Tendon Rupture > Treatments
Preparing for surgery
The decisions you make and the
actions you take before your surgical tendon repair
can be every bit as important as the procedure itself
in ensuring a healthy recovery. Getting a second opinion
from a surgeon who is as qualified as the surgeon who
gave the initial diagnosis is advisable in any case.
sure you have received any equipment you will need when
you get home from the hospital. This may include a knee
brace, crutches, ice packs or coolers, or a continuous
passive motion (CPM) machine. You should receive prescriptions
for any of these from your doctor when your surgery
the potential risks and benefits of the surgery, and
ask your surgeon any questions that will help you better
understand the procedure. It can also help to talk to
someone else who has undergone the same surgery.
physical problems, such as a fever or infection, should
be reported to your surgeon, and you should notify your
surgeon of any medication you are taking.
reduce the risk of infection, try to refrain from smoking
for at least a week prior to surgery.
possible, practice walking with your crutches in case
you need to use them after surgery.
sure the orthopedist performing the surgery is board-certified,
which can be determined by calling the American Board
of Orthopaedic Surgery at 919-929-7103.
to ask the doctor
to take to the hospital
At most medical centers, you will
go to "patient admissions" to check in for
your surgical tendon repair. If your surgery is going
to be inpatient, there may be a separate department,
so be sure to ask your doctor. After you have checked
in to the hospital or clinic, you will go to a holding
area where the final preparations are made. The paperwork
is completed and your knee area may be shaved (this
is not always necessary). You will wear a hospital gown
and remove all of your jewelry. You will meet the anesthesiologist
or anesthetist (a nurse who has done graduate training
to provide anesthesia under the supervision of an anesthesiologist).
Then, you will walk or ride on a stretcher to the operating
room. Most patients are not sedated until they go into
the operating room. Here are some important steps to
remember for the day of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This will
reduce the risk of vomiting while you are under general
the anesthetic and pain medications may make you drowsy
and you will be unable to drive, arrange for someone
to help take you out of the hospital and drive you home
when you are released.
shorts or a loose pair of pants that will fit comfortably
over your knee bandage when you leave the hospital.
You will also be given a brace so be sure there is plenty
of extra room in your clothes.
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.icle/index.asp?showarticle=yes&articleId=277&articletype=44">What
to take to the hospital
A quadriceps tendon repair is an open
procedure that cannot be done arthroscopically. The
procedure usually takes between one to one-and-a-half
hours to perform.
anesthesia is administered, which may be regional or
general, the surgical team sterilizes the leg with antibacterial
incision is made lengthwise on the top of your knee
from about four inches above your kneecap down to the
center of your knee.
ends of the ruptured tendon are identified and then
isolated from the surrounding tissue.
the rupture occurred more than a few days prior to surgery,
the surgeon must cut away any scar tissue, until healthy
tissue is exposed.
kneecap is positioned properly in its track.
use thick stitches to sew the tendon tightly together.
Most of the time the tendon tears from its attachment
on the kneecap. In this case, the sutures are placed
through drill holes in the kneecap for a strong repair.
The internal sutures are permanent and remain in your
incision over the knee is stitched and you are taken
to the recovery room.
surgery to repair your ruptured quadriceps tendon, you
usually stay in the recovery room for at least two hours
while the anesthetic wears off. General anesthesia wears
off in about an hour and spinal anesthesia may take
about two hours to wear off. Most patients experience
a moderate amount of pain after surgery. You should
take the pain medicine as directed. Remember that it
is easier to keep pain suppressed than it is to treat
pain once it becomes present. When you feel the pain
coming on, take another pill, as long as it is within
the time limit on the bottle. Your knee will be bandaged
and may be immobilized in a cast or brace. It may have
ice on it. The type of cast or brace used can vary
many physicians prefer to use a plaster or fiberglass
cast or splint to keep your knee straight. The most
common type of knee immobilizing brace is cloth with
metal stays and Velcro straps. You should try to move
your feet while you are in the recovery room to improve
circulation. Your temperature, blood pressure, and heartbeat
will be monitored by a nurse, who, with the assistance
of the doctor, will determine when you are ready to
leave the hospital, or, if necessary, be admitted for
an overnight stay.
| Post-op in Hospital
After surgical tendon repair, some
patients remain in the hospital for as long as 24 hours.
If your knee is not in a cast, you will begin doing
continuous passive motion exercises while in bed as
soon as possible after surgery is completed. Your leg
will be flexed and extended to keep the knee joint from
becoming stiff. This may be done using a continuous
passive motion (CPM) machine. The CPM is attached to
your bed and then your leg is placed in it. When turned
on, it takes your leg through a continuous range of
motion. There will likely be pain, and you can expect
to be given pain medication as needed. Be sure to ask
for medication as soon as you feel pain coming on, because
pain medication works best on pain that is building
rather than on pain that is already present. The nurses
will not give you more than your doctor has prescribed
and what is considered to be safe. Ice also helps control
pain and swelling. Physicians generally suggest that
you walk with crutches for about six to eight weeks.
However, older patients may be advised to continue using
crutches or a cane for a longer period of time. In addition,
you will be given an appointment to return and a prescription
for pain medicine. You will not be able to drive, so
be sure to have arranged for a ride home.
Your knee is usually held straight by an immobilizer
or cast for up to six weeks. Most patients can bear
weight on their leg soon after surgery, but you must
usually walk with the leg straight until the cast or
brace comes off. This can limit your ability to return
to work and drive a car for up to six weeks. Here is
what you can expect and how you can cope after surgery
to repair your ruptured quadriceps tendon:
will likely feel pain or discomfort for the first few
days, and you will be given a combination of pain medications
may be some minor drainage on the bandage since fluid
may have accumulated during the surgery. Expect some
blood to show through the bandage during the first 24
to 48 hours.
your leg is in a brace, remove it only to perform passive
motion exercises that may be prescribed by your physician
or physical therapist.
much as possible, you should keep your knee elevated
above heart level to reduce swelling and pain. It often
helps to sleep with pillows under your ankle. Icing
your knee for 20 or 30 minutes a few times a day during
the first three days after surgery may also reduce pain.
until you can stand comfortably for 10 or 15 minutes
at a time before you take a shower. Once you can, put
your brace or cast in a plastic shower bag and tie the
top around your leg above the brace to keep the bandage
dry. Ask your physician about the best place to buy
plastic shower bags in your area.
possible, the dressing on your knee is usually removed
one to three days after surgery. If your knee is in
a cast, the dressing usually stays on the knee for one
to three weeks.
a week after surgery, patients typically are able to
lift their leg without assistance while lying on their
back. Many surgeons will let you put weight on your
knee as long it is protected in a cast or brace.
two or three weeks after surgery, you may experience
night sweats and a fever of up to 101. Your physician
may suggest acetaminophen, coughing, and deep breathing
to get over this. This is common and should not alarm
physician generally will send you to a physical therapist
for a consultation about rehabilitation within six weeks
after the surgery.
to call the doctor after surgery
Because your quadriceps muscles lose
most of their strength when the knee is immobilized,
physicians usually suggest that you progress through
rehabilitation slowly once you are off crutches. Too
much movement may hinder the healing process. Your physical
therapist can help you learn the proper combination
of rest, gentle movement to stimulate blood flow and
healing, and light exercises. The first motion most
patients try is called active flexion/passive extension.
You lie on your back and slowly bend your knee. Then
you let your knee straighten as gravity lowers your
leg back down. You may still be asked to wear an immobilizer
that holds your leg straight while walking. Next, your
doctor may prescribe a removable hinged knee brace with
a dial adjustment that allows the knee to bend at various
degrees. Your doctor may initially lock the brace so
it only bends up to 30 degrees and gradually increase
your knee bending over a several-week period. When you
can comfortably bend your knee greater than 90 degrees
and have sufficient quadriceps strength to support the
leg, the brace is typically discontinued. This can range
from four months to a year after surgery depending on
your age and ability to participate in rehab. After
you stop using the brace, it is important not to twist
or bend in ways that may strain the kneecap and pull
the tendon apart. Rehab progresses into stretching and
strengthening exercises that focus on the quadriceps
and hamstrings the main stabilizing muscles for
your knee. You will then gradually increase the amount
of weight as your leg muscles get stronger. Most physical
therapists suggest you do not perform knee extension
exercises that isolate the quadriceps muscles. Instead,
physical therapy for a ruptured tendon may consist of
squatting movements that use the hamstrings, calf muscles,
and quadriceps at the same time. Once the muscles of
your injured leg are about as strong as the uninjured
leg, the focus of rehab turns to increasing your coordination.
After a few months of rehab, physical therapy can become
activity-oriented as you regain the ability to perform
complicated movements, using stationary bikes, elliptical
machines, and cross-country skiing machines. The time
it takes different people to return to activities varies
greatly after a ruptured tendon. Younger, athletic people
may be able to properly heal and complete rehab in five
to eight months, but older people or people with a history
of knee injuries may need up to a maximum of 18 months
of rehab. A surgical tendon repair has a long healing
time, but many people are able to return to activities
at full strength with few complications.
strengthening exercises: Quadriceps tendon rupture
The only way to prevent re-injury
of a ruptured quadriceps tendon is to adhere to the
prescribed rehab program. Once physical therapy ends,
you should continue to maintain flexibility and strength
in the leg. Physicians usually suggest that you continue
strength training even after your knee has been rehabilitated.
Balanced strength, between the quadriceps muscles in
the front of your thigh and the hamstrings in the back,
can help prevent forces from unevenly pulling on your
kneecap tendon. Have your physician periodically check
your knee for tendon strength. Always warm up before
any exercise and particularly before any explosive knee
activity such as running, jumping, or playing sports.