Considering surgery to lengthen patella tendon

[skibum9]

Hello. This is my first post here, but I have been reading the posts here since earlier this year. I broke my patella in half in November 2006 and my life hasn't been the same since. I have been to one of the specialists listed on this board and have been diagnosed with arthrofibrosis and patella baja. I need to consider surgery to lengthen the patella tendon or live with the limited mobility that I have. Does anyone have any experience or literature on this subject. Any insight would be appreciated.

Sharon

[missmyknee]

Hi Sharon

I'm glad you joined and wanted to welcome you to the forum.

There are only 2 people that I know of who have had a patellar tendon lengthening procedure done and they are MelP and another long time poster who happens to be named Sharon, too. You can use the search feature entering " patellar tendon lengthening" . You can also private message them by clicking on their screen name, going to their profile and clicking on, private message this person. There might be some others out there who have done some research on the subject.

Welcome to the forum !

Pam

[skibum9]

Pam

Thanks for the welcome. I spoke with MelP this evening about her surgeries and rehab. I'm starting to develop a list of questions for my next doctor visit. How are the 2 a days going for you?

Sharon

[missmyknee]

Hi Sharon

I'm so glad you got to visit with her. I hope she helped you out and answered some of your questions. I hope she continues to see good results and return to her activities.

Missed you at PT today. I had some new exercises added.....the wood wobble board, hamstring machine. I lost 1 degree in extension, now I'm at 6 intead of 5. Hanging weights are at 15 lbs now. I got to "borrow" a 5 lb weight to take to my apt to add to the 10 lb one I had. Also ultra sound might begin on my patella tendon tomorrow or Wed. I'm having tightness,sharp pain and burning to it.

Pam

[skibum9]

Pam

Glad to hear that you got some new exercises, but sorry to hear about the pain. How much longer do you plan to be up there? I'm glad to be home and my cats were very happy to see me. I have been faithfully doing my home PT routine several times a day, but feel guilty because my Mom has been working like crazy to get the yard under control and the house cleaned. I try not to do much to help, but I find myself trying to pitch in and me knee starts to get warm. I'm learning to take it down a notch every day, but it's hard because I have always been so independent.

MelP seemed to be doing well in her recovery, return to activities, and keeping up with her family.

Sharon

[missmyknee]

Hi Sharon

Well, that is some great news about MelP. I hope she continues with this success !!! The other Sharon had a similar procedure using her hamstring , if I remember correctly. You can private message her to find out any info from her. I think she just had OATS done to repair the cartilage damage from her baja. She posted on MelP's baja thread.

I will be going home this Saturday. It's been a long time here, but my apartment worked out perfectly and made the long stay bearable.....keep that in mind for the future. It will be nice to get back to the family. I have 2 mini dachshunds that have been kenneled all this time and can hardly wait to see them.

Another tough day at PT. The hanging weights and pushing down afterward was a little unbearable today, esp the afternoon session. Usually I can tolerate it , but not today. I was pretty tired when I got "home"

When do you have your return appointment ? Mine will be the end of June.

Pam

[skibum9]

Pam-

I will definitely keep the apartment thing in mind. The hotel was getting old, but not as bad as I thought since I spent so much time of the day at PT. I will be back up there the first week of June to do a couple of PT sessions to make sure I'm on track with my home program and then the last week of June for a follow up appointment.

Sharon

[wanna]

Sharon

You will see from my signature the trouble I have had with a TKR,revisions and infections.

However , just had a soft tissue operation including lengthening my patellar tendon . I basically had it cut (again !) and then restitched using a Y type technique which made it longer. This has already increased my flexion from 30 degreees to 90, and I am only 2 weeks out of ther Op - a long way to go with physio etc.

Unlikely I will get much more bernd due to other previous infection problems, however can only recommend this surgery

Andy

[skibum9]

Andy -

Thanks for the response. Best wishes for your recovery.

Sharon

[djay]

Hi Andy,

Good to hear about you op. I'm curious about the exact details as I broke a small part of my patella and ruptured the tendon about 18 months ago. Small section of bone was removed and the tendon repaired but i was immobilised for a long period and subsequently the tendon is about half the normal length and twice the thickness so i suffer from Baja/inferapatellar contracture and limited ROM (about 90-100 tops). Been through various scans, specialists, surgeons and sports physios but no solution yet.

I have a meeting next week with a surgeon following an MRI to see if there is anything they can do. Any chance you can elaborate on what happened to you and the op and rehab etc??

Cheers

dan

[Sharon]

Hi Sharon,

I'm the other Sharon who some of the others mentioned. I had surgery just about 2 years ago to reconstruct my patellar tendon using a piece of my quad tendon due to patella baja. The surgery was successful in that it returned my patellar tendon to a much better length and put my kneecap back into the correct position. In the first few months post-op there was the loss of a few millimeters of length to the new tendon due to scar tissue but it was nothing major. I was not a candidate for tendon lengthening because my patella baja was too severe and there was too much loss of my tendon-it had to be completely reconstructed. My OS's original thought was to use an allograft, however I'm really small and they had a huge problem actually finding a tendon for me. We waited about 6 months to see if one would come up but after that my OS decided to use the other technique, which is one that he actually created for situations like mine.

I did just have an OATS procedure 7 weeks ago due to continued pain even after my patella was returned to a better position. This was because my cartilage was badly damaged and worn down from the time my patella spent in the wrong position. I had 2 defects that were filled-one on my patella and one on my trochlea. After my patella tendon surgery I was never able to gain full flexion even though my OS said that I should be able to. He now thinks that the main reason was because of the cartilage damage and we're hoping that with that fixed I'll be able to get full flexion again. Right now I'm at just about 90 and struggling a bit with gaining more but I'm hoping that when I see him tomorrow he'll say that I'm on track and doing okay.

I hope this helps you. Feel free to ask if you have any questions about what I had done or anything.


Sharon

[skibum9]

Sharon

I'm glad that you have responded to my post. I have lots of questions because my doctor is basically proposing to reconstruct my patellar tendon using autografts (hamstring tendons) and allographs. I would like to know the details of the process that was involved to reconstruct the tendon (hardware, number of surgeries, rehab) and the time frame for recovery. Also, what is the OATS procedure?

I believe that I developed arthrofibrosis and patella baja within a pretty short period after breaking the patella in Nov 2006. I'm hoping to be able to climb the stairs in my house like a normal person, get in my truck without having to crawl into the passenger seat, and those other various daily activities which are taken for granted.

Thanks
Sharon (#2)

[Sharon]

Hi Sharon,

It sounds as if the surgery your doctor is planning is similar to what I had done. Mine was done using only an autograft. My doctor took a small section of my quad tendon, with a small piece of bone that was attached to it and transferred that to become my patellar tendon. I have one titanium screw in my tibia from the surgery in the place where the small bone block was attached to the rest of my tibia. I only had to have the one surgery to do the reconstruction and I believe the surgery itself only took about 2 hours for my doctor to do. After the surgery I was in a bledsoe brace for about 2 months and it had to be locked straight whenever I was standing or walking, otherwise it could be unlocked. I was full weightbearing about a week after the surgery, once my OS saw that the bone had started to heal. I started PT about 2 and a half weeks after my surgery. It was delayed a bit because a little part of my incision had reopened after I got the stitches removed so I had to wait for it to heal over. My OS's main objective was for my knee to bend and we worked really really hard on that. From the moment I got out of surgery I was on a CPM machine for 6-8 hours a day. It was very painful getting my ROM back but I knew it was necessary. As I had said in my previous post, I only got to about 100 degrees in the end but my OS thinks that was because of the cartilage damage. It was also really hard to get my quad strength back due to it being cut in the surgery. I always have a hard time with quad strength after surgery, but I think that made it a little harder to get back. I actually never stopped going to PT after that surgery...I joined their fitness program and kept working until I had my last surgery on April 18. As far as recovery time...my surgery was in mid-July and by mid-September I was able to work as a substitute teacher. That was right after I had gotten out of the beldsoe brace and was put into a smaller donjoy brace and it was hard at first. I think I got myself totally out of all braces by mid-November and that was when I finally felt that I was well on the road to being recovered. It's a hard surgery but since it did manage to get my patella back into the right position, I think it was worth it.

As I also said, it wasn't my last surgery though. I just had an OATS procedure 7 weeks ago. OATS is a surgery that is done in order to correct damage to the cartilage. I had pretty severe damage to a spot on my patella and a spot on my trochlea due to the patella baja. In this surgery my OS used a synthetic bone graft(it can also be done with autografts) to fill the areas where the cartilage was damaged. The idea is that my tissue will grow in around the bone graft and the cartilage will kind of regenerate itself. This was also a pretty hard surgery to go through but at this point it was my only option. I was still in alot of pain before this and my OS felt that if I didn't have this done now, a more extensive procedure would be my only option in the future. I know that I will still need a TKR in the future but this has at least hopefully put that a little further into the future than it was beforehand.

I hope this helped answer some of your questions. Feel free to ask away with anythingand I'll do my best to answer. I know there are very few of us who have had this type of procedure done so I'm glad to be here for you!


Sharon

[skibum9]

Hey Pam,

I was thinking about yesterday and today while I was up in Cincinnati doing PT. The guys took turns working on mobilizing the patella during both PT sessions. It didn't hurt so much last night, but this evening OMG. It hurts just to touch it. It was a long day with 3 hrs of PT, an hour waiting to chat with the doc on all the questions I had e-mailed up there on the procedure, then another hour in PT do to a strength test, and a 5 hour drive home. The strength wasn't very good, but now I have a number to shoot for and as an engineer this gives me something to aim for besides the vague term "increase your quad strength". He may have done the test to humor me, but now I have some motivation on what needs to be done if I choose this path. I'm going to try and return to work part time on the 18th and will be back up to visit my favorite PT folks on the 27th and 28th.

Hi Sharon,

Thanks for the response. It's helpful knowing that some people have had success with overcoming patella baja. Any more thoughts, helpful hints, or wish I had done that instead are welcome.

Sharon (#2)

[missmyknee]

Hi Sharon

Did you get alot of your questions answered while you were there ? Have you decided on what to do ? I never expect to get out of there before at least 4-5 hours. LOL.

I will be back in Cinn for a June 28th post-op and PT appointment at 1pm. Will you be there ? We are going to stay til Saturday.

I'm still battling a nasty, painful, case of patellar tendinitis. I'm still using one crutch. Tried to get off it and really aggravated the tendinitis. I do rehab 3x's week for 2 hours each session, plus home. I also get ultra sound to the tendon and taking diclofenac. Extension is still at 5-6 and flexion is 107 cold and 115 after ERMI. I'm still doing 15 lbs hanging weights.

Good Luck on your return to work. Don't over do it ! Maybe I'll see you on the 28th !!!

Pam