Quadriceps and Patella Tendon Repair Progression (6-12 weeks) | OEP372 - Ortho Eval Pal: Optimizing Orthopedic Evaluations and Management Skills

Episode Transcript
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Speaker 1 (00:00):
Hello everyone and welcome to episode 372 of the
OrthoEvalPal podcast.
I'm your host, paul Marquis,and today we're going to be
talking about quadriceps andpatella tendon repair, the
progression from 6 to 12 weeksafter surgery.
So we're going to be talkingabout some of the precautions
still at this stage.
We'll be going over some bracemodification, range of motion
progressions and exerciserecommendations and so much more

(00:23):
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Welcome back everyone.
Okay, so this is part three ofour patella and or quad tendon
repair rehab segment.
Now, if you haven't listened toour first two episodes, which

(01:52):
are 370 and episode 371, youprobably want to go back and do
that in order, just so thatyou're kind of up to where we
are now.
Now we're at the six to 12 weekpost-op period.
We're moving right along Now.
We're starting to gain somerange of motion.
The strength is going to startcoming along.
We're going to work on some gaithere in this section.

(02:13):
Now we really want to try tostart improving this gait
pattern, because we've beenlocked out into full extension
for quite a while and this canturn into kind of a sense of
insecurity when you get to thispoint, because we now start to
unlock this brace for gait.
So we go from zero to 40degrees.
Allow them to flex a little bitso that when they're walking in

(02:34):
the terminal stance phase ofgait.
They can flex that knee alittle bit, start to get more of
a natural gait going.
So if they're uncomfortablewith that, you could go back to
using a crutch on the oppositeside and just slowly work on
this weight bearing at zerodegrees.
Then have them, you know, kindof flex a little bit and see if
they can kind of accept a littlebit of load.

(02:55):
But you really want to get thatmotion at the back side.
So your hamstrings are pullingthe knee into flexion a little
bit when you're bringing thatheel up in the terminal stance
phase of gait and then you swingit through and just kind of
work on that.
You want to slowly increase thatrange of motion up to about 70
degrees while weight bearing.

(03:15):
You know, by the time you getto that 12-week mark, all right,
that's important.
Now, as far as range of motiongoes, we want to continue to
increase that range of motion.
I like to do it actively andhave it.
Have them gain it naturally.
They just have more confidencein themselves that they'll stop
when you need them to.
Some people will come out andthey'll be very, very stiff and
so you may need to help them alittle bit.

(03:36):
A little active assistdeflection won't hurt a thing.
Again, if you want to see how Ilike to increase range of
motion and deflection, I canshow you how I manually do it.
I'll add a video in the linkstoday in the show notes, so that
you can see where I like to putmy elbow and my hand underneath
that knee and let the kneebasically fall over my hand

(03:57):
slowly in deflection and thenyou slowly work on, you know,
gaining, that You're at.
You know 100 degrees, you wantto get to that, 105, 110, you're
slowly building up so that youknow, by the time you get to
weeks 10, 11 year or 12, you'regetting up to about 130 degrees
quite comfortably.
All right, so now let's talkabout exercises.

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Speaker 1 (04:53):
We are going to start with some weight shifting
exercises and I like to do thiswith about 10 degrees of knee
flexion bilaterally.
Maybe I'll get them on two Erexpads which are quite stable
when you're on with both feet.
Some people still use these weebalance boards.
I love them because you cankeep your knees almost in full
extension and really get youknow this side to side motion.

(05:16):
The base is very unstable, likeI would never go into a single
legged, you know Erex or um, youknow, can do ball type of thing
where you're where you'rereally working the
proprioception hard.
I would not be doing that atthis stage.
Really, this proprioception ishappening.
You know, with both feet on thefloor.
I like a side to side teeterboard.

(05:38):
It's one plane, um, fairly easyto work with.
You can get some hand support,some you know those stable ski
poles or your hands could be onsomething to give yourself some
support just to start to workthat very, very light
proprioception okay, and thathelps to increase that weight
bearing.
You start them at, you know 5 to10 degrees of knee flexion and
you progress to 15 degrees, 20degrees while they're in this

(06:02):
little kind of mini squatworking on balance.
Now, as far as closed kineticchain squatting, we have a
shuttle cardiovascular trainer.
That's how I like to start them.
Because they're flat on theirbacks.
You can start with less thanbody weight.
You can go with about, you know, 15 to 20 pounds of pressure.
If you want to start with that,I start with a double-legged

(06:22):
press, probably about 0 to 40degrees.
I may put the heel a little bitahead of the center of gravity.
Okay, because if you're on yourback and your feet are a little
higher on the pad, you're goingto engage the glutes and
hamstrings a little bit more.
When you start to drop thatheel closer to your center of
gravity, you're going to startusing the quads and become a

(06:45):
little more quad dominant.
So I start with the heels up,bring them down and start to,
you know, slowly engage thosequads with really lightweight.
I really track their amount ofweight and their reps and slowly
build that up over the next,you know, several weeks till we
get to about the 12 week period.
I may start them with some minilight lunges, like not true

(07:06):
walking lunges, but I'll have ahand, each hand on a chair on
each side of them and they'lljust do a little simulated light
lunge and then switch legs andgo to the opposite side.
You need to remember that thehardest part about doing a lunge
after you've had any surgery onyour quad tendon or patella
tendon is when that leg isbehind you.

(07:27):
Because you now have this, youknow, passive insufficiency
issue, where the quads gettingstretched a little bit, the knee
is flexing back there whileyou're going down into that
lunge and you get this nice bigpull.
So you got to be careful there.
I I'm actually more cautiousabout that part of the lunge
than when their leg is out infront of them, because they're
engaging their glutes, theirhamstrings and a little bit of

(07:49):
their quads.
So they're getting a littlehelp to do that.
They're just not getting thisbig passive stretch.
So be cautious with that.
Um, next, we want to get into,you know, a good quad set.
So sometimes throwing on alittle bio feedback to get a
better quad set is important.
Before getting into yourstraight leg raises.
So they should be able to turnthat quad on really well and
then start with some straightleg raises without the brace.

(08:10):
Now, okay, so we start to weanout of the brace.
Some of these folks are goingto have a little difficulty with
this.
So they may need some activeassistance.
You might need to, you know,especially on the takeoff.
After that you know they'rehitting.
You know the straight legraises and all other positions.
I like to get them on a bike atthis point.
If they have a comfortable 110degrees not a lot of stress you

(08:31):
can generally get them on aregular bike.
Some bikes have a little longercrank arm on it so you may have
to get to 115 degrees beforeyou can get around comfortably.
If they can't do that and youstill want them to bike, we have
a bike that has a modifiedpedal on it so we can decrease
that stroke.
So at about 90 degrees of kneeflexion they can start biking.

(08:54):
Um, I like to teach them how todo it active, assistively.
So the good leg is helping alittle bit.
At first the other one's alongfor the ride, or the affected
leg is along for the ride.
Then they start to kind ofengage a little bit more, then
get to a 50-50.
And then we start to justlengthen that pedal crank a
little bit more so they get alittle bit more range of motion
each time they get on, and thisis very encouraging when people

(09:15):
can get on a bike.
There's this sense ofaccomplishment that they really
like, and so I like to get themin there, you know, after that
six week mark, just to kind ofget their cardio going a little
bit, along with that upper bodybike to, you know, get some
blood flow going.
Also, I like to do some lateralband walking.
You can be, you can do thesewith full knee extension.

(09:36):
Um, some people, you know,around that 10 to 12 week mark,
will start to feel a little morecomfortable and may get into
just like a, an isometricsquatted position at about 10
degrees and do this.
That is perfectly fine, nothingwrong with that.
We do this a lot.
Start with a light band andjust build yourself up Then a
lot of these.
You know, we'll continue withblood flow restriction training.

(09:57):
If we're just having a hardtime getting a good pump or
getting some good cardio, wemight put some BFR on them and,
you know, increase those reps alittle bit with lighter, no
weight at all.
And also do BFR on thecontralateral side, on the
infected limb.
Maybe throw someone on the armsat this stage and continue to

(10:17):
work the arms a little bit andget that human growth hormone
release and promote some healing.
And, you know, disuse atrophyin that quad area.
So again at this point, folks,we are still not doing forceful
knee extension.
We're not kicking soccer balls,we're not doing any eccentric
loading, we're not doing anyjumping or plyometrics.

(10:37):
This is difficult tissue to healand can take a long time.
You don't want to mess these up.
I've never seen one messed up,so I can't tell you what that
looks like.
But you don't want to mess theseup.
I've never seen one messed up,so I can't tell you what that
looks like.
But you don't want to go therebecause the repair on a patella
tendon or a quad tendon a secondtime just isn't that great.
The integrity is just not asgood, the patient's going to be

(11:00):
much more apprehensive and therecovery just take forever.
So I'd rather the patient be alittle on the tight side and
we'd be a little bit moreconservative, just to get some
great healing there and thenlater on into the next section.
That we're going to talk aboutis 12 weeks on is how to, you
know, start to build thatstrength a little bit better and

(11:20):
start to develop someconfidence and decrease that
sense of kinesiophobia as theyget closer to you know, getting
back into sports or higher levelactivities.
So there you have it, folksPatellar tendon, quad tendon
repair rehab up to 12 weeks.
I hope you enjoyed today'sepisode.
Be kind to each other and takecare.

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Quadriceps and Patella Tendon Repair Progression (6-12 weeks) | OEP372

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