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Tuesday, November 23, 2010

Quadriceps tendon rupture and surgical repair (week 1)

On November 5th, 2010, I tore my left quadriceps tendon off my knee-cap (patella) when I fell whilst out for my morning jog. I was on a business trip in Australia so I had to immediately return to Canada for treatment. It turns out that it was a partial tear and I had some medial and lateral tendon fibres still attachd to the patella. Most of the de-attachment of the tendon was in the centre of the knee. During the clinical examination, the orthopaedic surgeon assessed whether I could lift my left leg. This was done by sitting with my legs out-stretched infront of me. This is the definitive test to assess whether a quadriceps tendon is ruptured. The quadriceps tendon acts as a lever and joins the quadriceps muscle to the knee-cap. When it is torn you cannot raise the leg nor bend the knee. You cannot move without the aid of straight-legged knee brace along with the use of crutches. In addition to the clinical test the doctor arranged for an ultrasound to observe the soft tissue damage. An MRI was going to take several weeks before an appointment could be made. So the ultrasound replaced the MRI and was done immediately. A radiologist did the ulrasound and he was able to determine the extent of the quadriceps tear. In my case , it was about a 50%-tear of the quadriceps tendon. Also, the radiologist determined that an avulsive fracture to the knee-cap had occurred. This essentially means a piece of the knee-cap was ripped off the bone along with the tendon. Lastly, I had a number of x-rays of the knee area to see whether the patella had shifted downward. Thankfully, there was no damage to the petalla-tendon and some medial and lateral fibres of the quadricep tendon remained and kept the patella in place. So the surgery, was going to be a straight forward tendon re-attachment. I had surgery on November 15th, 10-days after the injury in Australia.
I showed-up for surgery about 11am and by 1pm I was wheeled into the operating room. I was placed under a general anaesthesia and woke up in the recovery room about 2:15pm. The surgeon told me that the quadriceps tendon had retracted under the quadriceps muscle and he had to really stretch it to bring it back onto the patella. The surgeon used a new method of attachment to what I saw published on the web. Instead of drilling through the patella to anchor the sutures, the surgeon created a "trench" across the knee-cap using a dentist's high-speed grinder. He pulled the tendon into the trench and secured the tendon to the bone via suture anchors pulled through the patella. In addition to the anchor to bone, he mentioned that he also sutured the tendon to a portion of the quadriceps muscle above the knee. Lastly, I was put in a knee-immobilizer brace. I went home the next day about 15-hours after the surgery. The pain after surgery was fairly intense so I was given subcutaneous morphine injections every 4-hours until I was released from hospital. I've had bed rest with minimal movement for the last week and tomorrow I see the surgeon to have the dressing changed. For the past week, I've been on oxy-codone pain killers along with periodic treatment with Advil. Almost immediately post-surgery, I've been doing wheel-pumps every hour along with trying to contract and relax my quadriceps muscle, whilst my leg is outstretched and supported. I've found this difficult to do but after a week , I have some activity of my quadriceps muscle. At this stage, I can almost fully weight-bear while I'm on crutches and I can move around the house a little. I've even been able to do some dumb-bell exercises for my upper body whilst sitting upright in a chair. Tomorrow I have a stationary bike arriving, so I can maintain some cardio. I'll one-legged cycle with my good leg.
One of the things that suprised me after surgery was the degree of constipation that occurs , as a consequence of the anaesthesia and taking pain-killers. I've been taking a stool-softeners (docusate sodium capsules) that you can buy over the counter at any drug-store. Believe me, this has helped. At times, the intestinal discomfort was worst than the soreness in the knee. Anyway 4-days after surgery I had a bowel movement. My first sign of recovery!
I'm a real believer in nutrition as a supportive therapy so I've been eating a balanced diet along with taking a multiple vitamin/mineral supplement , additional Vitamin D and calcium. Also, I've increased my protein intake and I'll begin taking a Branched Chain Amino Acid (BCAA) supplement next week. Leucine, one of the branched chain amino acids, has been proven over and over again within the scientific literature to help with muscle protein synthesis and wound healing. I'm going to use every possible tool to aid my recovery.
Along the way, I've been reminded what an incredible family I have. My wife , Gwen, has shown me unending dedication, love and support. Plus, she reminds me everyday of the importance of making goals each day, no matter how small the goals. One goal earlier in the week was just to sit-up in a chair for an hour. Another goal was to make it up and down the stairs and yesterday my goal was to finally have a shower! Gwen helped cover my dressing and brace with a plastic bag so I could stand in the shower. These seem trivial but they are so important to demonstrate to yourself that you are making progress. I even cheered to myself when I had my first bowel movement!
On a more serious note, I was reminded in hospital of the importance family. My hospital room was shared with an elderly gentleman (Joseph) suffering from diabetes and other illnesses. He had been through a multitude of surgeries,
including having one of his legs amputated. He didn't complain and he talked lovingly about his wife , children and grand-children. He left me with his philosophy in life. He told me that family means everything to him and that he has learnt that a good family life encourages lots of loving and lots of learning. I will remember forever Joseph's message. I cherish my family.

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