# Shattered patella - 7 weeks in - anyone else out there??



## vttraveller (Feb 22, 2008)

hey all-
i had a nasty telemark spill back on jan. 4 of this year, resulting in a knee cap in several dozens of pieces - my or. surgeon was able to rescue about 50% of it, the rest he refered to as "chowder" and "gravel" (pretty reassuring, right?). the two pieces making up half of the knee cap were sutured back together, along with the tendon and muscle that it's all connected to. this was 7 weeks ago and i am feeling relatively good: hobbling around the house without walker or crutches, sometimes with a neoprene brace, sometimes without. my surgeon has directed me to start pulling on it with a towel around the arch of my foot, forcing it to bend (over the last 3 weeks), and i'm probably at about 60degrees. i'm an avid runner/biker/hiker/swimmer - hoping to get back into some of these things by mid-summer atleast. any helpful hints out there? i am just eating well, resting up and taking multi-vits. anyone who's had a similar problem, please respond.
best,
jess


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## EndoRando (Sep 21, 2004)

vttraveller said:


> knee cap in several dozens of pieces - my or. surgeon was able to rescue about 50% of it, the rest he refered to as "chowder" and "gravel"


Jess, I just found a pm from xcguy, who happened to remember my similar injury and asked me to chime in. I'd be glad to xcg, and I feel for ya Jess, I hope it turns out to be an easier ordeal for you than I went through.

I shattered my patella in early Oct '05 while on a biking vacation. I flew from Alaska to Boise to meet up with my good friend Nels. We were planning on joining the Turner Homer Gathering that fall. We drove south towards Utah, stopping in the Bryce and Zion areas to ride for a few days, and made our way then to St. George. We were to ride there a few days, and then a gang of Turner riders was to form after Interbike Vegas ended that would convoy gradually up to Moab.

For me it was day four of fourteen. I had ridden Gooseberry Mesa the day before, and on this day we were going to put in a couple of rides, the first being Slickrock Swamp. That's where I had a fluke of an accident, going over the bars, but landing on my feet running downhill thinking I'd stay upright and just run it out. I got tripped up though, and landed with all my weight on my right kneecap onto about an inch cubed rock. I rolled over, immediately removed the rock and pitched it over my shoulder, and had shocking thoughts that my trip was over. Man was I bummed...at the least I'd need stitches, and I may not be able to ride with them. I thought I'd try to force out any other sand or gravel from the gash by pushing on the sides of my knee, and I saw what I thought was a rounded white pebble. I tried to grab it and remove it when I realized it was the bottom of my femur! Yikes, this is not good. For sure riding was over. I hobbled back to the trailhead and our vehicle for the ride to the St. George ER.

Jess, like you, patella in several pieces. Emergency surgery that night, four days in recovery, and then a helluva flight back to Alaska. My wife even flew down to assist with the shuttle ride to Vegas and my flight from there. I've attached a few pics and x rays of the initial injury. Nels reluctantly continued his vacation without me, taking my bike along to keep at his house when he returned.



vttraveller said:


> the two pieces making up half of the knee cap were sutured back together, along with the tendon and muscle that it's all connected to. this was 7 weeks ago and i am feeling relatively good: hobbling around the house without walker or crutches, sometimes with a neoprene brace, sometimes without. my surgeon has directed me to start pulling on it with a towel around the arch of my foot, forcing it to bend (over the last 3 weeks), and i'm probably at about 60degrees.


My patella pieces had some holes drilled into them and wires inserted with ends bent to keep pieces in place. I was in a brace for six weeks after that, locked in a straight immobilized position, pretty much confined to my couch. I could hardly move my leg at all without enduring excruciating pain, and all the laying around drove me bonkers. Not only was I missing work, but I was a huge inconvenience to my family. It really sucked!

After a six week period of healing, it was time for some physical therapy. Oh boy, this wound up being worse than the injury. After being in one position for so many weeks, my leg was basically in a locked straight position, and I'd lost a ton of muscle mass. Therapists worked every session torquing and forcing pressure against my ankle trying to move the knee joint. Every degree of regained knee-joint motion came with a ton of pain believe me. Nine weeks of this, three sessions a week, two hours each session. Plus I did my own on days at home. I was determined to ride again, so that helped overcome the pain.

Into my ninth week of therapy, I had a follow-up xray taken. With the goal of regaining motion in mind, we were inadvertently putting pressure onto my kneecap from the top, which was having the effect of trying to splay the pieces outward. The fracture gaps had actually widened! And we had put so much force into the regime that one of the stainless wires actually stretched enough to break!

I'll continue, Rando


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## EndoRando (Sep 21, 2004)

Jess, since my course wasn't working out, my orthopedic surgeon suggested another surgery. It just so happens I have a bit larger kneecaps than most, we could remove the displaced pieces, leave intact the largest remaining portion, and start over. I really didn't have much choice.

So, in with a hammer and chisel, close 'er up, and heal again. Into a cast again, and run another course of physical therapy. The first pic below is how much mass I'd lost in that leg as a comparison, the second is directly after my cast was removed. Then an xray shot of my remaining kneecap.

There's a remaining piece of wire in my leftover patella piece, the portion still in place after it snapped. My doc said it would have been a ton of trouble to remove, and will eventually be encased in bone anyway and not be an issue.

Another six weeks of therapy, and I was finally able to return to work after missing out for five months. I had limited duty however, and still had a ton of pain going down stairs, attempting to crouch, and couldn't handle any impact yet.

I was given clearance to start biking again though, just not to push through pain too much. It was my wife who insisted I start wearing a knee pad now whenever I ride, and she made a lot of common sense. I really can't afford another injury to this knee. I now slip on a pad on that knee as a matter of routine right along with putting on a helmet.



vttraveller said:


> i'm an avid runner/biker/hiker/swimmer - hoping to get back into some of these things by mid-summer atleast.


Jess, I love basketball, and have played competitively most of my life. I also love racquetball, but I still can't run without any pain. The impact is still painful after almost two and a half years! So, if I could give you any advice it would be to be patient. I'd say pursue the biking and swimming as much as possible, but be cautious and test yourself before doing any serious running and hiking.

I've gradually built my srength back up with the biking. At first it was amazing how weak my legs were, and how much lower the gears were that I'd use on trails I knew. Grinding a gear too big brought on pain. Now that the pain has subsided, I can at least grunt the larger gears, and can tell I'm coming back.

I wish I could handle more impact yet, but it'll come.



vttraveller said:


> any helpful hints out there? i am just eating well, resting up and taking multi-vits.


Besides being patient with the healing process, I think you're on the right track watching what you eat. I used to eat whatever I wanted, but because I was so active I was always lean. Once I was injured, my eating habits didn't change much, but I did gain weight thru non-activity. Watch that. I'm still trying to burn it off.

My doctor also swears by the glucosamine/chondroitin combo supplements for joint maintenance. I've been taking them and hope they're helping.

Hang tough, just don't rush things. As you test yourself, you'll know when to back off because it'll be painful. Learn to listen to that pain to avoid delaying your healing process.

Best of luck to ya Jess, it sucks I know, but I'm getting through it and I bet you will too. But remember, and I know this is the hardest part, patience grasshopper.

If I learned anything it was the importance of protective equipment. The trail I was on wasn't really difficult, but I had a fluke accident and it could happen to anyone. If I would have armored up that day it would have been a non-issue. Instead, I ruined my vacation, went through a lot of needless pain, missed work, inconvenienced my family, and almost went insane! And it's so easy nowadays to slip the stuff on, and it really isn't all that uncomfortable to wear either.

I've become more timid with my riding since then, and that sucks. I always liked testing my technical skills and bombing whenever possible. I just don't go gonzo any more, at least not out of control, above my abilities. Pick up some decent armor and wear it if conditions warrant, you don't want to have an event worse than you just went through.

Rando


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## cocheese (Jan 12, 2004)

Well, I didn't have the exact thing happen, but I did have e knee scope a month ago yesterday. Two tears, one medial and one lateral, and a shot medial plica, which was removed entirely...all this from two "clean" MRI's. 6 weeks was the estimate of time before I'd be back to regular activity, but I don't see that happening. I've been doing PT 2x a day with PT appointments 3x a week ver since the surgery. The damn thing just keeps swelling up. Not cantelope type of stuff, but hurting and stiff and hot as all get out. My PT added in the stationary bike two weeks ago and it swelled up, laid off of it for a few days and have been able to stay on the road for a mile or so at a time without negative after effects. Now I've progressed to partial squats and they seem to be irritating it to the pont of pain and swelling afterawards, so I'm scaling them back. My strength and muscle tone is getting better and my range of motion is improving at about 130 degrees on a good day with no swelling. 

Anyway, I always thought that I would be a good patient and take it easy, but I think "taking it easy" has been one of the hardest things about the whole ordeal. Well, that and the fact that these surgeries may or may not fix the problem, no guarantee, etc...

I am taking a liquid glucosamine/chondroitin/msm supplement 750mg 2x a day along with some fish oils. I've only been on it for a few weeks so I don't know if they are doing anything. I just thought that I'd do just about anything to make this knee feel better so that I can ride pain free.

Oh, and I have to say that one of the best investments I have made for my recovery is this blue gel ice pack thing I got at Rite Aid. It's about the size of a small pillow with two velcro straps on it. You can put the gel part in the feezer for on hour or so, insert it into the blue sleeve, and the wrap it around the knee. It provides a little bit of compression and ice around the hole front and side of the knee, whereas ice kind of hits some of the areas but with pockets. This blue Rite Aid thing is incredible and really gets the swelling down fast. 20 minutes on, 60 minues off, repeat...

Well, more rambling than you wanted but this is what I have been oing through. Again, not exactly the shattered patella, but a knee thing nonetheless.

Good luck with your recovery! :thumbsup:


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## BoiseBoy (Mar 1, 2006)

*Patellar ORIF*



vttraveller said:


> hey all-
> i had a nasty telemark spill back on jan. 4 of this year, resulting in a knee cap in several dozens of pieces - my or. surgeon was able to rescue about 50% of it, the rest he refered to as "chowder" and "gravel" (pretty reassuring, right?). the two pieces making up half of the knee cap were sutured back together, along with the tendon and muscle that it's all connected to. this was 7 weeks ago and i am feeling relatively good: hobbling around the house without walker or crutches, sometimes with a neoprene brace, sometimes without. my surgeon has directed me to start pulling on it with a towel around the arch of my foot, forcing it to bend (over the last 3 weeks), and i'm probably at about 60degrees. i'm an avid runner/biker/hiker/swimmer - hoping to get back into some of these things by mid-summer atleast. any helpful hints out there? i am just eating well, resting up and taking multi-vits. anyone who's had a similar problem, please respond.
> best,
> jess


Jess, I am sorry to hear about your Patella, ouch!
I don't know you rage, but by being friends with Nels, I assume you are probably 30-40+
Reading some of the posts below will give you a good idea of the rehab and healing process that is involved. One thing is to remember that this is a slow process. There is always a balance between being too aggressive at regaining your mobilty and ROM of your knee and risking failure of the fixation. If you were on the Cup tour and had to get back for a big race you probably could be much more aggressive, however I get the impression that you are not a professional and are more than likely a nine to fiver like the majority of us. That being said, I typically will be a bit more cautious to get a good fixation vs be too aggressive to get you back to a sport in a shorter time.

Another area to think abot is the fact that your Patella is now shaped a bit differently, and you have significant changes to the cartilage, blood supply, bone, and musculotendonous areas. The mechanics of your knee will always be a bit differnt than pre-injury. You have damage to the underside cartilage that now predisposes you to significant arthrities as well. In all likelihood you will probably not be an avid runner again. There is a farily good chance that the other activities will do well for you including hiking, swimming, and cycling as these are typically much less demanding on the knee joints. 
I certainly don't want to come off as the black cloud, but the healing process will take a lot of effort.
As long as you have a good fixation and no complications I don't see why you wouldn't be able to get on the bike this Summer. You likely won't be at the level you would like, but I think the bike is a good goal to work towards.

Let us know how things are progressing and good luck.


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## le_buzz (Sep 27, 2006)

I'll second what BoiseBoy said about injury changing the mechanics of your knee
over time. I had a bad OTB nearly 3 years ago where I had a severe patellar
contusion, or a rally bad bone bruise. I have had ongoing issues with it ever since.
The first 2 mri's were normal and my doctors at the time said there was nothing
wrong with my knee. The last mri back in Nov. showed early stage
chondromalatia, or partial thinning of the articular cartilege. 
I have arthritic pain now when sitting for long periods on time, sometimes I have to take Advil. (It's hurting right now so I just took one)
I have been off the bike recently due to a wrist injury, but thats another story.

The good news is, if you are persistent with your PT, you should with any luck
be able to get full time back into cycling again. 
The bad news is, you will probably need to avoid activities that are hi impact on the knees, as in skiing, basketball, running. If you don't you risk bringing on
things like chondromalatia in the areas where your knee joint has suffered injury. 

I have an appointment in Sep. to see a doc who will probably do a scope
on my right knee. I'm wondering if once he gets in there he'll discover more
damage than it shows on the mri. I wouldn't be surprised given how much pain I have. 

Getting back to you, though. When you do get back into cycling, always wear
a knee guard, something that offers full protection like the Roach Rally FR.
Also, if you happen to ride a bike that puts extra strain on the knees, it might
be a good idea to replace it with something more mellow.
Bikes with pedal feedback are tougher on the knees than bikes w/o.
(I'm talking FS bikes here) I've noticed that virtual pivot style bikes such as
the santa cruz blurs, mkiii's, tend to aggravate my knee pain, whereas one's
with neutral chain tension, like the horst link style, do not.
Single speed bikes wreak havoc on the knees cause you have to put so much
more force into pedaling


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## xcguy (Apr 18, 2004)

*So, Jess, we responded like you asked*

Let us know how you're doing.


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