Ruptured Quadriceps Tendon

[fitnesskitty]

Hello All,

I hope you don't mind my jumping in here. I saw your posts on extension lag and wanted to ask what that is. My extension is good, but when I try to do straight leg raises, I cannot lock my knee straight; it bends a little. Is this extension lag? If I sit with my legs bent at 90 degrees, I cannot lift my calf out straight, only about two-thirds of the way. I have seen some improvement in how high I can lift it but was wondering if it is just a lack of muscle or what else it is, and will it come back in time?

Just a little background info, so you understand my injury and surgeries since it is different from yours. In August 07, I fell coming down my stairs and dislocated my patella. I had a surgery six days later to realign the patella, repair a tendon, and remove bone fragments. I was then immobilized for about a month or so and then started PT. I got stuck at 50 degrees ROM and it got progressively worse. My OS referred me to his partner, who said I had developed scar tissue, and a week later on the first of November, I had another surgery to remove scar tissue (LOA), a lateral release, then he did a manipulation under anesthesia. I had 20 degrees ROM on the day of surgery and he got 120 on the OR table. I started PT the day after the surgery and got to 80, then 90 a few days later. I am now at 134 degrees, only 4 away from my other leg, but as you can imagine, my muscles atrophied through all of this and I am working hard on my home PT exercises each day and I do weight machines at PT and at my gym and I cycle on a recumbent or stationary bike and use an elliptical at PT. I go to PT twice each week so I use the bike and elliptical there and then supplment that with an additional 1-3 days per week at the gym, getting there as often as I can.

I really hope no one minds my jumping in and I hope you are all doing well in your recoveries!

Take care.

Sarah

[milkoholicBear]

Sarah,
What you are describing is precisely that, extension lag.
It means that you can not, under gravity, extend your leg fully. Imagine the knee at 180 degrees, that would be zero lag. From there, you start to measure, and, if you can only extend to, say 160 degrees, then 20 is your lag.
By "under gravity", I mean like you're saying, sitting on a chair, knee at 90 degrees and attempting to straighten (extend) it (bring the knee to 180 degrees) using your quads strength.
This is extension under gravity.

As I am having one ( extension lag) too, I found out that, in general it is not being given as much importance as ROM. Eventually, it will disappear, with patience and exercise. Nevertheless, it is still a good idea to see your OS to get a confirmation that everything is all right with your extension mechanism (quad muscles, quand tendon, patella, patellar tendon).

HTH

[fitnesskitty]

Hi There,

Thank you for the explanation. My OS does know about it, and I have seen some improvement in it since I last saw him. It was a lot worse, so I am probably just being impatient with it. He said I just need to get my muscles build up. I see him in a couple of weeks, so he will be examining my leg then but I think everything is fine. It is just a follow up appointment. I just need to be more patient.

How many weeks post op are you? I hope that you are moving along smoothly in your rehab, despite the extension lag.

Take care and have a great day!

Sarah

[milkoholicBear]

Sarah,
I am now 12 weeks post op for a ruptured quad tendon, that occurred in July.
My ROM recovery was above average, as I got it all (~130 degrees) back by the 7th week post op.
I am walking now without any aid, with only a slight limp. I only use the crutch when I have to walk over snow or ice (I live in Montreal)
The only dark spot on my recovery is my lag, but, after meeting with my OS yesterday, I have been told that everything is OK in my knee, and that the lag will eventually disappear.

[fitnesskitty]

Hi There,

I guess I am just being impatient with my own lag. It is very strange to see that you cannot lift the calf out straight though, isn't it? So weird. I am 10 weeks post op from my second surgery and had some atrophy from the surgery I had in August too, so I suppose my recovery is probably on track considering the degree to which my quads/hamstrings have atrophied. It is good to hear that others know what I am dealing with. When I tried to tell a couple of friends that had never experienced knee issues, they looked at me like I was nuts, because it was hard for them to comprehend not being able to fully extend the leg from a sitting position and only getting perfect extension passively, when sitting or lying with the legs out straight. So, it is nice to be able to come here and talk knee issues with people that really get it.

Thank you for helping me to better understand my own issue. It sounds like you are progressing really well, especially since your OS is happy with the progress you have made. How is climbing up and down stairs for you? I cannot do that yet either. I go one step at a time since my muscles are weak, and especially going down steps, my knee likes to give out. If I know there is a ramp or an elevator, I am using those for now, till I get strong and confident again in taking stairs properly, and my house just has a few steps, so not to big a deal to look silly going up and down one at a time. :-)

Anyway, I hope you have a great afternoon! Take care!

Sarah

[milkoholicBear]

Sarah,.
Stairs are still a somewhat iffy enterprise for me, mostly going down.
Going up, I am doing one by one, and am trying to push on the bad leg each time, to strengthen it.
Going down, my bad leg is far from being at ease, so I am only using my good one.
I use a crutch every time at my house (one straight flight of 14 stairs to the upper floor). I must say, it looks like a ravine when I look down...., and I am paranoidly cautious going down.
At my parents in law, there are two flights of 9 and 7 stairs, and I don't use the crutch, but it's still one by one and I really need the railing.

I spoke to many people, and, without wanting to scare anyone, there is a remote possibility that one will never be as comfortable as before going down the stairs after an extensor mechanism injury such as ours. If this is going to be my case, than so be it. Maybe it will get better with time.

[irishknight]

My Pt has a good excercise to work on, while using stairs, step up backwards a few steps, then down each step normally, after about 15 reps of these there'll be a good ache in the quad.
I go to my OS tomorrow, I think I've reached about as far as I can go, 6 months post op from second surgery, still have about 15 degree lag, weekness is persistant, no pain unless I over work in PT, which I do 3 times a week with visits to local gym after and in between PT visits.
Happy happy




BOB/ Tooele, Utah.

[225Champ]

8 months post-sugery of Bi-lateral Quads rupture(both legs). I have more or less a 15 degree extensor lag on one leg. My OS seems think it will improve w/ exercise and additional time. The other option would be to have surgery again. The OS says give it a year. I am hoping for improvement. I continue to do straight leg raises, but the lag degree remains the same. Despite a change in my walk, the lag, and various minor aches/clicks, I am feeling really good. Walking the 15 stairs at home is difficult, but has improved.
I am just glad to be up and moving around after spending greater part of last summer in a wheelchair.

Wishing all the best recovery

[irishknight]

Well Dr says that I have 3 more months then I'll be at maximum. he wants 3 times a week PT with Gym as much as I can tolerate. groovy






BOB/Tooele, Ut.

[bill.cochrane]

G`Day to all from sunny Oz,
it`s now 14 weeks plus since my repair for a complete quad rupture and I have just been given the all clear to begin at the gym,my first session will be on Friday.The knee is getting stonger every day but is still weak compared to the good one (I really feel for you poor blokes who have had bi lateral ruptures), I have a slight tightness down my kneecap when I stand or sit for long periods but walking has improved out of sight.The OS said I have a 10* lag and walking and light weights is ok but no running yet, couldn`t run if I tried at the moment.I have been driving my manual for about 5 weeks now and have almost full ROM still no skydiving yet but the physio reckons I should be okay by end of March OS says he will reserve judgement until after next visit in April he seems to think my military parachuting career may be at an end...We`ll see about that!!

well better go keep up the good work everyone and hang in there.

Regards,Bill

[fitnesskitty]

Hello all,

For the first time since my injury, I walked up my stairs properly! My quads are finally strong enough to do this, though they are still weak. Slowly but surely I am getting there though. I got terrified when I looked down the flight, and chickened out and ended up scooting down on my bottom, but still, going up them the right way was a huge accomplishment for me. I am proud of that. My injury occurred on a fall going down these stairs, so my fear is more escalated by that. I dislocated my patella and only tore the tendon a little and chipped a few tiny bone fragments, so my injury is different from all of yours, but the recovery period has been sort of similar. I have about 6-9 more months before my quads will be built up again completely and I will feel completely normal. My injury was in August '07 and my surgery was a few days later. Then I had problems with scar tissue and ROM and had a scope to do an LOA and LR, followed by an MUA in November, so it really was not until November that I got to really start my recovery.

I now have all but 4 degrees of flex of my ROM, I can do 35 minutes on an exercise bike, at least 20 minutes at a time on an elliptical machine and I can do 50 lbs on a leg press and seated hamstring curls. At this point, I hav no choice but to take it one day at a time, so that is what I am trying to do!

What causes extension lag? If you have already said, I apologize. I am just wondering why I cannot lift my leg out straight, it is so weird!

Thanks for your help, and I hope you are all having a good day!

Take care!

Sarah

[225Champ]

My OS thinks I may have been too agressive in PT which could have caused my extension lag. In my opinion, surgery could have been performed differently on one leg over the other. Thus, his suggestion of another surgery, if necessary. Who knows?
I find that the quad of my extension lag leg is not as strong and there's a tendency to feel something similar to a cramp, when I perform certain exercises such as straight leg lifts or isometrics (quad tightening). I just back off from the exercise until the feeling subsides.
Walking feels quite different , but to watch me, it would be difficult to tell that I had a bi-lateral injury.

The body is phenomenal and healing does come. Be patient! PT and gym workouts have helped me get back on track. Take extreme care in your recoveries, and keep up the GOOD work!

Has anyone ever heard of IT Band? The iliotibial (IT) band is a tough group of fibers that run along the outside of the thigh. It's causing a popping sound, from time to time, when I get up from a seated position. It's not painful, but the last thing I want to hear is any type of noise. An audible pop was heard when I fell running. The stretching exercises given to me has helped.

Danny

[JoMama]

Hi everyone,

I'm new here, and wanted to say hello. I too am a victim of this (rare?) injury. I ruptured my left quad tendon while playing sand volleyball back in September, 2007. I think I scared everyone on the beach with the loud pop! I'm quite surprised I didn't find this site earlier. I was really coming to the conclusion that I wasn't going to discuss this topic with anyone who has been through this.

I'll give you my some quick details of my current progress. It's been about 4 months post-surgery, and I seem to be doing good. I've been jogging 2-3 days per week, running up stairs/bleachers, and weight-training. The running is going okay, though I'd say my jogging pace is about 50-60 percent of what it was. Of course I'm not expecting it to return to normal at this point (or ever?). I'm doing some relatively light weight-training, though I'm sure my good leg is doing more of the work. I was cleared to do perform the leg-extension machine, and can only do perhaps 10-15 lbs with the injured leg.

The only concern I really have is whether I'll ever be able to play beach-volleyball again (and at a relatively competitive level). From looking at the posts on here, there are some stories that give me hope, and some others which, well, give me a reason to be a little pessimistic. Is there any chance of a "full", "pre-injury" recovery for this injury? I understand there are many variables in this question. If any of you have recovered fully, please let me know! :-).


Anyway I wish you all luck in your recoveries. I understand it will take some time to ever return to "normal" - if we are all fortunate enough for this to occur.

Take care,
Joe

[frederico]

Welcome to the quad tendon rupture board, Joe! It sounds like you are doing great for 4 months post-surgery.

Whether you return to the pre-injury level of performance is a guess. My OS told me a quad tendon rupture is a "career ending injury" for a professional athlete - not because of a lack of strength, but a lack of quickness that results from the injury. Not being a professional athlete, I can't comment on that. I can say that I have substantially returned to my pre-injury level of activity. However, there is still the nagging fear of re-injury and I tend to consciously or sub-consicously protect or guard my injured leg somewhat, even after a year and a half post surgery.
If I were playing a competitive sport, (I bike, hike, swim, and train on an elliptical trainer), this would probably translate into not being as sharp as I was previously. I would imagine over time that would self-correct.

As I have said many times, recovery is slow but steady, just don't try to push it too fast.
Keep up the training! Best of luck to you and all the others on your recovery.

Fred

[philt]

Hi all, been a while since my last post so here goes the 8.5 month post-op update (repair to full rupture right quad tendon, aged 51 next month):

The good news: just got back from 6 days skiing in the French Alps - (Belle Plagne in the Paradiski range for those that know it). Day one was a little tentative - stuck to blue runs and nothing too demanding. Experienced occasional twinges of pain through the patella (especially after hitting a bump) but quads held up fine - just had to grit my teeth from time to time. By day six I was off piste in powder. Felt fantastic and worth all the hard work in the gym over the last few months. However, I stayed away from moguls and un-pisted black runs - didn't want to risk a serious tumble and twist to the knee. After effects each day were swelling and stiffness both of which I expected. Also needed a couple of km of piste each day to warm up the muscles. However feeling very little, if any, patella pain now - will wait and see of this returns in the gym over next few days.

The bad news: saw my PT the week before I went (2 weeks ago) and the right quads were still only 70% of the strength of the left quads - no progress in 5 weeks despite regular gym work which was a bummer when she told me. Will be working on this over the next few weeks and am hoping the skiing has helped.

The lesson so far (for me): having a goal (my pre-accident/op planned ski-trip) has helped enormously - I was determined to make this ski trip and achieved my aim even though I genuinely didn't know until I got on the piste whether I'd be able to ski or not (I took some work and DVDs with me in case it didn't work out!). Now looking forward to my next ski trip at Easter and even more determined not to let this injury rule my life - I'm treating it for what it was - a freak accident.

Hope this tale helps - there's life after a ruptured quad tendon - go find it!!

Take care all.

Phil