26yr old Male and I believe I possibly partially tore my quad tendon. I am glad I found this thread because I have some questions regarding my symptoms. It happened about two weeks ago and I planted wrong at the beginning of the day. I felt a twist of the knee but no immediate pain. I continued boarding the rest of the day without any pain. However the next day I noticed my knee was swollen, warm, and I could feel an indention right above the kneecap. If I pressed hard in the indention it would produce pain. I did the RICE method for a couple days and the swelling/bruising went away. I can walk/run and exercise absolutely fine with no pain or swelling at all? The only thing I still notice is there is still that indention and it does still hurt when I press my finger hard there. I can easily do the leg raise and extension tests as well? I am trying to get an informed decision as to the cause's or treatment of this injury. I dont have medical insurance currently so that is the other driving factor as to why I have yet to see an OS or get an MRI done.

 

If its just a partial tear should i just bandage it up, rest and do minimal activity? I know it depends on the % of the tear, however the way I am able to still run and be active with no pain should indicate that the tear isn't that serious, correct?

 

Any thoughts and suggestions are really welcome.

post #4202 of 6376

eriego24

 

I'm no medical expert but one of the give away signs of this type of injury is an indentation above the knee cap, and if all of our experiences on here are anything to go by then you really don't want to mess about risking a full tear, get yourself to a doctor and get it checked out asap.

It may well only be a partial tear but you should definitely stop running straight away, minimal activity will help a great deal but i really think you should see a doc to get a professional opinion. The one thing you have on your side is age so natural healing should be better (theoretically) and it may be possible to get away without surgery, i wish you the best of luck.

All the best Steve

post #4203 of 6376

I am a 77 year old Quad Ripper and have been on this Forum since the day of my injury. I am at 15 weeks postop with 123 ROM. I walk well on the level. Now rebuilding leg strength.

 

The indention is the sign of a serious injury. The indention on my injured leg was about 1.25 inches wide and about 3/4 inches front to back. The tear will only get worse if you if you plant wrong again. You are now weak and the likely hood of a full rupture is likely and serious.

 

Go to an Emergency Room and get it checked ASAP. They will Xray it and if necessary will put you in a brace and crutches.
 

post #4204 of 6376

eriego24,

 

I'm a 60 year old Quad Ripper. 4 months post op now and ROM stuck at 80 for the last couple of weeks.

I agree with the comments from StevieP and Richard 2212 its really not worth the risk, get checked ASAP. If its not torn then you REALLY don't want it tearing. Get checked and save yourself a heap of pain and trouble.

 

Good Luck.

 

Ian

post #4205 of 6376

NYYankee and Estearn, keep it up.  I got out of the bledsoe brace right after Thanksgiving, so 8 weeks post-op, though I would take it off at home and put on a compression sleeve with a hinge for the prior 10 days .  One week with the compression sleeve and hinge then just an over-- the counter small compression sleeve which I use more for muscle wamth and to keep the swelling down than real support.  My program is pretty much what Estearn described with wall squats (at least 1 minute 3x just south of 90 degrees), chair sits (without actually sitting (10x3), leg presses at the health club (started at 45 pounds and have added 10 pounds a week for 4 weeks), balance exercises, and step-ups with concentration coming down.  Two weeks ago my PT got me on the elliptical machine then last week walking backwards on the treadmill at about 2 mph and backwards on the elliptical machine with an incline. At the end of Friday's PT session, my ROM was 145.  My therapist really has me focusing on form too.   He also has me stretching the quad and hamstrings.  I really haven't had significant pain since post-surgery.  knock on wood.   My advice to all is to take the exercises and PT seriously.  

Happy New Year to all, and may 2013 be a year of health and happiness.        

post #4206 of 6376

Nearly 9 months.

Improving, but it seems to plateau out every now and then with little apparent change. It is slow.

But then another leap forwards - I've found this lunge exercise really useful http://www.mayoclinic.com/health/lunge/MM00723 and can lower myself on to the good knee, without holding on to anything, for the first time.

post #4207 of 6376

Boston, I am amazed by your ROM.  My good leg is only 129.

 

Today is 10 weeks since my surgery and I just came back from physio.  I had a ROM of 116.  My brace was thrown away after five weeks and I have done very consistent physio since four weeks post op.  I do a lot of flexing, chair squats below parallel for 20 reps and half squats for 50 reps.  I also do extension with no weight and a ten second hold for 100 reps per day, stretching, balance work on the half ball and can do the exercise bike finally....my long legs held me back on that.

 

I have also been training very hard in the gym (upper body) and I try to do as many standing exercises as possible for stability and balance.  This was frightening at first but I am doing shrugs now with 500 pounds on top of my 295 pound body weight.  I feel no pain in my leg at all.  Yesterday I did a lot of extra thigh work at home and today for the first time, I feel good muscle soreness in my injured quad.  I see this as a huge advancement as things seem to be firing properly.

 

Happy new year to all and may 2013 be injury free.

post #4208 of 6376

Dear StevieP

Hope your surgery has gone well.

I was looking back through some  earlier posts on this thread- on Page 15 posts 441 & 448 talk about a condition called Arthrofibrosis- I wonder if this is your problem?

http://en.wikipedia.org/wiki/Arthrofibrosis

http://www.kneeandshoulder.md/arthro_01.html

post #4209 of 6376
Quote:
Originally Posted by Moose44 View Post

Hello all, I'm very happy to report that the surgery went very well, the tear was not as bad as originally thought, the inner quadricep muscle tore off the tendon and only a small tear to the actual tendon itself. So back home and not too significantly medicated. We are still in massive debate about whether to go or not, as we had planned a few days pre and post cruise in NY and after just walking to the car on crutches I realized that I'm going to be useless for that part.
PT seems pleased with the 1st session and will work with my personal trainer to make sure I do the correct exercises. My leg is locked straight for 6 weeks, although I am allowed to put as much weight on it as I can handle.

Does anybody know where Moose44 landed on the cruise debate? Tough spot to be in, that's for sure.

post #4210 of 6376
Dear catinthehat, unfortunately due to an emergency job coming in for my surgeon, my op has been postponed until later in January or early feb, so I have a while to wait yet but in the meantime I will check out the link you've put on here as I'm not convinced my problem is all down to scar tissue, hopefully I'll find out soon.
I just checked out the link and decided to edit my post. That sounds about right to me as I have lived with arthritis for the last 24 years anyway, it seems feasible that this condition could well be affecting me now, I'll be asking the surgeon about this when I see him, thanks for bringing it to my attention.
Edited by StevieP - 1/2/13 at 4:38pm
post #4211 of 6376

Happy New Year to all you fellow quaddies.

 

Just wanted to share what I hope is a useful insight I learned from my PT last session, especially those who have mentioned difficulty running. I am at 22 weeks, and running is still very, very tentative. Sure, a big part of it is leg strength, as well as psychological hesitation and worry that the leg won't hold. However, this point really helped me understand. If you break down the motion and body movements of running, it is really simply small jumps from one leg to the other. That means that the injured leg needs to be strong and coordinated enough to go through repeated small jumps. We broke that down into exercises to help the jumping action - you need strength to push off the injured leg and strength/confidence to land with all your weight on the injured leg flexed. Needless to say, my leg it turns out is still not strong enough to do that confidently.

 

I've started some new exercises to help with those issues, in addition to straight-up leg strengthening exercises. First is hopping off a step and landing full weight on the injured leg in a slight flex. This simulates the landing phase of the running movement. Second is doing reps of high knee kicks with the injured and uninjured leg to simulate the push-off phase.

 

Needless to say, I think these exercises should only be done when your OS has given the okay to do dynamic exercises, which in my case was after the 20 week mark.

 

Sorry if this is too much detail, but I'm just hoping it may be helpful to some of you guys.

 

Cheers!

post #4212 of 6376
Quote:
Originally Posted by catinthehat View Post

Dear StevieP

Hope your surgery has gone well.

I was looking back through some  earlier posts on this thread- on Page 15 posts 441 & 448 talk about a condition called Arthrofibrosis- I wonder if this is your problem?

http://en.wikipedia.org/wiki/Arthrofibrosis

http://www.kneeandshoulder.md/arthro_01.html


Sounds right. This must be common with this injury and is most likely what I had as well as StevieP and others. My surgeon explained to me that with the trauma I experienced with the rupture and then with the invasive surgery, the scar tissue was growing everywhere in and around my knee. He said it would be as if a cup of superglue was poured inside my knee area, gluing everything together so it would restrict movement.

post #4213 of 6376

Dear StevieP

This is what I could find on the net about the best treatment for arthroplasty. 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2835585/

A systematic review was published in 2010 which is an evaluation of the available scientific/medical literature on the subject taking into account the quality of the evidence.

There seem to be 3 main approaches 1) Manipulation under Anaesthesia or MUA 2) Arthroscopy or arthroscopic surgery where only a small incision is made and they put in a fibreoptic arthroscope in order to view/control the surgical instruments that are also inserted 3) Open arthrolysis- more conventional open knee surgery.

The evidence is limited but MUA and Arthroscopy appear to be superior to Open Arthrolysis. Admittedly this was arthroplasty from all causes, not restricted to post quad tear.

post #4214 of 6376

Hi

I'm a 59 year old lady currently 5 weeks post op after rupturing both quad tendons. I have plaster casts with a hinge in the knee area. At the moment I have 20% movement in my knees and will be having the hinges changed to allow 40% movement in 3 days time. The repair pulls a lot and is stiffer and a bit more painful now than it was 2 weeks ago even with just the 20% movement. As my injury is to both legs I am using a wheeled walking frame and can manage short distances around the house. Has anyone else experienced this pulling and stiffness? No PT has been arranged for me yet.

Happy New Year to you all and best wishes for your recovery.

post #4215 of 6376

I only ruptured my left quad, started pt at about 3 weeks in the pool. Mine was tight and painful when I started pt out of the pool. It gets better after starting pt, just stick with it. I was locked straight for six weeks when not in pt. I don't ever remember it getting tighter after starting pt and after my brace was set it to let me bend my knee. Have a good New Year, hope all goes well for you.

post #4216 of 6376

Happy New Year for everybody,

Finally I am 5 months post op and every 2 weeks able to compare injured and good legs.

See my results :

2 Dec 46%

15 Dec 54%

 4 Jan 65%

I can walk without limping and able to use stairs up and down. Flexebiliti is 100%

Do not want to make any prediction.

Best wishes and steady recovery.

Sam

post #4217 of 6376

Hi: I fell while hunting and resulted with a complete tear of the L Quad Tendon. Mind blowing pain until I figured out that if someone else moves you leg for you, then the pain was tolerable. My repair which was the drill holes in the patella and stitch technique took place 5 days later and I am post-op 3 days now. My anesthesia provider gave me a femoral nerve block with an indwelling catheter, which provided a numb anterior thigh and knee for about 45 hours post-op. I highly recommend this as it allowed me some much needed rest in those first 2 days. The surgeon, who in his past was the ortho MD for the NE Patriots and Boston Bruins, told me he would stress the repair while still in the OR, to see how much flexion could be attained without repair separation from the bone would start to occur, and this 90 degrees, so my brace although locked straight, is set at 70 degrees. On post-op day 2, I was to unlock and attempt flexion while standing only, and was able to get 15 degrees before profanity might result, so I am wondering if this sounds right, Today I am going to try for 20 degrees. I've been following this web page for a few days and find it valuable. Thanks

post #4218 of 6376

I am 77 years old at 16 weeks post-op. You are doing fine - don't push yourself. Read the postings in this Forum - you will find the best information here. Patience - go slow - this is a long term recovery process - maybe a year.

 

I am at 123 degrees ROM and walk normally except when negotiating stairs.

post #4219 of 6376

Thanks Richard, your words are encouraging.  Tonight I flexed easily to 30 degrees, not much pain, but clearly tight.  I fear pushing it because I don't want to screw up the repair, but my suspicion is that is tough to do since the brace is set to stop where the surgeon wants it to.  I know this is a long process and will not be impatient, but am encouraged by the thoughts that I swim on a regular basis and work out at the gym as well.  The surgeon also commented that the tendon appeared in good shape, not "discolored" which I take to mean is a good thing, and that he was able to get so much flexion in the OR after the repair.  At my first appt, he said I should expect to be at 30 degrees by 2 weeks post-op, and I'm there already.  So I take this to be a good thing.  BTW, I am 57 years old.

post #4220 of 6376
Well, seems I had it all wrong! My hinges were loosen to 20%. I am 5 weeks post op from BQTR surgery. Treatment here in the UK seems very different to that which most of you have experienced. I had cylindrical plaster casts for 2 weeks post op until the clips came out. Then plaster casts from toe to knee and upper knee to groin with a fixed hinge piece joining the two. Apparently the hinge was set to 15% for 3 weeks and has just been moved to 20%. The casts come off on 28th January. I am assuming PT will start after that but I haven't seen the consultant for 3 weeks and won't see him until 28th. I am bending my knees as much as possible but at only 20% I think it's going to take a very long time to get back to normal. Best wishes to you all.
post #4221 of 6376

I just wanted to thank Skip Intro for the lunge link and Boston for the backwards on the eliptical info,I had been suffering through a long plateau and adding these two ideas plus deep slow squats has moved me to a breakthrough.  These breakthroughs are the only "atta boys" that really give any satisfaction, worked the heavy bag today for the first time in 20 months and delivered chest high knee strikes with decent form, not power shots but it's the thought that counts.  Good luck everyone and keep working.

post #4222 of 6376

Just an update, at the end of post-op day 5, got rid of the ace wrap and now a lighter dressing, so my leg seems way more comfortable under the locking brace.  I am needing less percocet (only 4 today instead of 5-6).  Flexed my knee to 34 degrees tonight, without much pain but real tight.  My daughter who is a physical therapist says I am doing just fine, not to push it and be patient.  Ice is my friend and swelling is the enemy.  So, there you have it, knowing it's gonna be a long road.

post #4223 of 6376

Beginning post-op day 9 and pretty comfortably reached 45 degrees of flexion.  Seems as the swelling goes down, flexion gets easier.  Went to the hospital and talked with my friends who were in the surgical procedure, and they told me that when the OS had completed the actual repair, he flexed my knee joint hoping to see 60 degrees of flexion before any separation of the repair would be seen (explained as seeing the sutured end of the Quad Tendon start to pull out of the groove) and was morethan pleased when he saw 90 degrees.  So my locking brace is set to flex to 70, when unlocked, and I am to exercise it twice a day, nottoexceed 70 degrees.  Perhaps with my quad muscles being in such good shape, (from cardio workouts and swimming regularly prior to the injury) and the surgey taking place 5 days post injury, maybe the muscle retraction wasn't that bad and I'm crossing my fingers that rehab will progress well.  I'll keep everyone informed.

post #4224 of 6376

The most important thing is that this is a slow recovery injury, need a good three months for  good re-attachment of the tendon to the knee cap. From there on a slow program of PT will build the strength back into the quad muscle that has been some what idle for the last few months. Take care as to not fall and re-injure the surgical attachment, slow is the word. ACL repairs and even total knee replacements seem to go faster and smoother that the quad tear, so that thought must be keep in mind. I have 8 months in still have a slight limp and can do stairs with the railing as a help, at this point in time the surgical leg still feels different than the other one, but time is on our side.

post #4225 of 6376

I am a 78 year old Quad Ripper. I am 18 weeks Post-Op. Today I graduated from PT after 25 sessions with flying colors. At 125 degrees ROM, walking well on the level and slight inclines. Walking well on treadmill. Extended walking, descending stairways and inclines need improvement. PT instructions are to continue strength building and to take things easy - don't overdo. 

post #4226 of 6376

Richard, i think you are doing extremely well.I'm only 45 and I'm 32 weeks post op and only just over 100 degrees. Saying that, i am waiting for an op to remove scar tissue and manipulate the joint which should hopefully give me more ROM, apart from that i am getting good strength back in my leg from lots of walking and I'm even having less difficulty getting up and down stairs. occasionally i trip up as my fine motor skills are not quite there yet but I'm sure it will all come back eventually.

 

All the best Steve

post #4227 of 6376

Hi All!

My story is not mine, but my husbands. Brief history:  12/2011 he was injured at work with the end result: dislocated patella, patellar ligament injury (it's been a while, can't tell you if torn, partial tear, or stretched...) anyway, our Ortho dude put my husband thru PT for a period of a few weeks to see if the instability in his knee got better. That answer was NO, and surgery was scheduled at about 1 month and a half out from beginning injury. (Because this is Workmans Comp, we are at the mercy of 'their' protocols and decisions...) thank goodness we had a competant surgeon from a well-known Ortho group. Recovery, Rehab, return to work and full duty in ?April 2012.

 

August 2012 (6 mo. out from FIRST surgery), hubby fell in a muddy spot while fishing with our son. He purposely 'guarded' his knee and landed on his butt with NO trauma, touch, etc. to his knee. End result? Shattered patella/quad tendon rupture. Surgery #2. Partial patelloectomy/quad tendon repair.

 

Recovery (his nurse, me, didn't let him do anything his ortho didn't want him to!), Rehab (slow and easy, working almost two weeks behind 'protocols'), and Freedom (almost)- January 7,  2013 (5 mo. out from SECOND surgery), hubby at PT, his phys therapist was doing a 'manual strength test' (whatever that is...)to see if his knee was strong enough to allow a light running regime along with 'work related' excersises (He is a paramedic, most of their jobs require some sort of lifting-)  and as he was letting up pressure, KABOOM! Guess what? A peice of his leftover patella broke off with the quad tendon attached. YUP. It did. So, we go back to a DIFFERENT surgeon this week because I guess Workmans Comp needs a second opinion and someone HAS to be to blame (sarcasm inflected).

 

Now, my hubby is not a small guy- 250 lb.; 5'11/6' tall; wide shouldered and his quads are about the size of my waist...Anyone else out there have difficulties after quad tendon repairs like this? I'm curious to know-

 

Wish us luck on surgery number THREE. Hubby is disappointed and discouraged.

post #4228 of 6376

I'm 47 and lying in my hospital bed 24 hours post surgery on a fully ruptured right quadriceps tendon.  Was playing golf and looking for my ball when I stepped in a rabbit hole, rolled my left ankle and came down hard and awkwardly on my right leg with enough force to rupture the tendon. I've been having problems with this knee for about a year with cortisone shots in August and November to try and get the inflammation in the knee under control. Found this forum in the day after surgery together with a great 14 page pdf from Massachusetts General Hospital which discusses the entire rehab process.  As many posts in this forum discuss, the info from Mass General clearly discusses the need for patience and gradual strengthening to get the knee back in to action.  It seems like a long road 24 hours after surgery!  Particularly for someone who doesn't take well to not doing much! But then I guess that's one thing we all have in common here. If we were couch potatoes we probably wouldn't be rupturing tendons!  It's been great to read many different stories and successful rehabs of so many!  Thanks a lot!

post #4229 of 6376

Old Runner Guy,

 

I hope 2013 treats us all better than 2012 did.  I also hope you master land running again in the new year.

 

Well, I saw the surgeon today about my kneecap.  It's six weeks post op and I'm rehabbing for the second time since my original quad tendon rupture last February.  It's like groundhog day!

 

He told me all is going well but my quad muscles have taken severe double whammies in the past year so it will take time to regain strength.  I'm okay to start using the elliptical and stationary bike but not the erg machine.  I have started walking 2 miles outdoors with the support of a knee sleeve.  He said I should be able to start jogging in four months which is May.  All I can do is try to be patient and take things a day at a time.  At least I can go for longer walks now.  I look forward to those first running steps in the spring.

 

All the best to my fellow quad rippers!!!

 

Dan

 

PS, to those who don't know my story.  I'm a 64 year old runner.  Had complete quad tendon rupture Feb. 2012.  Was pretty well healed and starting to run again until Nov. 16 when my kneecap fractured top to bottom along the left drill hole.  Kneecap was surgically repaired with two screws and wire, and incision to relieve tension caused by facia on the left side of kneecap on Dec. 4th.  Now, here I am six weeks later going through the same daily rehab ritual the rest of you are.  All I can say is don't do what I did!!!  And hang in there.  It will get better - eventually.  :-)

post #4230 of 6376

Ashb:  Sorry to hear your story.  I am post-op day 12, and remember that first day well.  The shock of it all, but I had a femoral nerve block with a continuous catheter, that took all my pain away for the first 45 hours.  My OS had me start flexing my knee on post-op day three, to which I achieved 15 degrees.  My job was to do it while standing twice a day, and not to exceed 70 degrees, where he had locked my brace.  I'm up to 45 degrees now, and see the OS tomorrow for the first time since surgery.  He treated these injuries for the NE Patriots and Boston Bruins for years and believes in early movement as part of the rehab.  I have worked in the OR myself for 37 years and have seen this repair many times.  My daughter is also a Physical Therapist and assures me that with proper managment, this outcome is generally good, but does take time.  Keep posting your progress and we'll all hang in there together.

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