n0ragrace

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Hello everybody. New to this board. Had a quad complete rupture about 12 weeks ago. Repair done right away (next day) and rehab has been good but slow.
Visited the Ortho yesterday and was notified the repair was not done right. There is a gap between the quad and the knee which prohibits the lower leg from lifting, like the good leg.
The remedy is another surgery to fix. Very depressing to learn that. Getting a MRI and will look at other opinions. Rehab for another 12 weeks to get to where I am at now is awful.
Welcome to the club, Don! No one really asked to join but these guys are all here for you anyway. This is such a tough thing to go through. I'm so sorry.

Can I ask what kind of gap is in question? Do you know the method they used for the reattachment? Would love to hear an update about alternatives...I can imagine grafted tendon being an easier alternative that doesn't require drilling into the patella, etc. If you need to start another recovery process, I hope you keep in mind that it isn't like starting over! We ebb and flow in and out of stages of feeling healed, and the first part to get through is the mental portion of recovery. You've done it before (for 12 weeks!!!) and you can do it again.

Another positive is that all orthos will tell you that the quads tendon repair recovery is the toughest beast...any other surgery after that is jelly beans.

Frank, I appreciate the encouragement and glad to hear you are back to some more serious movement! It's all uphill from here.

I did revisit my ortho after getting a CT scan of the patella.... two big holes that the doc says we should graft bone into and remove the sutures. It looks like my bad reaction to the suture material caused a "sawing back-and-forth" and the sutures basically rubbed out a bigger space for themselves. Ouch. Since it's been apparently dormant for a while and I'm not necessarily feeling pain, I'm going to wait another 6 months before deciding to go back in for the surgery. This would be an easier one, since the tendon looks fully healed (yay!) and bone is a much easier fix than everything else. I'm just glad the doctor didn't tell me I need a titanium kneecap or something... I think I'm still a bit young for that!

Cheers to everyone and happy recovery.
 

Don379

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Thank you for the replies. I did have a second opinion which confirmed the tendon did not attach correctly. I don't think grafted tendon is being used. But will ask more on. The second Doc thought the failure although clinical - probably could relate to over aggressive rehab. My thought was doing spinning in the last month may have exasperated the tendon attachment - which I thought I could "hammer" the strength training on. So for rehab #2 I have to wait and find rehab methods that will not interfere with the tendon healing process.
Mentally missing out on summer activities is difficult. I will need to lean on opinions on how to satisfy my cardio craves. Life long runner and more recently biking does not play into the rehab plan.
Swimming may work but I have not done for training so will have to learn.

Frank, you sound like a machine! Keep it moving. And Grace, your kind words are appreciated and the enthusiasm you show is noticeable!
 

martyg

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Thank you for the replies. I did have a second opinion which confirmed the tendon did not attach correctly. I don't think grafted tendon is being used. But will ask more on. The second Doc thought the failure although clinical - probably could relate to over aggressive rehab. My thought was doing spinning in the last month may have exasperated the tendon attachment - which I thought I could "hammer" the strength training on. So for rehab #2 I have to wait and find rehab methods that will not interfere with the tendon healing process.
Mentally missing out on summer activities is difficult. I will need to lean on opinions on how to satisfy my cardio craves. Life long runner and more recently biking does not play into the rehab plan.
Swimming may work but I have not done for training so will have to learn.

Frank, you sound like a machine! Keep it moving. And Grace, your kind words are appreciated and the enthusiasm you show is noticeable!

Aerobic activity is the antithesis of tendon repair protocols. Your world should be all about slow, controlled eccentric motions in a gym. The bike will help with bloodflow, and has a huge range of other benefits, but in no way should it metabolically take away from gym time.

I am in week 18 now. I am in my second strength training block (squat workouts with 135 pounds, deadlifts at 185 - lots of eccentric work), but regularly working in hour long recovery rides, and one, two hour ride per week, with 60 minutes of that ride at tempo.

When shopping for a PT, look for someone who has completed their fellowship, or who has a PhD in the field. I know several, but they are not licensed in NYS. Don't look for, "....opinions on how to satisfy my cardio craves." Go to a professional and rely on their knowledge of peer reviewed scientific studies. You may need to suck it up for 12 or 16 weeks. Focus on the gym. Focus on checking the box, everyday, on best practices for recovery protocols so that you create the ideal environment for cell division, and be able to kill it in the gym come your next woorkout.

I don't wish "good luck", because it shouldn't come down to luck. Best to you.
 

Don379

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Thanks Marty, that is what I need to hear. Biking at week 8 probably was not a good idea, but I was thrilled with the Range of motion improvement and probably took it too fast from there.
I have to focus on this ideal environment for cell division. I think most the patients normally do not try "hard" recovery and maybe why I was not warned to take it slower. Although I will also admit I was not that much of a gym rat for rehab on this. But back to square 1 in a few weeks - after 2nd surgery.
 

martyg

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Thanks Marty, that is what I need to hear. Biking at week 8 probably was not a good idea, but I was thrilled with the Range of motion improvement and probably took it too fast from there.
I have to focus on this ideal environment for cell division. I think most the patients normally do not try "hard" recovery and maybe why I was not warned to take it slower. Although I will also admit I was not that much of a gym rat for rehab on this. But back to square 1 in a few weeks - after 2nd surgery.

Uggg. I am Doing the Right Thing, because the alternative really sucks. Here are my take-a-ways from this process:
  1. This is all about cell division. If you push it, you are not being tough. You are cheating the process. And you cannot rush the cell division process.
  2. Seek out a physician that specializes in optimized performance. I can absolutely guaranty you that anyone at the top of their game is paying attention to hormone optimization. TrumanRX is a good start.
  3. Same with diet. It should be based on measuring a multitude of markers, via blood work. Check out InsideTracker.
  4. Engage the best Source of the Truth with regards to rehab. Finding that PhD level PT in Buffalo may be a challenge. I did regularly engage a PT in my early days. As time went on, I relied on a PhD level PT friend of mine via Zoom, with check ins every month or so. I am not the person who needs a PT standing over me encouraging me to get one more rep.
  5. If it will not hamper you metabolically (especially now), get into the gym. You still have three limbs and a core to work. Heavy weight sessions will boost testesterone, HGH< and increase circulation - all will accelerate healing.
As I said earlier.... this is simple. Check every single box, every single day. The caveat is that people mistake "simple" with "easy".

Get ready to crush it!
 

Ben304

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Hello everybody. New to this board. Had a quad complete rupture about 12 weeks ago. Repair done right away (next day) and rehab has been good but slow.
Visited the Ortho yesterday and was notified the repair was not done right. There is a gap between the quad and the knee which prohibits the lower leg from lifting, like the good leg.
The remedy is another surgery to fix. Very depressing to learn that. Getting a MRI and will look at other opinions. Rehab for another 12 weeks to get to where I am at now is awful.

Hi Don - hang in there. I'm one of the few that had to have the same surgery twice (last September, then retore before fully healed exact same leg this February). Definitely some dark days, but you'll get through it. Lots of reading and Netflix / HBO Max / Amazon Prime for me! I'm 12 weeks post-surgery (was 8 weeks straight-legged in immobilizer leg brace this time) and getting close to a normal gait back, was on the training bike some about 10 weeks and have done a couple short 5-10 mile "real" bike rides on fairly level trail the past week. I was kind of expecting the worst 2nd time around, but anecdotally....I think it feels more stable 3 months post-surgery this time than it did the first time for whatever reason. I did decide to take a lot of supplements this time, which my orthopedic surgeon said he didn't really believe in....but figured it can't hurt to try. Daily the past 12 weeks unless I forgot occasionally, taking Chondroitin glucosamine, cellulose, vitamin D, calcium, and another multivitamin. I'm not going to try and sell anyone on it and maybe it doesn't make a difference, but like I said, for whatever reason my knee feels like it's actually coming along faster / more stable after the 2nd surgery than it did the first, which was pretty unexpected. I just hope that progress continues, as I know I'm far from out of the woods...
 

martyg

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A quote worth considering below. As I have said, this is a game of dell division. Cell division doesn't care how fit or tough you are. Don't rush the protocol. Instead use each step to build as robust a structure as possible, before moving on.

"After 10 weeks, fibrous tissue gradually changes to scar-like tendon tissue, a process that continues for years. The repaired tissue never completely regains the biomechanical properties it had prior to injury and the biochemical and ultrastructural characteristics remain abnormal even at 12 months" (Miyashita et al., 1997).
 

Old Runner Frank

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Just checking in here to see how everyone is doing. Martyg, appreciate your helpful advice, but haven't heard any progress reports from you in awhile. Hope you're mostly recovered now.

I am currently five and a half months post-op. I'm feeling strong, running daily again for seven weeks, and doing frequent workouts for overall strength and flexibility, including core strength. I'm still struggling to regain my last 5-10 degrees of ROM. I believe I'm still making progress, but it is very slow at this point. My orthopedist offered to do an arthroscopic procedure to release scar tissue if I'm figuratively and literally stuck. Anyone have any familiarity with that?

Best to all on this Memorial Day weekend.
 

Don379

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Checking back at the board. Had the repair surgery #2 last week. I was expecting the worse for 2nd recovery but so far it is not as bad as first time. I am in a cast for another week, will see how it goes from there. Thankful for the insights from everyone here.
My ability to walk on sand / and in gulf waves before surgery was NOT good. The leg had pretty much full ROM but the no strength from center of quad was very limiting.
The doc said the first repair should have held and was not at all my fault for failure. I tend to think I did not help the tendon process enough and as mentioned here. Will be very slow to push range of motion.
Frank, I am a life long runner and wonder if you should back off to see if your ROM can get better? I have found biking to replace long runs better overall on old body. The running I hope to get back to will be shorter faster type, 200 repeats to get leg turnover faster. Higher intensity running and shorter may mix it up. The long base builds from running can be suspect on older frames, tendons etc.
The bottom line is no matter your setback keep your body a moving!
 

peter826

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Checking in at 14 months. Things are mostly normal, but I do continue to see improvements even this far into the process. I believe this is really a year long (or more) process for many. It has been for me, though some of that may be due to not having access to a gym due to covid. I think back to where I was at six months, I feel completely different now. What is lacking is strength. I realized the other day I cannot do a leg extension of even 20 pounds on my repaired knee. The good one, I can pretty easily do 70. I can push the bar up about halfway, and then it stops as I don't have the strength to go further. I will need to work on this. Will have to start with leg weights at home, as 20 is the minimum on the machine. This weakness does not seem to have translated into anything noticeable in day-to-day life. I wonder why or why not. If anyone is doing leg extensions, I'd be curious to know how far into your recovery you were before you began doing them, and how you progressed. This was something my therapist told me would be the hardest thing to do.

BTW, I seem to have regained even more ROM in the past few months. Or, perhaps more accurately, getting to max ROM is requires less stretching. I am routinely doing things like sitting back on my heels that I could do a few months ago, though back then with some stiffness and trepidation. Now, I'm not noticing that at all. Feels very natural and not stiff.
 

martyg

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If anyone is doing leg extensions, I'd be curious to know how far into your recovery you were before you began doing them, and how you progressed. This was something my therapist told me would be the hardest thing to do.

Five months in. All of my leg extensions are eccentric only. Not because of lack of ability, but because eccentric motion provides the stimulus for tendon growth, so that is where I spend my metabolic capitol. Negatives with 30 pounds. Count of 15 in duration for each rep. Full squats, 5 x 15 with 135. Deadlifts with 185. Two hour bike rides with an hour at tempo. Starting agility work in 30 days.

The goal is an awesome ski season, ending with two weeks if heli in Iceland.
 
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martyg

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Checking back at the board. Had the repair surgery #2 last week. I was expecting the worse for 2nd recovery but so far it is not as bad as first time. I am in a cast for another week, will see how it goes from there. Thankful for the insights from everyone here.
My ability to walk on sand / and in gulf waves before surgery was NOT good. The leg had pretty much full ROM but the no strength from center of quad was very limiting.
The doc said the first repair should have held and was not at all my fault for failure. I tend to think I did not help the tendon process enough and as mentioned here. Will be very slow to push range of motion.
Frank, I am a life long runner and wonder if you should back off to see if your ROM can get better? I have found biking to replace long runs better overall on old body. The running I hope to get back to will be shorter faster type, 200 repeats to get leg turnover faster. Higher intensity running and shorter may mix it up. The long base builds from running can be suspect on older frames, tendons etc.
The bottom line is no matter your setback keep your body a moving!

I'd can running for a good, long while. If you need to get out, walk hills in Chestnut Ridge. Focus on very controlled descents when walking.

Rushing higher intensity running will be a great oath to reinjury. You need a solid 12 months, under ideal conditions, for that tendon to heal fully. Explosive starts would be a no go in my plan.

Cycling will do a lot of wonderful things, but it will not be the most optimal stimulator of tendon growth.
 

Don379

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Does anyone have knowledge on Regeneten patch for the tendon ? My doc thought this would be helpful to heal in repair.
 

Don379

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five weeks in after 2nd repair. joint is stiff but feels a whole lot better than first repair. Not nearly any fluid build up around knee joint. Strength in front quad above knee not there but it feels way more stable than before.
 

Old Runner Frank

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I didn't realize that I haven't posted here in a month. I check this thread regularly to see how everyone is doing.

Don, glad to hear you are coming along. The strength will come with time. Don't know when you can start working on flexibility, but presumably you will do so cautiously. Sorry, I am unfamiliar with the Regeneten patch, but it sounds like a good idea. Wonder why it's not used all the time for QTR injuries? How is everyone else progressing?

At six months post-surgery, my knee feels really strong, but I still have not been able to recover full ROM. It's reasonably functional, so after consulting with my orthopedist, I'm going to evaluate it over the next couple of months to decide if I want to do a follow-up arthroscopic procedure to release the scar tissue. Meanwhile, I have developed pain on the inner (medial) joint line over the last few weeks, which has made walking difficult and running impossible. Best guess is that it's a tear in my medial meniscus. I'm scheduled for an MRI next week to figure out what's going on. My inclination is to muddle through the acute stage and rehab it non-surgically, but it might make sense to have the doc go back in to take care of both problems with one procedure. Guess I'll know more after the MRI.

Hope everyone enjoys the holiday weekend.
 

Rod9301

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Checking in at 14 months. Things are mostly normal, but I do continue to see improvements even this far into the process. I believe this is really a year long (or more) process for many. It has been for me, though some of that may be due to not having access to a gym due to covid. I think back to where I was at six months, I feel completely different now. What is lacking is strength. I realized the other day I cannot do a leg extension of even 20 pounds on my repaired knee. The good one, I can pretty easily do 70. I can push the bar up about halfway, and then it stops as I don't have the strength to go further. I will need to work on this. Will have to start with leg weights at home, as 20 is the minimum on the machine. This weakness does not seem to have translated into anything noticeable in day-to-day life. I wonder why or why not. If anyone is doing leg extensions, I'd be curious to know how far into your recovery you were before you began doing them, and how you progressed. This was something my therapist told me would be the hardest thing to do.

BTW, I seem to have regained even more ROM in the past few months. Or, perhaps more accurately, getting to max ROM is requires less stretching. I am routinely doing things like sitting back on my heels that I could do a few months ago, though back then with some stiffness and trepidation. Now, I'm not noticing that at all. Feels very natural and not stiff.
With the leg extension machine, lift the bar with both legs and lower it with one leg only.

This will not put stress on your knee and will help get strong faster
 

martyg

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With the leg extension machine, lift the bar with both legs and lower it with one leg only.

This will not put stress on your knee and will help get strong faster

Negative reps are going to be the driver of tendon growth. You should be emphasizing eccentric motions for a year out. Not exclusively, but they should be a focus.
 

Old Runner Frank

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Checking back here to see how everyone is doing. Please post your progress, including trials and tribulations, as I find everyone's stories inspiring.

At seven months, my repair feels strong. Been able to resume full activities (running, working out, etc.), but I could still use another 10 degrees or so range of motion. I'm still leaning on it regularly, but it feels like I've hit a wall. The MRI did show a small tear in my medial meniscus; however, I was able to make it through the acute phase, and am now completely asymptomatic, so my orthopedist agrees that no intervention is required at this point. I'm going to try to decide over the next couple of months if I can either gain a little more ROM and live with what I've got, or do the secondary procedure to release the scar tissue.

Hope everyone is continuing to make progress.
 

Don379

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Thanks for waking up the board Frank!

Second repair is at 10 weeks for me. Range of motion is focus can pedal on bike but with no resistance. Wall sits, squats are - very light

The repair feels better but there is more tightness and soreness in knee. However the strength in quad above knee is better than first repair. There was a lot of fluid above knee cap before which was hiding the tendon gap missing from first ill fated repair.

Been a bummer not being able to run, bike and sail. Hear war stories from ACL folks, knee replacement folks and one who tore both quads in same year which I don't want to hear!
Been paranoid on Lipitor and thyroid meds I have been on for years contributing to "tendon brittleness".

I feel I am progressing, see ortho in two weeks. Hopefully I can start to use leg to get back to running and biking after that. Will also need to build strength the right way on bad leg.
 

Don379

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See the Doc tomorrow. What questions should I ask? At the 12 week mark. Pretty close to full ROM 120/140. Little strength in leg. There is some swelling and soreness around knee but nothing major.
Still clumsy walking down stairs and even going up the strength is not all there.
Need some more balance work. Want to avoid activities like lunging? Or other exercises that can not help recovery.
I can not run. I try but the bad leg just wont cooperate. Walking faster is happening so I hope jogging may be something that can be done soon. ( I am a life long runner).
Biking - been spinning but with no resistance which does not do that much. I actually get a higher heart rate from walking.
Thinking yoga exercises and Pilates are needed more. Afraid of lunging knee stretches though.
 
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