Patellar tendonitis after ACL reconstruction

**BakerBomber79** · 03-07-2007, 04:49 PM

I had a patellar tendon graft 15 weeks ago and now I’m pretty sure that I have patellar tendonitis. My primary problem is that I can’t squat more than a few inches when attempting one legged mini squats with the injured leg without experiencing severe pain; it almost feels like I functionally can’t handle it but I don’t have any problem starting in a crouch and standing up which is what makes me think it’s the tendon that’s causing my problems. I started doing hot-cold therapy recently, 3-4 cycles a night consisting of 5 minutes of direct icing with an ice cup followed by 15 minutes of moist heat with a heating pad on the highest tolerable setting. It’s helped a lot with the pain and the squatting has gotten a smidge better but I’ve been told it takes up to 3 months to get tendonitis under control and that it likely will stick around to some extent forever.

Can anyone tell me if it’s possible to over ice or over heat?

Could my problem be anything other than tendonitis?

Any suggestions for getting the squat back?

**drmark** · 03-07-2007, 05:01 PM

Patella tendonitis after AcL surgery usually a rehab related problem. First question is whether or not you have full extension equal to the other knee? That is the principle cause of it.

**BakerBomber79** · 03-07-2007, 10:25 PM

Originally Posted by drmark

Patella tendonitis after AcL surgery usually a rehab related problem. First question is whether or not you have full extension equal to the other knee? That is the principle cause of it.

Extension of the injured leg is about the same as the uninjured one. It is past 0 degrees.

**drmark** · 03-07-2007, 10:48 PM

Do you know the difference between closed and open chain quad exercises. We do not have our patients do any open chain exercises, like the leg (knee) extension machine. This causes patella pain/patella tendonitis problems

**fez** · 03-07-2007, 11:12 PM

have you seen a pt? what do they say about it? or ask your doc.

i had acl replacement just about a year ago and i still have a little patellar tendon pain when walking down stairs. i think the patellar tendon takes longer to heal than the acl does.

when you are doing the squats, are you careful to keep your knee above your ankle? when i was first doing pt, if i let my knee get forward (say over my toes) it hurt like hell. keeping my lower leg more upright helped quite a bit.

**BakerBomber79** · 03-08-2007, 01:44 AM

Originally Posted by fez

have you seen a pt? what do they say about it? or ask your doc.

when you are doing the squats, are you careful to keep your knee above your ankle? when i was first doing pt, if i let my knee get forward (say over my toes) it hurt like hell. keeping my lower leg more upright helped quite a bit.

I stopped doing one-legged squats six weeks ago since they hurt so bad. I basically get a couple inches down and then I can't go any further; it feels like my knee is gonna explode or something. I was doing them against a wall but the PT said not to do anything that hurts the patellar tendon. I don't do any leg extensions. My routine currently consists of ham and quad stretches, leg bridges with a soccer ball underfoot, wall sits, one-legged pillow stands, elastic leg band kicks (around both ankles as well as attached to one leg and a stationary object such as a table), braiding, and pattern hopping. The only lifting I do is leg presses and leg curls with very very high reps and low weight. Anything with near heavy weight hurts so I do 3-5 sets of 50-100 reps with very low weights about three times a week. Plus I ride the stationary bike 40 minutes everyday.

My primary concerns are squatting and walking down stairs. Then of course there's the fact that my leg has atrophed like crazy, which I know is normal but it's still pretty crazy. My doc and PT have been pretty unhelpful. They just say it's common and to keep up what I'm doing. The PT said I SHOULD get the squat back but that's not exactly encouraging.

**drmark** · 03-08-2007, 05:52 AM

The cornerstone of what we do is step ups. Working from 2 inch up through 8 inches. 6 sets of 25 everyday.

I don't think we ever have people do much in the way of on legged squats.

**Vinman** · 03-08-2007, 06:15 AM

if you are going to therapy, ask them to do some modalities to help with the patallar tendon pain. They could use some ultrasound or perhaps iontophoresis.

Dr. Mark: would it be too soon to use dexamethazone on a healing patellar tendon donor site?

Also I would rec. heating the knee before rehab sessions with modalities, stretching after heat, exercise, then ice after.

**drmark** · 03-08-2007, 10:49 AM

Cortisone type medications injected into the patella tendon will cause a rupture of the tendon.

Then you will wish all you had was tendonitis.

**Vinman** · 03-08-2007, 12:43 PM

Originally Posted by drmark

Cortisone type medications injected into the patella tendon will cause a rupture of the tendon.

Then you will wish all you had was tendonitis.

did not mean injection, mean for iontophoresis..............

**Kellie** · 03-08-2007, 03:39 PM

BB79, are you by chance Ian? If so, I am sooooo sorry not to have responded to Spence's email, but you'll probably get better advice here anyhow.

I think it's normal to have the squatting recovery as soon as everything else - I am almost 2 years out and still have trouble going down stairs normally - I get pain and generally have a hard time controlling the step to the extent I can on the other side. I don't think I ever got tendonitis, although I did get some tracking syndrome that makes it harder to stand up (although the squatting isn't as painful). I wish I had some good insight, but I really don't on your issue . . .

(and if you're not Ian, I hope this helps anyhow!)

**ikkin** · 10-16-2007, 02:55 PM

hey all, another question for you.

i'm 13 days post-op allograft ACL reconstruction and everything feels great (130 flexion, 0 extension, swelling is reducing quickley, etc.), EXCEPT...

the patella tendon in my repaired knee now hurts like hell! mostly when going down stairs and doing anything open-chain. it feels like it isn't tracking correctly or something...and subsequently KILLS. i'm worried...has anyone had a similiar problem?

**Vinman** · 10-16-2007, 03:02 PM

what types of open chain stuff are you doing?

**ikkin** · 10-16-2007, 04:25 PM

v,

i was sort of using the term "open chain" as a blanket statement for any movement where my foot isn't on the ground. my patellar hurts when i pick up my repaired leg in bed in the morning, it hurts when i sit down to pee (which i guess is closed-chain, technically), it hurts LIKE HELL going down stairs, it hurts when i raise my thigh....it just hurts.

any ideas?

**drmark** · 10-16-2007, 05:28 PM

do you have extension equal to the other leg?
what was the graft source.

**ikkin** · 10-16-2007, 09:20 PM

hey dr. mark,

i'm 2 weeks post op and my extension is pretty close. it was measured at 2 last week, my unrepaired leg is -2 or something. repaired leg flexion is currently 130.

i know you won't like this, but it's an allograft.

advice is super appreciated though! please help. i'm worried i'm pushing it too fast or my surgeon made the graft too tight or something...ideas?

**amyzilla** · 10-16-2007, 09:22 PM

ikkin, I seem to remember having the same problem (with an allograft). It went away after probably two or three months. Have you mentioned this to your doc or physical therapist?

**ikkin** · 10-17-2007, 08:17 AM

hey amy,
thanks, that's hopeful news. i've mentioned it to the PT guy...his response is: "Well, we'll keep an eye on it. As long as it doesn't get worse you should be okay." I'll probably give the doc a call tomorrow.

**escii** · 10-17-2007, 09:46 AM

<quote>
was sort of using the term "open chain" as a blanket statement for any movement where my foot isn't on the ground. my patellar hurts when i pick up my repaired leg in bed in the morning
</quote>

This type of action has been SLOWLY getting better after the initial manglement. 7 weeks out and I'm finally feeling comfortable adding that motion it a workout routine. It was hella painful the first two weeks.

Sigh, I get to go through it all again in 7 days

**Mofro261** · 10-17-2007, 11:08 AM

I had some similiar problems with the catching, but my PT person was proactively on top of it before it became a problem. Massage your knee cap- take your thumb and index finger in a the shape of a vee and slowly press downward at the top of the knee cap. This made a noticable difference to me. Also massage any of the points where incisions were made- this helps to break up scar tissue which can impede returning to normal range of motion.

**Vinman** · 10-17-2007, 03:32 PM

Originally Posted by ikkin

hey all, another question for you.

i'm 13 days post-op allograft ACL reconstruction and everything feels great (130 flexion, 0 extension, swelling is reducing quickley, etc.), EXCEPT...

the patella tendon in my repaired knee now hurts like hell! mostly when going down stairs and doing anything open-chain. it feels like it isn't tracking correctly or something...and subsequently KILLS. i'm worried...has anyone had a similiar problem?

good beacuse you should not be doing any open chain knee extension. The only open chain stuff you can do is strait leg raises and hamstring curls.

As for the tendonitis itself, make sure you are stretching well and often. I find many peeps with ant. knee pain have tight hammys.

**ikkin** · 10-18-2007, 12:59 PM

thanks guys, i've been taking your advice the last couple days and working on extension and stretching. i'll start massaging today, woo! anyway, thanks so much, it seems to be MUCH better! you're the best. i really appreciate the hep.

**Mcalla** · 07-25-2008, 08:53 AM

Hey guys, I have a couple of questions. I'm 5 weeks, 2 days post op ACL reconstruction with patellar tendon graft and I still don't have full leg extension in that knee (around 3 degrees or so), what can I do to get to 0 degrees?

Also, my PT has started making me work on the leg extension machine at therapy, but I've heard other people say you should never do leg extension b/c it's hard on the new graft? What have you heard?

Thanks

**thebentwoods** · 07-25-2008, 05:31 PM

My PT told me that a patient needs to gain full extension by 6 weeks or its not going to happen. I'd do whatever your PT is telling you in the realm of closed chain. But work it religiously to get that extension.