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TKR Patella and quadricep tendinosis

@Josephine,

My knee started to feel slightly better on Wednesday and I was so happy to feel better that I went out shopping for about an hour to get things done and then out to dinner to treat myself, so I didn't have to cook. On Thursday, the pain with walking was back in full force. The pain truly is stemming from my knee. I would think that if it was anything serious that would require surgery, the pain would not have subsided a little on Wednesday......
I am back to limping when walking.

I am hoping that whatever the problem is, it can be helped by resting allowing time to heal....
 
MidwestTKR said:
I told him that I feel it was caused from the bad shoes I was wearing since when I stopped wearing them for a few days, the pain went away UNTIL I overdid it a week ago and was running errands for several hours on my feet. The next day, the pain was back.
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Well that about says it all! I've often said that most pain is caused by activity. Your story proves it. Go easier on the activity and your leg will go easier on you!
 
Hi All,

The MRI results are in:

@Josephine
- please let me know your thoughts. It hurts significantly to walk.

I was able to access my MRI results in the patient portal today. Waiting for my ortho doc to call me to discuss. I just left them a voice mail.

Of note, the pain in my knee last week began mostly being centered not just in the general knee area, but underneath the left of my knee cap and down my patella. I told the MRI tech that when I had my MRI done as well. Here is a synopsis of the results:

"Surgical change versus small partial tear of the lateral aspect of the distal quadriceps tendon, measuring up to approximately 5mm in width and approximately 15mm in length.

There is mild accompanying distal quadriceps tendinosis.
There is mild proximal patellar tendinosis.

The medial collateral ligament appears intact.
The biceps femoris, conjoined tendon, fibular collateral ligament, and iliotibial band appear intact.
Muscle bulk appears appropriate for patient age.

IMPRESSION:
1. Nonspecific moderate knee joint effusion.
2. The prosthesis appears intact.
3. Surgical change versus small partial tear of the lateral aspect of the distal quadriceps tendon.
Mild the distal quadriceps and proximal patellar tendinosis."
 
I just spoke with the physician's assistant in the ortho surgeon's office. (He was involved with my surgery as well.)
He said the tear is not from the surgery as it is a lateral tear and they went in medial.) He mentioned that he thought the recovery would involve resting the knee-leg and PT. I asked him if I should be using a knee brace or crutches. (He is going to FU with the ortho surgeon and call me back tomorrow afternoon regarding the treatment plan.)
 
Yes, that sounds about what I thought. However, to address these points in my detail

MidwestTKR said:
There is mild accompanying distal quadriceps tendinosis.
There is mild proximal patellar tendinosis.
Mild the distal quadriceps and proximal patellar tendinosis
Nonspecific moderate knee joint effusion.
Surgical change versus small partial tear of the lateral aspect of the distal quadriceps tendon.
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These are all the result of excessive activity. I know when you answered my questions you said you were doing no exercises but this tells a different story. Can you confirm then, that you have done no exercises since your surgery on April 20th? And if the answer to this is 'yes you have' please give me a list of them as per this

- how many sessions you do each day
- enter exercise by name then number of repetitions of each
 
@Josephine,

My TKR was over 3 years ago- it was April of 2015. Since recuperating from my TKR, I have done NO PT exercises. I have only been living my regular life and I don't exercise regularly or belong to a gym. I have no idea for sure how I did this. I am however a divorced, single woman that owns a house and is working full time and trying to care for a house by myself, I am very busy. This year, I hired someone to do the outside mulching etc as I knew I could no longer do it. I do remember tripping over the garden hose and almost falling about a month ago, so perhaps this injury was a result of that. I just don't know but it is not from exercises.
 
MidwestTKR said:
I do remember tripping over the garden hose and almost falling about a month ago, so perhaps this injury was a result of that.
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I'm so sorry. I didn't mean to upset you. Perhaps the fall did contribute to it. Who knows?
 
It could be the tripping over a garden hose. Sometimes the most innocuous movements cause our bodies to protest. I threw my back out picking up a fluffy throw pillow once. A light as air pillow! It took weeks for my back to become normal again.

How this happened no longer matters, of course, except as a matter of curiosity. It just feels more controllable if we know why something happened. The important thing is to help your poor knee heal this new insult. Your surgeon is right about rest being the first step. Rest and elevation (which will help the swelling and therefore your pain) will help for now. Eventually you will need to exercise your leg back up to strength. Healing the tendon is the main thing for now. I’m sorry this happened to you. :sad:
 
Sometimes even turning over in bed wrong and upset the knee. Many of the times, you never know what you did to upset it, it just happens. The best thing to do is to ice and elevate and rest until it goes away.
 
Hi everyone, thank you for your replies.

I met with the ortho surgeon this am as he wanted to go over the results of the MRI in person. He had the MRI images pulled up and told me that i have 2 very small partial tears- one in the patellar tendon with tendinosis and 1 in the quadriceps tendon with tendinosis. I also have moderate effusion (swelling in the joint of the knee.

He told me that I will "need to be patient as it is going to take quite awhile to heal." He has ordered PT and wants me to stay off my leg as much as possible. He wrote a note for work that I must do only desk work for 3 months and avoid standing for long periods of time, ice it and also had their rehab area give me a patella strap. I showed him where it hurts when I walk and that is where the tears are. The pain with walking is worse than before I had my knee replacement.
 
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What kind of PT will you have to help the tears heal?
 
@Jockette ,
The tears are very small partial tears and will heal on their own. I just edited my update to reflect that. The PT is to strengthen the muscles around the tendons. I also think they may be able to do some type of other therapy besides exercises. Perhaps to increase blood flow to the area to promote healing? I have my first PT eval on Tuesday afternoon next week. I am going to ask a lot of questions!
 
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Then why are they sending you to PT if the tears will heal (slowly) on their own?
MidwestTKR said:
He has ordered PT and wants me to stay off my leg as much as possible.
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This sounds contradictory to me. I always equate PT with exercise.

What does he want you to do/have at PT?
 
Hi Jockette,

The Ortho doc gave me the impression it is to strengthen the area (?muscles) around the tendon so it doesn't put as much pressure on the tendons. I have to admit, my muscle tone in my legs, is non existent!) When I googled tendinosis, everything he is doing, is what they advise for patients to recover. He also told me that anything that causes additional pain, I should refrain from doing.
 
Ok, thanks. I wasn’t trying to give you a hard time, I was just wondering about the PT aspect of it and what it was supposed to accomplish.
 
Hi Jockette,

I appreciate all the feedback so thank you!!!!! As those of us on the boards here know all too well, when we are in pain that significantly affects our ability to perform normal ADL, it is very difficult. I don't know what I would have done without the wonderful people on the board when I was recovering from my TKR of the left knee 3 years ago. I didn't expect to have another type of problem that would cause so much pain. Although I have tendinosis in both the patella and the quadriceps tendon, the pain in the patella area is what is causing me to be in so much pain when I walk.

I just looked up the PT tx for patelar tendinosis and per the Mayo clinic it said that PT is helpful and often involves:
  • Stretching exercises. Regular, steady stretching exercises can reduce muscle spasm and help lengthen the muscle-tendon unit. Don't bounce during your stretch.
  • Strengthening exercises. Weak thigh muscles contribute to the strain on your patellar tendon. Exercises that involve lowering your leg very slowly after extending it can be particularly helpful, as can exercises that strengthen all of the leg muscles in combination, such as a leg press.
  • Patellar tendon strap. A strap that applies pressure to your patellar tendon can help to distribute force away from the tendon and direct it through the strap instead. This may help relieve pain.
  • Iontophoresis. This therapy involves spreading a corticosteroid medicine on your skin and then using a device that delivers a low electrical charge to push the medication through your skin.
 
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Very interesting. I hope your pain will settle down for you soon.
 
I've had bursitis and tendonitis in the past and I think PT was more help than anything else to improve the situation_ stretches in particular. But it can be a long haul. I was in PT a month before I noticed much difference at all and it was 3 months before it was pretty much back to normal. Sometimes steroids helped, sometimes not. I also found a good soak in the hot tub worked temporarily. Rest is very important and elevation doesn't hurt. Some people like ice or a heat/ice rotation.

Unlike a lot of other people I didn't find supportive shoes helped at all. While poorly fitting shoes are always bad, I went barefoot as much as possible or wore ballet flats with memory foam. ( I work from home most of the week and am probably barefoot well over half the day most days and I realize that isn't going to cut it for the typical office job ). It has helped the tendonitis but it might also work for me partly due to my tendency toward plantar fascitis. Years ago they used to say wear supportive shoes, firm soles, arch supports. A couple of years ago some studies came out for fascitits saying flexible soles, less firm support. I tried it and for me that works much better. You may be entirely different and the point is to try different things and listen to how your body responds. A good pair of shoes is a pair that feels good all day for you. But don't be afraid to experiment and think outside the box.
 
@Jajakio ,

Thank you so much for your post. It was so helpful to read. I am going to talk with the PT and ask all kinds of questions. I absolutely agree with you that I will need to "listen to how my body responds." Anything that causes more pain, is not good. It's interesting you mentioned the hot bath, because I was just wondering last night if I went into my bathtub that has jets, it might possibly increase blood flow to the area and help a little. I guess I can give it a try and see how I feel afterwards. I also find that going barefoot when I am in the house, feels better.
 
After having a lot of pain when walking for a month, I had an MRI and was diagnosed with mild partial tears in both the patellar tendon and the quadriceps tendon, tendinosis of the patella tendon and quadriceps tendon and moderate knee joint effusion. My ortho doc has ordered a patella strap and physical therapy and told me to be patient as tendonosis takes quite awhile to heal. He has also restricted me to just a desk job for 3 months as I heal and to rest my foot as I am able.

I decided to start a new thread on this to see if there are others that have had this and hear how they did with recovery. Thankfully the TKR I had 3 years ago is fine, but the pain with walking with this is worse than the pain I had before my TKR.
 
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