Quad and Patellar Tendon Ruptures
Treatment and Rehabilitation of Patellar Tendon Rupture
by ACE Physical Therapy and Sports Medicine Institute
Tips for Patellar Tendon Rupture Recovery.
- If you fall or experience sharp pain in the front of the knee upon landing from a jump, seek medical help immediately.
- Apply ice to the injury site as quickly as possible.
- Follow your doctor’s instructions to avoid damaging the surgical repair.
- Your thigh strength will takes months, not weeks, to re-gain the pre-injury strength.
- Follow your Physical Therapist’s protocol when rehabilitating this or any injury.
- They are part of a medical team that works together to get better rehabilitation outcomes following a surgical procedure.
Young and old alike can suffer a quadriceps and patella tendon rupture. A high impact like landing from a jump or falling down could tear the tendon. This commonly happens in sports that involve running or jumping. When the forces through it exceed its tensile strength capabilities, the tendon can rupture. A rupture is painful, and a complete tear in the patellar tendon is incapacitating.
While anyone could rupture a patellar tendon, it is more common among males and may be different based on age. Those who are below 40 tend to rupture the big tendon in the front of the knee and below the kneecap; older generations, on the other hand, tend to rupture the tendon that attaches at top to the patella. In both cases, these injuries usually occur when the muscle is under a significant eccentric (lengthening type contraction) load.
An extensive and prolonged rehabilitation process will allow the patient to return to their pre-injury lifestyle and activities in almost every case, providing the patient follows the prescribed regimen. This includes performing the exercise routine aggressively and for the duration needed to re-develop the strength, endurance and proprioception of the entire core and lower extremities.
Understanding The Knee Joint and the Patella Tendon Rupture
The knee joint requires a tremendous amount of dynamic support by the surrounding muscles to enable it to perform the every day and high-level activity that some people perform on a daily basis. The muscles and the surrounding soft tissue can withstand enormous amounts of pressure and force, including pressure and forces that are significantly in excess of the person’s body weight. If the muscle contracts so forcefully that the tendon tissue cannot withstand the force, it tears away from the bone or in the mid substance of the tendon tissue.
The knee joint consists of three bones: Femur, Tibia and Patella. The Patella is sits in a groove of the Femur and “glides” up and down when the knee is flexed or extended. The movement of any joint occurs when the muscles surrounding the joint contract. The Patella’s role in motion is to provide a “fulcrum” type action for the Quadriceps muscles. There are 4 Quadriceps muscles (Rectus Femoris, Vastis Lateralis, Vastis Medialis, and Vastis Intermedius) which come together at the knee joint and form a common tendon that engulfs the Patella. The Patella is attached to the Tibia via the Patella Tendon (mis-named because it actually attaches the Patella which is bone to the Tibia which is bone therefore it should be called the Patella Ligament). For the purpose of this blog, we refer to it as the Patella Tendon because in most of today’s literature that is the name that it has been given.
A total patella tendon rupture is debilitating. If someone ruptures the Patella or Quadriceps Tendon, they will not be able to bear weight on that leg. The knee joint’s function is greatly reduced if there is no anterior knee support. A partial tendon rupture can be managed with a prolonged period of immobility.
Surgery and Rehabilitation
Whether the rupture total or partial, physicians normally recommend surgery as the treatment of choice, and it is best to perform the surgery as soon as possible. Waiting for a prolonged time can cause the patient’s knee to experience gross muscular atrophy, range of motion loss, and significant functional loss.
In most cases, the surgery requires the surgeon to re-attach the torn tendon back to the bone. Mid-substance ruptures are less common. The tendon is literally “stitched” back to the bone. Holes are drilled into the Patella and sutures are passed through the holes. The tendon is pulled to the bone that has been specially prepared by the surgeon, making it easier for the tendon to adhere and re-attach to the bone.
Rehabilitation begins shortly following the surgery. The doctor and Physical Therapist need to communicate the restrictions that will be in place to protect the surgically repaired tendon. The Physical Therapist works alongside the patient during the lengthy rehabilitation process because performing the incorrect activities could damage the repair or stymie the healing process.
What To Expect During Recovery
If you have patella tendon rupture surgery, you can expect a gradual recovery with extensive rehabilitation. The first phase of rehabilitation usually begins within the first week of the post-op period of time. The doctor will give you specific details of weight bearing and allowable activities. Initially, your Physical Therapist will focus on reducing swelling and controlling pain.
Regaining motion and strength begins gradually and is a slow, arduous process. The second phase of this rehabilitation process begins approximately 4-6 weeks after the surgery. Based on the doctor’s protocols the Physical Therapist’s focus will be to regain all of the motion, strength, endurance and proprioception throughout the involved lower extremity.
Pain: Everyone has a different pain tolerance. There is usually a significant amount of pain in the first couple of days following the surgery due to the extensive amount of surgical “work” that takes place during the procedure. Use the RICE principles (Rest, Ice, Compression and Elevation) of inflammation control and the pain medication that is prescribed by your surgeon and your pain level will be managed during the initial 48-72 hours of the post –op period. Controlling the swelling is the most important aspect of pain control during the initial post-op period.
Weight bearing and braces: Your doctor will determine your weight bearing status. You might be required to be non-weight bearing (NWB), using an assistive device, and you might have to remain NWB for up several weeks. In many cases, the surgeon will allow you to be weight bearing as tolerated while wearing an adjustable range of motion brace that is “locked” in a fully extended position. This fully extended position places very little tension or force on the tendon that has been repaired. If the knee is bent (flexed) even a degree or two, the tendon repair might be damaged if too much weight is placed on the involved leg. Fortunately, new surgical techniques and “anchoring” devices make the repairs a lot stronger.
Driving: Returning to the driver’s seat is determined in part by which leg is involved, if the transmission is automatic, and if the patient has quit taking narcotics. The doctor ultimately determines when you are ready to drive. Normally, you should be able to resume driving within the four weeks following the surgery.
Work: Returning to work depends on the physical demands of your job. Most patients can return to some form of limited duty work within a few days following the surgery. If you have to walk or be weight-bearing most of the day, you should plan to take several days to weeks off based on what is done during the surgery. If you have a sedentary job, you might be able to return with in the first week of the post- op period. Ultimately, your doctor will have to make this decision and you should be wise enough to follow the doctor’s instructions. Placing too much weight on the repaired tendon too soon can cause damage to the repair site and/or slow down the healing process.
Having fun: Recreational sports, hobbies, “work outs”, house chores and other activities will have to be placed on hold until the tendon has healed sufficiently to allow you to perform the motions associated with your activity. This can range from a couple of weeks (in a brace) to several months. High level activities that require running, jumping and agility type movements might need to wait for 4-6 months or longer prior to beginning to perform them in the post –op time period. The ruptured tendon can take up to 1 year or longer to completely heal.
Physical Therapy: Your initial Physical Therapy will focus on reducing the swelling and pain following the surgical procedure. In most cases, there will be a restriction to passive motion, for a couple of weeks. The passive motion will increase weakly with a desired amount of motion achieved by the 4th and 8th week. During this time period, you should try to maintain or develop good core strength. You will need it to regain full function of the involved joint. Approximately one month after your surgery, your Physical Therapist will “step-up” the strengthening phase of your rehabilitation program.
Quadriceps and Patella Tendon ruptures are devastating to the patient. They will lose compete function of the involved leg until the surgery is performed to repair it if it is a complete tear. Fortunately, the new techniques and anchoring systems that are used to re-attach the torn tendon to the bone have enabled Physical Therapist to be more aggressive with the rehabilitation programs. This approach helps to re-establish the pre-injury function more quickly.
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