Quadriceps Tendon Repair
On March 26th I had a ladder go out from me, resulting in a fall of about eight feet. I struck the wayward ladder with my left foot, thus taking all the impact on that leg. The result was a torn quadriceps tendon.
In the course of getting this injury treated, I found that most medical professionals (though generally very pleasant) seem to take the view that informing the patient is a very, very low priority. Since I am rather concerned about my well being, I did a fair amount of research on the quadriceps tendon, the tear, and its treatment.
Before getting to the discussion, you should keep in mind that I am a philosophy professor and not a medical professional. I’m presenting this information with the purpose of sharing my own experiences and not with the intent of providing medical advice or a diagnosis. If you are injured, then you should see a medical professional. Now that the disclaimer is out of the way, on to the information.
The quadriceps is a group of four muscles that link to a single tendon (the aptly named “quadriceps tendon”). These muscles are located in the upper part of the leg and are connected to the knee cap via that tendon. These muscles play critical roles in allowing people to walk, run, jump and squat. The tendon, as I found out, also serves to absorb the shock of landing.
The quadriceps tendon is normally very strong and rather difficult to tear. However, there are a variety of circumstances in which it can be torn. In some cases, age or a pre-existing condition can weaken the tendon-sometimes so much so that it will tear (or rupture) while walking or due to a minor fall. Among healthy folks, a quadriceps tear is usually due to a fall or an impact injury such as suffered by football players or skiers.
To deal with a quadriceps tendon tear, you first need to know that you have one. In general, you only need to worry about this if you have suffered serious trauma to your knee/leg, such as in a fall, skiing accident, or other such accident. However, there are cases in which the tendon tears without this sort of serious calamity.
In some cases you will hear a “pop” when the tendon tears, although you might not. And, of course, there are other injuries that make popping sounds. The following are common signs of a quadriceps tendon tear. First, you might find that your knee cannot bear any weight at all.
Second, you might be able to stand and walk, but find that your knee will “give” way during movement. In my case, I was able to walk after the injury, but fell down twice before I could figure out how to compensate.
Third, you will experience pain (obviously) and swelling of the knee area. Bruising is also likely. Of course, this is compatible with a wide range of injuries.
Fourth, you might notice that your knee cap is now lower than it should be-you might even see a noticeable gap between the quadriceps muscles and the knee cap. If the knee cap is out of position, this might well cause problems with moving the lower leg (mine would lock up at a certain angle).
However, the defining test of a serious tear is that you will not be able to straighten out your knee against resistance and you will not be able to perform a straight leg lift/raise. A straight leg raise is done in the following way: lie on your back on a flat surface and attempt to lift your leg straight up. If you can do this, then you do not have a complete tendon tear (though you may have a partial tear). If you cannot do this, then the odds are good that you have completely torn your quadriceps tendon.
Naturally, you should not leave it at a self diagnosis. If you have had a serious accident, then you should seek professional help. The professionals will, if they know what they are doing, x-ray your knee and also perform a physical examination. While X-rays do not show soft tissue damage, they will show if the knee cap is out of place. You might get an MRI, but you might not-my diagnosis was based on the x-ray and a physical examination.
If you are diagnosed with a quadriceps tendon tear, then you will most likely be going in for surgery. Partial tears can apparently be treated non-surgically, but that is something you would need to discuss with the doctor.
A complete tear, which is what I suffered, requires surgery-the tendon will almost certainly not re-attach to the knee cap on its own. Here is a page that briefly but effectively describes the nature of the injury as well as the surgery for treating it. Roughly put, they will cut open your knee, drill two (or more) holes in your knee and then run suture thread through the holes to the tendon to anchor it in place.
If you are told that you will need surgery, then here are some things that you should do to prepare.
First, you will need to stop eating and drinking at least 12 hours before the surgery, so plan accordingly.
Second, after the surgery you will be even more disabled (you’ll be in pain and in a knee immobilizer, brace or cast) so be sure that you have a ride home and that your home is ready for your return. You will need to keep your leg elevated, so have some pillows set up on your bed for that. In order for the elevation to work, you need to be truly elevated (above the heart). Sitting in a recliner with the leg rest up won’t cut it. You won’t be able to shower normally, so I would suggest getting one of those shower heads that have a hose attachment. That way you can wash your hair by standing beside the shower stall. You should also get some liquid body soap. I’ve had to replace my shower by washing myself from the sink using the liquid body soap in water first and then rinsing with plain water and a wash cloth. Get some baby wipes for areas that you’d rather not use the same washcloth that you use on your face.
You will most likely arrive at the hospital/clinic a few hours before the surgery. After you check in, you will probably be brought to a waiting room. While you wait, you’ll put on a gown, have blood drawn, be hooked up to an IV, and given a pill to keep you from getting an upset stomach (take it). Then you will be wheeled down to the prep area and given an antibiotic (attached to your IV). You’ll meet the surgical team and then its lights out-the operation is performed under general anesthesia.
If all goes well, you’ll wake up in the recovery area, hooked up to a machine that lets the nurses know that you are still alive. You’ll be in some pain at this point. After that, you will be wheeled to a waiting room, given some pain medicine as well as water. Drink plenty of fluids-you will most likely be rather dehydrated from not drinking. I know I was.
The surgery is usually done outpatient, so you will most likely go home that day. If you are having problems, then they will keep you overnight. I went home that day. Be sure to get the instructions from the physician’s assistant who will speak with you. You will most likely get prescriptions for pain killers, muscle relaxents, a blood thinner, and a stool softener. Get them all. The pain killer and muscle relaxant functions are obvious: you will be in lots of pain and will want to kill that. I’m rather tough (I’ve run ultra-marathons and have a black belt) and I used them the first few days. The blood thinner is to keep you from getting blood clots. You’ll also be told to do “foot pumps” to keep the blood flowing. Do those religiously-you don’t want a clot.
While you might be tempted to pass on the stool softener, do not. I repeat, do not. Be sure to drink plenty of water and eat normally as soon as you can. Also, go to the bathroom as soon as you can. Otherwise, you will have some unpleasant problems (just imagine trying to pass packed clay…that should be sufficient motivation to use the softener).
For the next two weeks, your main job will be to rest and recover. Depending on what your doctor says, you can probably move around somewhat, but be careful. Aftter those two weeks or three weeks, you will have the staples removed from the incisions and you will probably have the immobilizer replaced with an adjustable brace. If you are in a cast, then you will probably be in it for six weeks. Lucky you.
The PA will most likely tell you to not remove the immobilizer for any reason for a week and then only to change the dressing a week after the surgery. Heed his/her advice. The immobilizer is there to prevent you from moving your knee because doing so could ruin the surgery. Resist the temptation to take it off-a fall or a moment of forgetfulness can be all it takes to ruin the surgery!
As I write this on April 20, I’m 17 days out from the surgery. My leg is in a locked adjustable brace and is also wrapped in an ace bandage. I can move around well on crutches and, when this blog is posted on April 21, I will be back to teaching.
I’ll write additional posts as I go through the recovery process.
Update (4/11/2011): I’ve written a short book about my experiences with quadriceps tendon repair. It is available at Amazon for the Kindle and at Barnes & Nobles for the Nook. Both versions are 99 cents (and might even be worth every penny).