Quadriceps and Patella Tendon Repair Progression (0-2 weeks) | OEP370

The podcast episode focuses on the first two weeks following quadriceps and patella tendon repairs, providing essential strategies for managing recovery. Emphasis is placed on avoiding complications, proper bracing techniques, and establishing patient confidence during the rehabilitation process.

• Discusses the importance of early management in recovery 
• Highlights strategies for controlling swelling and promoting circulation 
• Explains the necessity of using a dial brace locked in full extension 
• Offers guidelines on maintaining limited range of motion 
• Provides exercise recommendations to activate muscles and aid recovery 
• Addresses pain management and appropriate modalities 
• Stresses the importance of building patient confidence post-surgery 
• Previews future discussions on rehabilitation progress and strategies

✅Are you looking for One on one Coaching? We have it!
✅ Hop onto our email list? 👉👉 Click HERE

✅Show sponsor RANGEMASTER.
Get your FREE BlueRanger Pulley: email Jim@myrangemaster.com and enter Ortho Eval Pal in the Subject line.

✅Meet our new Sponsor: Medcor Professionals
Get $10 off of a Saunders Cervical Traction unit: Coupon Code- OEP10

Get $10 off your first order for all other products: Coupon Code-FirstTime10

Support OEP today!

Want to join the OEP community? Click HERE to jump onto our email list. SUBSCRIBE at the bottom of the page.

Ask me your ortho evaluation questions and I will answer them on the show: paul@orthoevalpal.com

Come visit our WEBSITE!! Click HERE to check it out

Be sure to "follow" us on our new Facebook Page

I finally made it to Instagram. Stop by and check us out

Are you looking for One on one Coaching? We have it!

Be sure to check out our 600+ videos on our YouTube Channel called Ortho Eval Pal with Paul Marquis

#quadtendonrepair #patellatendonrepair #orthoevalpal #podcasts #PTpodcast #medical #health #orthopedics #Physicaltherapy #DPT #Medicalproviders #sportsmedicine #athletictraining #chiropractic #occupationaltherapy

Chapters

• 0:00 Managing Quadriceps and Patella Tendon Repairs
• 11:13 Early Rehabilitation Strategies for Tendon Repairs
• 15:41 Engaging With Audience Feedback

Transcript

Speaker 1: 0:00

Hello everyone and welcome to episode 370 of the OrthoEvalPal podcast. I'm your host, paul Marquis PT, and today we're going to be talking about quadriceps and patella tendon repairs. We're going to be talking about the progression of this from zero to two weeks after surgery. We're going to talk about some tips to avoid complications early on after a quad tendon or patella tendon repair. We'll be talking about bracing and crutch use. We'll discuss some precautions soon after surgery. We'll even give you some exercise and modality recommendations and so much more.

Speaker 1: 0:32

But before we get started today, I'd like to mention our sponsors. First of all we have Rangemaster. Rangemaster is known for their shoulder rehab equipment. They offer products from shoulder wands to finger ladders, overhead pulleys to shoulder rehab kits. Rangemaster is your one-stop shop to help with the treatment of frozen shoulders, post-op rotator cuff repairs, total shoulder and reverse total shoulder replacements and so much more. If you'd like to get a free sample of Rangemaster's Blue Ranger pulley system, just email jim at myrangemastercom and add OrthoEvalPal in the subject line. We also have MedCorp Professionals. Now, I know the folks at MedCorp Professionals personally. They're a great bunch of folks and locally owned, family operated medical supply company. They carry everything from radial pressure wave units, which I have and use on a regular basis, to traction devices, resistance bands, to compression garments you name it. They have it. Most impressively, though, is their customer service. It's second to none. If you're looking for medical products for your clinic or products for your patients, go to wwwmedcorprocom, and if you use coupon code OEP10, you can get $10 off a Saunders cervical traction unit, and you can also use the code FIRSTTIME10 if you're a first-time purchaser on their website and get $10 off your first order.

Speaker 1: 1:53

Now, welcome back everyone. So, as usual, I get this light bulb moment for a podcast topic which just snowballs into more than you know. Enough content, for you know more than one episode, and so I'm going to break this topic up into two, maybe three episodes, just so that I don't overwhelm you with a bunch of content that is just kind of confusing. We're just going to give you zero to two weeks after a quad tendon or patella tendon reconstruction, and we're going to just talk about how we would manage that.

Speaker 1: 2:27

And you know, as I was working with this patient of mine who had a patella tendon repair, I started thinking about all of the things that could go wrong here after surgery, and I'll be the first to admit that treating tendon repairs probably makes me a little more nervous than anything else out there, and I have seen tons of these and luckily I'm batting a thousand in the last 33 years never had a re-rupture under my care. But I also am maybe a little more conservative. When I see these patients I really step back and say to myself, okay, what could I do, or what could the patient do to cause some sort of a complication here? All right, so if you think about that actually you could think about this every single time you see a patient what would I do today that could make this patient worse? And then you clear all of that stuff and that opens up the field for whatever else you want to do and can do in a safe environment. Okay, so if you look at it this way, your approach is going to be much more targeted, much more strategic.

Speaker 1: 3:32

And then you need to remember you just can't treat these patients who have tendon repairs like a, you know, a total knee replacement or a total shoulder replacement. You have these soft tissues that are repaired that you don't want to tear off. You don't want to, you know, upset the surgeon who did this surgery and put all this work into repairing these tendons. So it's important that you look at your anatomy, you understand it well. You need to remember that the patella tendon and quad tendons take up a huge amount of load. All right, it's a large muscle group, a very large tendon group. And I also want you to think about and go back to you know your college days when you were studying this. Remember selective tissue tension. All right, passive knee flexion and hip extension are going to stretch that extensor mechanism, ok. And. And active knee extension and hip flexion are going to shorten the quad tendon and patella tendon. So remember that when you are working on your patient, remember that at the time frames that they're in, it's important that we get these patients in soon after surgery, like three to four days, so that we can start to prevent DVT, get the calf activated a little bit, get some elevation, get some edema control, start to get the quad to turn on a little bit and get all the surrounding muscles activated.

Speaker 1: 4:55

So let's just start talking about bracing and crutches first of all. So these folks usually that come out of surgery and they have a dial brace on it's locked into full extension. We use a dial brace because we want to, at some point in the future, allow a little bit of range of motion on a progressive basis, you know, week by week. So you want something that is adjustable but lockable. All right, because at first you want this brace to be locked out into full extension. They need to have a long brace for good leverage. Short braces don't really do a good job at preventing flexion of the knee. You want these people to be sleeping with this brace on.

Speaker 1: 5:34

Okay, because at night it's common for us to flex the knees, maybe even kick a little bit when we're, when we're dreaming or sleeping, and so and sometimes you might get up in the middle of the night not think about it and flex that knee, and so we really want that brace to be locked out. They would need to be sleeping with it and whenever they are walking they're using crutches, they're to be weight bearing as tolerated. If the brace is locked out into full extension and you're driving your weight through the femur, through the tibia, and the knee is not flexing whatsoever, you really can walk with that knee in this extended position. You can put full weight bearing on it. You know right away pretty much, but we recommend weight bearing is tolerated just because at first they're going to be a little uncomfortable. So that brace is on at all times while they're using crutches. It's locked into extension while they're using the crutches, all right.

Speaker 1: 6:23

So we're also going to see a lot of swelling in this patient. So we want to teach them how to properly elevate the leg. That's important. I like to do a lot of ankle pumps when that leg is elevated. If they need some ice, you know, for pain control, then they can ice while they have it in that elevated position because they have this brace on, it needs to be pretty tight. They're also going to have a lot of lack of movement. So you need to remember, because they have this lack of movement, they're in pain, they just had surgery, they're at high risk of DVT. So I have these folks do lots of ankle pumps, okay, and so that's very important. Now let's talk about range of motion. They really shouldn't be moving this knee past 25 to 30 degrees of flexion in the first couple of weeks.

Speaker 1: 7:09

When I get these patients going, I first ask them can you do a heel slide? I want you to pull your heel toward your butt. Okay, that's how I like them to try to imagine doing this. I don't want them to flex the hip, to pull the knee toward their face in order to get it to slide. I like them to really activate that hamstring because, number one, you're not getting an aggressive, passive stretch to the quad. When they're doing this they're going to be a little uncomfortable, but when you're actively using the hamstringstring you're inhibiting the quadricep even more so the quad is going to relax a little bit more and have less pull on on the repair. So I like them to just try to do an active heel slide. See how they do now.

Speaker 1: 7:55

If they've got zero degrees of extent or flexion and they just can't activate it, they can't pull it up, then the way I like to try to get flexion is not to grab them at the ankle and push the knee into flexion. I like to take my hand and put it under the popliteal space and I like to raise the knee up in the middle, and so therefore, the heel will naturally slide toward the bottom. They really relax well. The other thing that it does is it prevents the over compression of the posterior femur and tibia from getting compressed together, so it kind of spreads it apart a little bit. Patients tolerate this really well. So this is how I like to start with just light, passive range of motion. I go from zero to 20, 25, 30 degrees of flexion, really nice and easy. I don't want a tremendous amount of tension in that patella tendon and it should be nice and comfortable.

Speaker 1: 8:48

Okay, now I, you know, want to make sure and emphasize that you do not let the patient hang that leg off the edge of a plinth. You don't want to be doing aggressive passive range of motion. I'm telling you right now, this has to be very light. You need to gain the confidence of the patient so that later on, as you start to advance the patient, they have confidence in you, that they can number one do what they're going to do and that they're being well guided. They have to be very dependent on therapy at this stage of the game because they really don't know what that leg will do, how well it will hold up, and they can't just work through it, like some people will work through the pain after a total knee replacement and, and that's okay, we want them to do that, but not in this situation. So it's not always more pain. Um, you know, no pain, no gain. It's sometimes no pain, all gain. So we want this to be nice and gradual.

Speaker 1: 9:43

I might take these people. If they are really having a lot of capsular stiffness, I may put a little roll under that knee at 10 degrees of flexion and just get a very gentle stretch and I might put a little heat over the quad. Maybe I'm avoiding that incision if it's still kind of, you know, not well healed. But I may just put it on the quad just to get it to relax a little bit and slowly work them up into passive flexion. But again, I pull up from underneath the knee.

Speaker 1: 10:11

Let's talk about some exercises. Well, I like to do ankle pumps. If that leg is in full extension at the knee then you can do resisted ankle pumps. I like to do TheraPen to start off with. We want to get this quad starting to turn on because obviously it's going to be inhibited. We just had patient, just had surgery. There's some swelling, there's some pain, there's going to be some quad shutdown. So very sub-maximal quadricep isometrics. I leave them at full extension. If they're there, that's great. I just talked to them about lightly turning it on. You might just see a quiver going on there. We'll jump into some glute sets. I'll do some patella mobilization, especially medially and laterally. But I am not going to jam on this into superior glides because obviously that's going to be stretching a patella tendon repair. If they had a quadricep repair they're going to tolerate this a lot better. Okay, so then you can go into some superior gliding, but it depends on if they've had a patella tendon repair or a quadricep tendon repair.

Speaker 1: 11:13

Um, I love to do bald bridges early on. I will take that leg, I'll keep it in full extension, I'll grab them under the ankle, I'll lift it up in the air, bring them up into kind of, like you know, 45 or 50 degrees of a straight leg raised position. I'm completely passively extending the knee. They tolerate this very well. I'll place that ankle on a ball and they'll take the other foot, put the other ankle on a ball and I will hold their leg on the ball so it doesn't roll off. And I will have them knock out three sets of 10 or three sets of 15 ball bridges and they have to keep the legs straight. They're activating the glutes, the back extensors, the hamstrings and, as a result, the quads are not getting a big stretch on them and they're turning off. They tolerate this really well. When they're done, you take the leg and you put it back on the table from here I might put them on onto an upper body ergometer. While their brace is in full extension, the leg is rested, I'll put them on the UBE. I'll throw some BFR on their arms right away so that we can get this nice physiologic response. We're going to have human growth hormone release and that will promote healing systemically and be very helpful.

Speaker 1: 12:25

I do not do BFR on the surgical lower extremity until two weeks have gone by. We will talk about that in the next episode and how we do that. Now. Let's say the patient's in a lot of discomfort. Well, we could do some modalities. You can use ice to control pain and I like to do interfercial current if they're having a lot of discomfort right around the knee. But absolutely no NMES or Russian stimulation to the quadricep musculature for either a quad tendon or a patella tendon repair. You do not want that muscle yanking on that repair. All right, you can run the risk of re-rupturing those tendons and your patient will be absolutely miserable and never come back to therapy. So you are not to use NMES on those patients within the first two weeks of physical therapy.

Speaker 1: 13:18

I also like to teach patients how to properly elevate their leg. This may take some assistance with somebody at home. How to properly elevate their leg. This may take some assistance with somebody at home. If they are to do an attempted straight leg raise, active, assistively, maybe they should have their brace. They need to have the brace on, locked out into full extension, okay, but really they're not trying to do that until the two to six week mark and that's with active assistance. So if somebody can take that leg and get it elevated for them above their heart, that's great.

Speaker 1: 13:44

So Lots of stuff in the first two weeks. What I really want you to get out of this is how do you not hurt the patient or harm the patient? I should say A lot of patients you know have a little hurt while you're working with them, but you really don't want to harm them. And so building confidence in that first week is very important, because they're looking to you for guidance and they need to have that confidence in you. So building that confidence up, getting them where they need to be, to that 25 to 30 degrees of knee flexion in the first two weeks is more than enough. They need to be in their brace, they need to be using their crutches. They need to be watching out for icy surfaces, slippery surfaces, so they don't they don't fall down, and then you give them some good guidance. You're not gonna be doing a ton of stuff with them, but getting them started in the right direction with a lot of education is super important. So I'm going to stop there for today, for week zero to two.

Speaker 1: 14:40

Next episode we're going to discuss a progression from the two-week to the six-week mark. We'll talk about how we move forward with that patient who's had a patella tendon or quad tendon repair. I'd love to get your feedback on this type of content, okay, giving some real specific treatment advice. I think that there are a lot of people out there on social media who show you a bunch of stuff. If you watch Instagram or you're on Facebook or TikTok or whatever it might be, they have a million exercises to improve your knee range of motion. Well, we need to be very cautious here, okay, and we need to be very strategic when we treat these types of patients. So I need you to kind of take those types of social media examples with a grain of salt. They're applicable in certain situations, but not all situations. So I want you I hope that's what you got from this episode today is how to prevent complications when you see these types of tendon repairs.

Speaker 1: 15:41

So if you do want to give me feedback on this type of content, just go to the show notes and go to send us a text. You click on that. You can send me a text. I don't I can't respond to it, but I can certainly bring it up in a future episode and I actually get a lot of my content ideas this way.

Speaker 1: 15:58

So please, even if it's to say hello, I'd love to hear where you're from and what type of content you're listening to, what type of content you like to listen to. And it can be as simple as I like to have you know actual treatment techniques you know in the podcast, or patient presentations, whatever it might be. I'd love to hear from you. If you can't text it to me, send me an email. I'd be more than happy to answer you by email also. Also, don't forget to jump over to Apple podcast. Leave us a rating and review. I really appreciate the feedback helps me make OEP better for you and so that you have better content to consume. So hope you all have a great day, be kind to each other and take care.