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Quadriceps Tendon Rupture, Repair and Rehab - Page 236

post #7051 of 10808
Originally Posted by NJ Pete View Post

About ROM - repost from conservative to


Those are some good guidelines and examples. Good to see it in black and white. I guess my UW Sports Medicine was even slightly more aggressive, but I had good results.

Taken from the rehab protocol:



post #7052 of 10808

Scoobs, great question about running. The slowest part of the recovery seems to be regaining full strength in any movement where the injured knee(s) are only bent by a few degrees. Running requires pushing off and landing from positions where the knees are only slightly bent. Recovery comes slowly over time, and the only thing you can do is to keep exercising the knees every day using bicycle, stationary bike, elliptical. reverse elliptical, running, leg press, squat, deadlift, knee extensions and the like. Once you are 95% recovered (as you indicated), the persistent coaxing through daily exercise will eventually pay off; you really don't have far to go!

post #7053 of 10808

I just saw my OS. Looks like if I had not gotten this last surgery my patella would have been destroyed as well as the femoral grove. He said there is not much out there these days for patellafemoral replacement.


So my advice to all:  If your don't feel your recovery is going as expected and you have a complication in some way, get a second opinion.


My 1st OS group missed my Quad Tendons failing. My second OS missed my patella tracking issue causing permenant damage. My third OS seems to be on the same page as me. I can only understand what he should be doing because of the intense research I have done with this.




I am angry at this point. Mainly because I put the outcome of my recovery in someone else's hands. I will NEVER do that again...so I may say this now.

post #7054 of 10808

NJPete - Glad to hear you are ok and recovering.


I am hitting my knee hard know 3 days a week to try and get the last 25% of the muscle back. As we all know this is not an easy injury to recover from. The 25% loss of my muscle was sure a big problem. Pushing hard now to get it back in the next 6 months. I continue to wish everyone good luck in recovering. Running I do try sometimes but I am afraid. I can do it though. My knee does still buckle once in a while.

post #7055 of 10808

@kcarp1, thanks so much.


One thing I did not realize with all the loss of blood and swelling was that it made me anemic. For days I have had "Extreme fatigue, Pale skin, Weakness, Shortness of breath, Headaches, Dizziness or lightheadedness." I never associated this with something I was undergoing. After surgery I was in pain and there was swelling and some bleeding. Wow, do I feel MUCH MUCH better today.


My doc also cleared me for PT. He said and I quote, "Let's give er all you got." He also said I don't have any limitations outside of taking it slowly with this recovery. I have been cleared to do what I need to do within safe limitations.


So, I am feeling much better about my situation. For the first time in 18 months I have not felt the patella catching as I descend stairs. I am not going to jump for joy just yet. I will take it conservatively to get my ROM and strength back then provide more updates.


I am VERY optimistic at this point.

post #7056 of 10808
Originally Posted by RUNNERMX View Post

Scoobs, great question about running. The slowest part of the recovery seems to be regaining full strength in any movement where the injured knee(s) are only bent by a few degrees. Running requires pushing off and landing from positions where the knees are only slightly bent. Recovery comes slowly over time, and the only thing you can do is to keep exercising the knees every day using bicycle, stationary bike, elliptical. reverse elliptical, running, leg press, squat, deadlift, knee extensions and the like. Once you are 95% recovered (as you indicated), the persistent coaxing through daily exercise will eventually pay off; you really don't have far to go!

@NJ Pete

Fascinated about your analysis here and has me intrigued to try something different with the exercise bike, which I do for 60+ minutes a day. Generally I have the seat as close as possible to the pedals to try to keep my ROM good. Reading your idea I am inclined to move the seat as far away as I can to see if that will help my transition back to running. Something to try. I am about to head out on a two-week trip where walking will be my main rehab activity, but this will be a worthy experiment when I can start it.
post #7057 of 10808
Originally Posted by old bruce View Post

@NJ Pete

Fascinated about your analysis here and has me intrigued to try something different with the exercise bike, which I do for 60+ minutes a day. Generally I have the seat as close as possible to the pedals to try to keep my ROM good. Reading your idea I am inclined to move the seat as far away as I can to see if that will help my transition back to running. Something to try. I am about to head out on a two-week trip where walking will be my main rehab activity, but this will be a worthy experiment when I can start it.

@old bruce, very true. You can't work on your VMO when the seat is close. You can work on ROM though. Try breaking it up to 30 mins close and 30 mins normal.


Good luck to you my friend.

post #7058 of 10808
Originally Posted by NJ Pete View Post

@old bruce, very true. You can't work on your VMO when the seat is close. You can work on ROM though. Try breaking it up to 30 mins close and 30 mins normal.


Good luck to you my friend.

@All....I found this site awhile back and it has really given me great info and a lot of VMO specific exercises. Check it out.


post #7059 of 10808
Thanks to Runnermx, NJ Pete and Eric 308 on the running/vmo advice and analysis.
post #7060 of 10808

@NJ Pete, I am happy you sound so positive on your recovery.  This may be the solution to regaining your complete health back.  


I hit 118 ROM today and my PT (Paige) started me on balance and strengh exercises to help me get ready for the ski season.  Things are moving in the right direction at last, even if I am not confident at all about putting on skis and ski boots at this point.


Good luck everyone and keep up the good fight.

post #7061 of 10808

@NJ Pete  So glad to hear you're doing better both physically and mentally!


@Red Nighthawk Amazing progress since those days of being stuck in the 80s!


Looks like a good day all around!

post #7062 of 10808

Sorry to do this to you all. Please read through if you can. It is simply food for thought.


Harmonic Technique

Rational for use





Dr. Eyal Lederman DO PhD


15 Harberton Road

London N19 3JS

0044 (0) 207 263 8551








ãCopyright Eyal Lederman 2003




CPM Creating an ideal environment for repair


Over the last two decades the importance of passive motion has come to light by the extensive research into the effects of passive motion on repair processes in the musculoskeletal system. There are several physiological mechanisms by which passive motion may be clinically useful:


  1. Improving the quality of repair
  2. Improving the rate of repair
  3. Improving drainage of oedema following tissue damage
  4. Reducing overall pain


The significant therapeutic effects of passive motion on tissue repair have been shown in connective tissue, joints and muscle.

Connective tissue: the importance of movement


There is a strong body of evidence to support the view that periodic, moderate stress is essential for connective tissue nutrition, homeostasis and repair.1-6 In many of the studies remobilization was introduced with passive movement.7-16 Moderate active movement has also been shown to beneficial in assisting tissue recovery following an injury and immobilization.2,17-22 These studies provide us with important general directions as to the use of passive motion or/and exercise in treating connective tissue damage.


Connective tissue matrix - Movement encourages the normal turnover of collagen and its alignment along the lines of mechanical stress. This provides the tissue with better tensile properties. Movement improves the balance of GAGs and water content within the tissue which helps maintain the inter-fibril distance and lubrication. This reduces the potential for abnormal cross-links formation and adhesion. In avascular structures, such as cartilage, ligaments and tendons, periodic stress provides a pumping effect for the flow of interstitial fluid. This may support the increased metabolic needs of the tissue during inflammation and repair.1,23 Another important effect of early movement could be in preventing the secondary damage of the connective tissue matrix by distention from oedema. Movement within the pain-free range and low loading force may help drain the fluid build up and reduce distention.


Ligaments - Passive motion has been shown to stimulate various aspects of repair in ligaments. If a knee is mobilized soon after injury, the ligaments show higher strength and stiffness compared with immobilized ligaments (providing that the joint movements are not excessive and scar formation is not disturbed).24,25 Similarly, the strength of repair ligaments has been shown to be greater in animals that were allowed to exercise.26


Tendons – After surgery, tendons that undergo mobilization have a higher tensile strength and rupture less often than immobilized tendons.27-31 Early mobilization of an injured tendon reduces the proliferation of fibrous tissue and reduces the formation of adhesions between the tendon and its sheath.32,33 Animal experiments have shown that tendons undergoing early mobilization are stronger than immobilized tendons. For example in one such study it was demonstrated that when the tendon was mobilized at 12 weeks post-operation, the angular rotation of the joint was 19% of the full range of movement. Mobilization delayed until after 3 weeks post-operation produced an angular rotation of 67%, while the early mobilization within a five days of surgery resulted in angular rotation of 95%.27 The total DNA and cellularity content of mobilized tendons at the repair site were significantly higher than was found in immobilized tendons.34 Increased DNA and cellularity signifies an accelerated tendon repair and maturation. Motion also stimulated the reorientation and revascularization of the blood vessels at the site of repair in a more normal pattern, which are well adapted to withstand the mechanical forces imposed on the tissue.       


Skin - Wound repair in skin has also been shown to be affected by passive motion.35,36 Mechanically stressed scars being much stronger and stiffer than unstressed scars. The mechanical properties of a scar closely resemble those of normal skin, the collagen fibres developing in a biaxial orientation. The cosmetic appearance of a scar healed under mechanical loading is greatly superior to that of unstressed scar.36-39

Importance of movement to joints


Articular cartilage homeostasis and repair, synovial fluid formation and flow and the connective tissue supporting the joints are all structures and processes responsive to mechanical stimulation.40 These structures and processes respond to particular forms of mechanical events indicating that Harmonic Technique could be potent therapeutic tool in treating various joint pathologies.40,41


Trans-synovial pump


Some of the positive responses in joint repair seen in rhythmic passive approaches could be attributed to the activation of a physiological mechanism called the trans-synovial pump. This pump facilitates the formation and drainage of synovial fluid in the joint and is activated by movement (passive or active). The pump has three elements to it all stimulated by movement; a fluctuating intra-articular pressure,42 an increased synovial blood flow and facilitated drainage into the lymphatics.40 An increase in the intra-articular pressure produces an outflow, while a decrease in intra-articular pressure and increasing the influx into the joint cavity.43,44 Another important part of the trans-synovial pump is the effect of movement on the periarticular vascular and lymphatic flow.43 On one end of the pump movement causes increased blood flow around the synovium (which important for the formation of synovial fluid) and on the other end of the system it stimulate drainage into the interstitial spaces (lymphatic system).45,46        

   The pattern of pressure may vary on whether the joint is moved actively or passively. In the human knee, during passive motion the pressure in the knee tends to remain under negative pressure. It only rises at extreme flexion and extension. During active movement the overall pressure in the joint increases but the patterns remains similar to the one observed during passive movement.47 It suggests that application of passive movement may be less stressful to the swollen synovium and capsule of inflamed and effused joints and therefore more appropriate in the treatment of acute joint injuries, in particular, in conditions where the patient is unable to initiate movement due to force losses of pain.



Cartilage nutrition


Articular cartilage has no direct supply route from the underlying bone and the nutrition and viability of the chondrocytes are totally dependent on synovial fluid.48 The supply of nutrients to the cartilage is partly by diffusion and partly by hydrokinetic transport. Furthermore, movement produces smearing and agitation of the synovial fluid on the cartilage surface which aids this transport.49-52

   Nutritional transport to the articular cartilage occurs over a relatively long distance. Different joint pathologies that alter the structure and function of the synovial membrane and the capsule will impede this transport.53 For example joint effusion may result in synovial membrane ischaemia.54 This could lead to damage and death of the chondrocytes and the subsequent degeneration of the articular cartilage.


Joint injuries and immobilization


Joint injuries can vary from mild sprains causing minor damage to the synovial lining, capsular and ligamentous structures to more severe articular surface damage. The damage to any of these join structures will initiate a repair process which is similar to the one described above in connective tissue.

   The inflamed synovial lining follows a similar history of repair described above in connective tissue. Some important consideration for passive motion therapy is that the inflamed joint is usually hypoxic and acidotic. This is due to several factors; a high synovial metabolic rate, reduced synovial capillary density, capillary "burial" under thickened synovial lining, and in the end stages, a chronically reduced blood flow. The inflamed synovial linings will also demonstrate villus projection encroaching on the joint space.46,55 These areas of the inflamed synovium may be crushed by excessive movement further aggravating the inflammation. In particular if this movement is active (active movement imposes greater stresses on joints).

   Further complications to simple injuries can be the lack of mechanical stimulation brought about by inactivity or immobilization of the joint. In essence, joints being designed to be mobile and under repetitive mechanical stress are therefore very sensitive to immobility. The effects of immobility are usually quite extensive resulting in atrophy of the capsule, ligaments, synovial membrane and articular cartilage. Adhesions and abnormal cross-links can develop fairly rapidly after the onset of immobility resulting in reduced overall movement of the joint.

   The synovial tissue of immobilized joints seems to be the most sensitive to the effects of immobilization. The synovial membrane in the immobilized joints undergoes fibrofatty changes. The resultant fibrofatty tissue proliferates into all the articular soft tissues, for example in the knee, into the cruciate ligament and the undersurface of the quadriceps tendon. With the passage of time, fibrofatty changes will proliferate to cover the non-articulating area of cartilage, with the subsequent formation of adhesions between the two surfaces as the fibrofatty tissue matures. The proliferation of fibrofatty tissue and adhesion formation has been shown to occur as early as 15 days after immobilization, becoming well established after 30 days.56,57 These changes have been shown to occur in experimental animals as well as in human spine and knee joints.36-59 In the knee, similar but less extensive changes have been observed in subjects with damage to the anterior cruciate ligament. Adhesion formation and fibrosis have been found between the patellar fat pad and the synovium adjacent to the damaged ligament.59

   The chondrocytes are highly sensitive to compressive loading for normal homeostasis of the articular cartilage.15,18-22,60-62 Immobilization has a deleterious affects resulting in reduction of GAGs thinning and softening of the articular cartilage. This degrades the mechanical strength of cartilage.  Furthermore the chondrocytes are totally dependent on synovial fluid for their nutrition. As the synovial membrane progressively atrophies, there may be a decrease in nutrition and gradual destruction of the articular cartilage. Indeed, in animal studies the contents of synovial fluid itself were shown to be negatively effected by immobilization (these changes were normalized by remobilization).63

   Other complications of joint injury may be brought about by joint effusion. Above a critical effusion pressure, there may be an impairment of synovial blood flow. 54,64-66 This could impede the normal functioning of the trans-synovial pump reducing the movement of nutrients and metabolic waste products through the joint cavity. For example, it has been shown in osteoarthritic knees that increased intra-articular pressure reduces synovial blood flow, which may contribute to joint anoxia and cartilage damage in chronic arthritis.67,68


Joints: the importance of movement


The introduction of movement at an early stage after injury can help protect the joint against many of the changes described above as well as reversing some of these changes. The effects of passive motion can be observed in several areas: 


  • Range of movement/joint stiffness
  • Quality of repair
  • Pain levels and pain medication
  • Return to normal activity

Range of movement/joint stiffness


Initially, the most common cause for joint stiffness and a reduced range is intraarticular swelling (edema and blood), periarticular swelling and later adhesion of the different joint structures.69 Early mobilization with CPM could help reduce joint swelling by activating the trans-synovial pump and draining the edematous periarticular structures. Early passive movement was shown to increase the rate of improvement in range after joint injury or surgery.70-74 

   Passive motion has been shown to facilitate the transport of synovial fluid contents by activating the trans-synovial pump. When a tracer substance was used to study the nutrition of the anterior cruciate ligament under conditions of passive motion and immobilization, it was found that in the mobilizes knees, the clearance rate of the tracer was so rapid that it did not have sufficient time to diffuse into the intracapsular structures.75 Other studies have shown the benefits of passive motion in reducing haemartherosis.76 After 1 week of treatment with passive motion, there was a significant decrease in the amount of blood in the mobilized, compared with the immobilized. Passive motion was shown also to affect the outcome of septic arthritis, leading to less damage of the articular cartilage.77 This was attributed to the effective removal of the damaging lysosomal enzymes by accelerated clearance rate.

   Activating the trans-synovial pump could be also important in inflamed joints where there is an increased in synovial fluid volume and pressure (a common cause for the sensations of tension, pain and limitation of movement). Passive or low stress active motion of joints may help to reduce effusion and facilitate the rate of repair.78,79 It was shown in swollen knees that the clearance rate in the knee joint was increase with dynamic (active movement in this study) cyclical activities such as cycling and walking.79 Passive cycles of flexion and extension of the spine have been shown to produce pressure fluctuations within the facet joints.80 When saline was injected into the facet joint artificially to increase intra-articular pressure (as if the joint is effused), cycles of active and passive motion caused a drop in this pressure. This effect was greater when the movement was specific to the effused joint.

   Apart from activating the trans-synovial pump, passive motion assist the joint range by pumping blood and edema fluid away from periarticular tissues. This may account for some improvement in range seen with the use of passive motion after surgery.73

   Adhesions that form later after injury are also a common cause for a reduced range of movement.59 Intra-articular adhesions that were formed during immobilization were shown to be reduced by passive motion and the return to active movement.57 This is of particular interest to our clinical work, demonstrating that the adhesion is a “living” adaptable tissue like other connective tissue, and that it has the capacity to remodel itself in response to its mechanical environment. This remodelling was taking place without any forceful stretching of the joint. Connective tissue adhesion affecting the periarticular structures the (capsule and ligaments) may also be reduced by passive or active movement.

Quality of repair


Passive motion has a beneficial effect on the quality of repair of different joint structures and is extensively used postoperatively to facilitate joint repair.71,81,82 The ligaments, tendons, synovial tissue have all been shown to have better repair with early introduction of passive movement. The effects of passive movement on ligaments, capsules and tendons have been discussed above. 7,8,9-14,15,16 In cartilage passive motion has been shown to promote the repair of minor damage in experimental animals (Fig.5.15).83 Cyclical stress brought about by movement stimulates the metabolic activity of chondrocytes, resulting in proteoglycans and collagen synthesis.84 The viability and repair of the articular cartilage depends on these cyclical mechanical stresses.18,19,21,22,85,86,87 Even slight degrees of motion or intermittent pressure are sufficient to stimulate the production of small amounts of cartilage.8

Pain levels and pain medication


   Passive motion has been shown to be useful in reducing pain and pain medication in different joint conditions including back pain sufferers. Passive motion into full extension has been shown significantly to improve the range of movement and to reduce pain in spinal disc injuries.88 A treatment of 20–30 minutes produces immediate positive changes (the frequency used being 10 cycles/min). In another study a 12-minute daily passive motion using BackLife CPM of the lower back into flexion-extension cycles produced significant relief of back pain.89 

   Passive movement is also used postoperatively to facilitate joint repair.81,82,71 This form of treatment tends to reduce the recovery time and pain level and improve the quality of repair. Passive motion provided on a daily basis was shown to reduce pain in patients with osteoarthritis of the hip.72 Some of the pain relief may be associated with the direct effects of movement in activating the trans-synovial pump. This may increase the clearance rate of the inflammatory by-products from the site of damage and reduce the swelling in the joint. Another mechanism for pain relief could be related to movement facilitating the repair process. Neurological gating of pain may be another possible mechanisms producing pain relief by movement.


Return to normal activity


Generally, patient who receive early passive motion for joint surgery tend to have reduced hospital stay and early return to normal daily activities.35,74  

The addition of passive motion was shown to reduce pain in frozen shoulder118 and to be beneficial and safe and useful after rotator cuff repair.119,120

Muscle Tissue


Muscle is the main tissue to undergo shortening and is often the cause of restriction of the range of movement after joint injury. Such changes in length are due to adaptive sarcomere and connective tissue changes.90,91 It has been demonstrated that in muscle immobilized in its shortened length, there is a reduction in the number of sarcomeres (up to 40% within a few days). This is accompanied by shortening and proliferation of the muscle’s connective tissue elements (epimysium, perimysium and endomysium).92-95 Such changes account for some of the stiffness and reduced extendibility of muscle during passive stretching.90 Without movement or muscle contraction, there may be excessive oedema and stasis in the tissue spaces.93 This may eventually lead to excessive connective tissue deposition rather than regeneration of the contractile elements. Some of the changes in innervated and denervated immobilized muscle are very similar, suggesting that the structural changes are largely a result of the absence of mechanical stress on muscle tissue.35 

Effects of movement on muscle


As with other tissues in the body, muscle regeneration is dependent on dynamic longitudinal mechanical tension (stretching or muscle contraction) for homeostasis, regeneration and adaptation.

   Longitudinal tension promotes the normal parallel alignment of the myotubes to the lines of stress,93,96 and is also required for the restoration of the connective tissue component of the regeneration muscle.93 The normal development of connective tissue in muscle is important for the development of internal tendons, fasciculi and adequate well-defined skeletal attachments. If normal development of connective tissue fails muscle function will not be restored even when full muscle fibre regeneration has taken place.96    

   Tissue culture experiments highlight the importance of both stress and motion to repair and adaptation in muscle. Passive stretching of muscle activates intracellular mechanisms that result in hypertrophy (increase in cell size) of the muscle cells.97 Smooth muscle cells that are cyclically stretched demonstrate increased synthesis of proline, a major constituent of collagen.98 Studies using skeletal tissue culture have shown that muscle cells incubated under constant tension synthesize protein at 22% of the rate observed in vivo, whereas passive intermittent stretching resulted in a level of 38% of that found in vivo.99

   During remobilization of muscle, the number and size of the sarcomeres generally return to preimmobilization levels.90 Animal studies show that passive muscle stretching leads to increased muscle length, hypertrophy100 and increased capillary density.101 In humans rhythmic muscle tension brought about by passive joint movement has also been shown to promote muscle hypertrophy.102 Such hypertrophy has been observed in diverse conditions such as muscle wasting in patients who are terminally ill.103 In subjects with osteoarthritis of the hip, passive manual muscle stretching has been shown significantly to increase the range of movement as well as the cross-sectional area of muscle fibres and their glycogen content (decreased muscle mobility leading to muscle atrophy and reduced glycogen content).101 Patients who had surgery for rotator cuff tears were shown to undergo hypertrophy when passive movement was added.104




Studies of passive motion have shown to beneficial to different aspect of repair, particularly, in acute musculoskeletal conditions.




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post #7063 of 10808

This is the link I found this from - www.cpdo.net/harmonic_tech_evid.doc

post #7064 of 10808

@NJPete....thanks, dude. Although I've read shorter novels, I'm pretty much in agreement with your post. I never used a CPM, but everything else applies to my rehab. I think in a nutshell they are saying that early assisted PROM makes for better long term results. My OS actually mentioned the fact that starting early makes for less scarring and "better scarring". I personally didn't GARA about my scar, but the use of steri-strips vs. staples sure was a lot more comfortable.

post #7065 of 10808

Hi.  I really wish to reply to all the good folks out there having pain, doubt, and other issues with achieving recovery.  I am not a professional athlete, I am not young (60), and I have no special gifts except tenacity and a high pain threshold. My primary athletic activity is I bike thousands of miles a year, but I do so on a touring basis, not as a racer. You will encounter may naysayers, as I did--people who told me to get used to limping, who told me the injury was a sign of age, and people who told me I needed to be careful.  But - You can get better with grit and determination, actually way beyond anything you might expect at the beginning. 


I completely tore my quad tendon on Feb. 28, 2011.  I couldn't stand or walk without my right leg crumping like a cheap suit.  I was also afraid of surgery so I delayed having the tendon reattached until March 21, 2011.  My surgeon was fantastic; he had me in PT one week after surgery and the PT person kept stressing the importance of regaining ROM no matter the pain.  I even worked at it at 3 a.m. when the post-operative pain was so bad, I couldn't sleep anyway.  My surgeon, when I asked him about that, said it was a good thing to do.  I regained full ROM - meaning I could get the heel of my foot to touch my leg, in 4 weeks.  I quickly regained the ability to extend the leg with weight attached and by early June, my surgeon asked me, was I back on my bike.  I said NO, YOU HAVEN'T CLEARED ME.  He said to get back on the bike.  I began commuting to work by early July, but only after I could get out of the saddle, which is very, very necessary in an urban environment.  I rode 101 miles on October 15, and then closed out the bike season out of being cautious.  In 2012, 2013, and now 2014, I have ridden more than 5,000 miles each year, and each year my leg has gotten even stronger and I feel amazingly fantastic.   Because of continuing weight-work on my previously injured leg, it is now stronger than my non-injured leg.  I have lost 45 pounds of weight, so I am actually "underweight" and can climb like I did in my early 20s, my resting HR is about 45 bpm, and I can even run for 6 miles or more.  My recovery has been not only complete, but I am in much better physical shape than since I played soccer in high school and college.   I am convinced, because of my injury, I turned a corner in my life.  The lessons I learned in terms of taking care of my body and becoming fit will never be forgotten. 


Don't let anyway tell you that you cannot do this or discourage you in any way.  The surgery is amazing opportunity to rebuild not only your leg, but for some people (like me), to rebuild their lives.  It can be really hard to see in the painful 4- 6 weeks after surgery when it is hard to visualize even kneeling, standing on the injured leg, or regaining the strength that used to be there.  But you can and you will.  I wish all of you nothing but the best. 

post #7066 of 10808

@Virginiacyclist, you are inspiring to us all. Hats off to you for what you have acheived.


@Eric308, you are absolutely correct about that. I see some surgeons are still putting people into casts. Not sure I agree with that approach.



post #7067 of 10808

@Virginiacyclist Man that is a great story. Thanks for sharing. I agree about this being a turning point. My recovery is about  is about 75% and I'm 5 months out. BUT...I'm in the best shape I've been in over the last 15 years. Lost about 7 pounds.


The side benefit from working the knee has been great. My latest blood test results were all good!


@NJ Pete Keep it coming brother. Great info. Thanks. 

post #7068 of 10808

OK, who is going to volunteer to check the references on NJ Pete's article?

post #7069 of 10808
Originally Posted by Surfhard View Post

OK, who is going to volunteer to check the references on NJ Pete's article?

Now quit interrupting...I was just finishing down through #69 Palmar RM on the effect of intermittent changes in tension on protein and collagen synthesis in isolated rabbit muscle.

post #7070 of 10808
@Red Nighthawk. Thanks for the PM with some advice for another ROM laggard.

8 weeks PO today
ROM hit 60 deg today with PT help only but PROM is still around 45 max. My brace is set at 40 ROM
PT 3x a week, 3x on my own daily.
1st full week driving! Yeah!

I am making small progress but my physical therapist is starting to get concerned as she has treated other patients with this injury and thinks I'm way behind. She really worked me hard today pushing me up to the 60° however I can't get anywhere close to that on my own. I've been stretching it several times a day but I have found that the swelling hampers my ROM. Going to work it had over the weekend!
post #7071 of 10808

@Hattonda, 60 degrees at 8 weeks is actually ahead of where I was.  I just checked my records and I was at 57 degrees at 10 weeks, so keep at it, you're not so far behind as you may think.  However, I'd suggest you pick up the pace on your own.  NJ Pete suggests we stretch for 5 minutes sessions 20 times per day!  I never got to that level but I'd stretch for 5 minutes, more or less depending on the exercise, for a dozen times each day.  Get yourself that little bike and work it while watching TV or reading a book.  Constantly stretch the knee every chance you get.  It's real, real important!

post #7072 of 10808

LMOA...that is freakin funny...RE: Check the references. Ok, I think that might be the last time I post an entire article, including the references.


@Hattonda, yes you are behind a bit. Don't get too stressed over this. Also, don't let your PT bend you until there are tears in your eyes. At 8 weeks, there is still potential damage that can happen if stretched too far. I recommend conservative but frequent ROM exercises. I like to do this 20 times a day or more if you can. If you are sitting, pull your leg back until you feel the pressure and hold for about 5 mins. Do the same if you are laying on your bed but hang your leg off the side. Let gravity take it down. If you have an ankle weight (1-2 lbs) could assist a bit more. Also make sure your PT is doing the patella mobilizations and possibly deep scar tissue massage. If not, you may want to find another PT.


For everyone else - I was cleared to do my own ROM exercises. I know it is nothing like a QTR, but ROM is ROM. I lost mine AGAIN. So, I am standing in my kitchen, standing on my good leg pulling my bad leg up. I was about 90 degrees at this point. I am pulling and holding and pulling and holding when I look down at this huge wet spot on the floor. The first thing I think of is, "freakin kids spilled something on the floor and did not pick it up." At a closer observation I realize it is blood from my knee. Apparently, they don't stich you when they do arthroscopic surgery. The hole closest to where they cut the retinacular had a blood vessle that started to bleed again. Oh boy. So, I got some paper towels, cleaned it up, put some steri strips on it, a surgical gauze pad and an ace bandage. I called my OS and he said he would have done the same thing. He wants me to take it SLOWER until the reopened incision heals. It looks like...two steps forward and three steps back. I spent the weekend immobile. I am telling you...I am going to be better than ever.


Also, did you guys see Victor Cruz of the New York Giants last night? Looks like he tore his Patella tendon. He will most likely have to have an operation VERY similar to the one we have undergone.



post #7073 of 10808

Laughing My Off A**? (LMOA)...I think I am losing too much blood these days. Sheesh!!



post #7074 of 10808

I got some good news today and some bad news.  First the bad news.  My PT for the past 5 months is leaving the state.  Her Navydoctor/husband got reassigned to Florida, so she gave me the bad news today.  Paige has brought me from 50 degrees ROM to 118 degees and I'll never be able to repay her for that.  The good news today is my OS is thrilled by my improvement in ROM, after stagnating in the 80s in July, and he now thinks I'll be able to ski in January!  Right now, I doubt that, but it's cool that he is so optimistic.

post #7075 of 10808

@Red Nighthawk  Great job on the 118 degrees.  Clear sailing from here.  that stubborn bugger finally let go!!  Paige will have gotten as much satisfaction as you and your online cheering section.

@NJ Pete  I can only wish you the best my friend.  Your insight and experience has gotten me through tough times.  


@Victor Cruz  Any special high price secrets you can share with the gang here on recovery?  Get well soon, the Giants needs ya bud!!


Best wishes to all

post #7076 of 10808

@skicarver, I heard he underwent a patella tendon repair on Monday. I have no idea what type of surgery he had or what they did during or post his procedure. It they did the normal cut and replace like most of us here, he will most likely be out for the rest of the season. The one thing I despise about surgeons and they way they cut for tendon surgery is they refuse to cut around and temporarily relocate the "infrapatellar branch of saphenous nerve." This is that nerve resides on the surface of the knee that makes your knee numb. Most of us are numb for the rest of our lives. In total knee replacements there is a process to find this nerve and relocate it. Granted the TKR comes in from the inside of the knee...but still.


Nevertheless, Vitor needs the absolute best here. This is what I would do for him. I think if he did everything on this list, he MAY be able to get back the Giants IF they get into the playoffs this year. This is agressive but if you had the bank he had, you might be able to do it as well. Science has come a long way. The combination of all this would work for him.


  1. Nutrition - Gotta LOAD up on foods high in enzymes and rich in calcium (I am NOT referring to MILK either) – more than 60% of his calories MUST come from this
  2. CPM immediately
  3. Neuromuscular electrical stimulation (NMES) - reduce muscle loss ONLY; Prefer one that runs a program for 30 minutes; Run in repair and rebuild mode
  4. PT 2-3 times daily – Patellar mobilizations, PROM and all the UW Guide stuff
  5. PRP – used to assist in the healing of tendons
  6. Adipose derived Stem Cells – ASC injections have shown to be promising in re-growing tendon tissue
  7. PT with a focus on Graston technique – break up scar tissue and promote blood circulation
  8. Continuing to work out rest of body 7 to 10 days after surgery



post #7077 of 10808

So very strange, RE: Victor Cruz injury. I looked at the film before but it did not appear that he ruptured during the leg plant. Usually the instant a rupture occurs the leg is useless. You can see in the video that he puts pressureon the right knee and pushed off. Usually on the push off it would rupture but the video does not show this.


I stand corrected though. The news said he ruptured his patella tendon. Either way, is in for some intense recovery.

post #7078 of 10808

Hello to all you quad tendon rupture recovering and recovered athletes.


My husband has the misfortune of rupturing both quad tendons yesterday.  He knew  immediately that his ski season was over before it began.  The pain when he fell was excruciating.


We saw the orthopedic surgeon today, did some pre-op stuff, and will do more tomorrow.  Surgery is on Friday.


I have some questions that you might be able to answer.  I started reading this thread, but due to its length and to my need to take care of my patient, it may take a while to read through it all.  I'm comforted by the fact that he should be able to ski next season.


Right now he can walk very slowly and carefully using a walker.  However, he is having a lot of trouble getting up from the sofa.  I am not strong enough to pull him up, though I can help.  Will this be more or less of an issue after the surgery?  Should I buy a lift belt or a gait belt?  Any recommendations?


What about a raised toilet seat?  The surgeon indicated that he will be in a plaster cast for at least two weeks, with no ability to bend the knee.  He specifically mentioned the difficulty of sitting on the toilet.  I was thinking that a raised toilet seat might make it possible, if he can sit on it with his legs sticking straight out.


Will he be able to walk, using the walker to support his weight, shortly after the surgery?  The walker has a seat, and he has rejected the idea of a transit wheelchair.  I know he will want to walk, and will not like any of my suggestions to alleviate the difficulties.  But at this point I believe he will go along with anything reasonable that I suggest.


About how long before he is self sufficient and I can leave him for a day or a 3 day weekend to do some skiing?  I know he'll want me to, but not until he can shower, drive, and get around by himself.  He'll want to push things, and I'll have a hard time saying NO, as I skied 2 1/2 months after tibia plateau surgery.  This winter is all about him and what he needs, of course, but some ski days would be nice.


How long before he can walk up and down stairs, like the 2 flights to access our condo at Mammoth Mountain?  I know every person is different; I'm just looking for some guidelines.  Neither of us has really wrapped our mind around the reality of what he will face in the next few months.


Sorry if my questions sound silly, or have been answered 17 times already in this thread.  At this point I am floundering and in need of quick advice, so thank you to anyone who can provide it.

post #7079 of 10808

Believe it or now, there are at least three of us here who have sustained double QTR's.  One, is one too many for me, but it is what it is.  I'm sorry for your husband, but he's lucky to have you to help him through this.  Our double guys will be replying to your questions very soon I think, and they'll be a better source of information for you and your husband than me.


Getting up is difficult and it will remain so for quite awhile.  Do whatever you have to do to help yourself help him, but eventually, he'll have to do this on his own.   Getting up from the toilet is very difficult so a raised seat sounds like it would be of help.  I was not allowed to put weight on my leg for seven weeks PO, but there seems to be quite a range of PO protocols out there.  He may 'want' to walk, but it'll be in his best interest to follow the OS orders precisely.  He'll regret it if he tries to be a hero and try walking too soon.
Going up and down stairs is a big deal.  I'm almost seven months PO and I can finally go up and down, but down is still not comfortable.  
I wish you both well.  He is in for the fight of his life!  Others will provide better information very soon I trust.
post #7080 of 10808

@skibum4ever, you are going to want to read some pertinent information on the website I put together - http://www.quadtendon.com. It sounds like your husband tore his tendons not ruptured. Ruptured simply means the tendons are no longer attached to the patella. This means there is NO possibility of standing on that leg, or in his case, standing on any leg. I have documented a few things you will need for surgical preparation. I also recommend against the stapling of the incision post surgery. I have been through Bi lateral (both quad tendons) ruptured and the surgery following. I also had both legs revised less than a year later.


Surgical Preparation list - http://www.quadtendon.com/repair/Pages/Sugical-Preparation.aspx


What to expect - http://www.quadtendon.com/repair/Pages/default.aspx


Some additional things I recommend are:


  1. Nutrition - Gotta LOAD up on foods high in enzymes and rich in calcium (I am NOT referring to MILK either) – more than 60% of his calories MUST come from this
  2. CPM immediately
  3. Neuromuscular electrical stimulation (NMES) - reduce muscle loss ONLY; Prefer one that runs a program for 30 minutes; Run in repair and rebuild mode
  4. PT 2-3 times daily – Patellar mobilizations, PROM and all the UW Guide stuff


This is what the rehab protocol will look like - www.uwhealth.org/files/uwhealth/docs/pdf6/sm_pat_tendon_quad.pdf



You can also PM me if you have any questions. I have been through quad tendon issues a bit and can help you with any questions. This forum is the BEST place to come to grab some advice from a lot of people that have been through the same thing your husband will experience.

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