Knee > Quadriceps Tendon Rupture > Treatments

   Surgical Tendon Repair

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.

   Make 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 is scheduled.

   Understand 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.

   Any 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.

   To reduce the risk of infection, try to refrain from smoking for at least a week prior to surgery.

   If possible, practice walking with your crutches in case you need to use them after surgery.

   Make 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.

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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:

   You 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 anesthesia.

   Because 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.

   Wear 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.

   Take 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.

   After anesthesia is administered, which may be regional or general, the surgical team sterilizes the leg with antibacterial solution.

   An incision is made lengthwise on the top of your knee from about four inches above your kneecap down to the center of your knee.

   The ends of the ruptured tendon are identified and then isolated from the surrounding tissue.

   If the rupture occurred more than a few days prior to surgery, the surgeon must cut away any scar tissue, until healthy tissue is exposed.

   The kneecap is positioned properly in its track.

   Surgeons 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 knee.

   The incision over the knee is stitched and you are taken to the recovery room.

After 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.

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.

Home Recovery

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:

   You will likely feel pain or discomfort for the first few days, and you will be given a combination of pain medications as needed.

   There 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.

   If your leg is in a brace, remove it only to perform passive motion exercises that may be prescribed by your physician or physical therapist.

   As 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.

   Wait 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.

   When 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.

   Within 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.

   For 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 you.

   Your physician generally will send you to a physical therapist for a consultation about rehabilitation within six weeks after the surgery.

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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.

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   Knee 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.