Quad Tendonosis options a year after acl surgery

by BSmit
(ga)


I was diagnosed with quad tendonosis in june.

A year previous to this i had acl surgery on the same leg.

Before I could pinpoint my extreme pain my doc did a scope on the leg and cleaned it out.

The pain persisted and that is when i was diagnosed with severe tendonosis in the quad tendon.

Since then I have had 3 Prp injections and tried everything under the sun as far as modalities and Physical Therapy.

It is now november and I have no improvement whatsoever.

I am a professional basketball player and i obviously am a free agent or I would have more people on my side.

I am now realizing that not only is this season a long shot but I am beginning to believe this may be the end of my career because of this pain.

I can never get a straight answer on if surgery is a possibility for this. Is it? what does it entail? what is the success rate? rehab time? Potential long term problems being that I am a high level athlete?

Thanks in advance I will be anxiously awaiting a reply!



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Joshua Answers:

Hello BS.

So, why exactly, I wonder, were you diagnosed with Tendonosis as opposed to Tendonitis?

1. What did your doctor tell you?



2. What exactly did the doctor 'clean out?' And when exactly did that happen in relation to the acl surgery and the diagnosis in June?

3. When does the season start, in the context of how long do you have to heal before you have to start getting back to high level activity?

4. What happened that you had to have acl surgery?

5. History of Tendonitis pain or injury?

6. Age?

7. General description of dietary intake.

8. PRP didn't help at all? (Bummer, I like the idea of PRP, I hope it turns out to be an effective treatment.)

9. Say a little more about what exactly you have tried, and whether it worked a little, a lot, or not at all.




Joshua Tucker, B.A., C.M.T.
The Tendonitis Expert
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Feb 20, 2010
Part 2 - Reply - Quad Tendonosis options a year after acl surgery
by: Anonymous

Thanks for the reply.

I am not sure how long ago you replied but I can tell you that the reason I have not been doing anymore online is because I have continued this neverending battle against tendonosis.

I am soon scheduling surgery bc I am yet to see any improvement after another final push in therapy the last month.

To give you a little information my PRP injection began in july and my last was in november. So several weeks apart.

I have tried shockwave, ARP, PT, etc. After meeting with James Andrews and his staff they are leaning toward surgery bc nothing else seems to give me any relief. I have missed the entire season and now my aim is for next season.

However, I am extremely worried that there is no chance. They have given me a 70% success rate of surgery which doesn't make me feel comfortable.

My tendon has a few calcium deposits in it that may be causing the pain, but nobody is 100% sure where the pain is coming from.

I was diagnosed with Tendonosis in June 09 and when I had the scope they only cleaned out the knee bc this was prior to them pinpointing where the knee pain was coming from.

So basically, a waste of a surgery, which makes me even more hesitant to have another major operation on this leg.

Any input you have on this would be helpful, bc I am very worried about the pain never leaving and the surgery not working. Let me know what you think, bc I am very interested in hearing your opinion.

Thanks


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Joshua Comments:

Yeah, it's a bummer when surgery doesn't work as promised.

I'm curious what would happen if you supplemented with your tolerance level of Magnesium (read this link and follow the dosage link at the bottom of that page.

As this link will explain, Calcific Tendonitis is a function of not enough Magnesium. Not enough magnesium and the body will deposit calcium. Take magnesium, and the body reabsorbs it.

It's possible that you are magnesium deficient, and, long story short, that has set up a pain dynamic.

Also, being highly athletic and muscley, I bet your muscles and connective tissue structures are TOO TIGHT. Thus putting too much tension, CONSTANTLY, on your tendons.

This can send a pain signal to the brain.

(CONTINUED IN PART 3)





Feb 20, 2010
PART 3 - Also... - Quad Tendonosis options a year after acl surgery
by: Anonymous

My ACL injury was during a high level workout before a very important time and freak accident i jump stopped and my knee popped.

Also, my diet is very strict and I eat very well in line with a professional nutritionist that I had assigned to me. So, that is under control as well. The last thing i tried with all this was iontophorisis (sp?) with acedic acid to try and break the calcium deposits down.

This was unsuccessful.


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Joshua Comments:

(CONTINUED FROM PART 2)

It's possible that all that therapy didn't work because there's nothing wrong with the quad tendon. Take the tension off, and pain goes away.

Maybe you do have an actual injury, I didn't reread your original post.

You might have some rip and tear, and the way the body heals sets you up for further injury signal. If you don't deal with that adequately, if you use a lot of different therapies that aren't the RIGHT tool for your job, then it's not going to get better.

So the first thing I would have you do is get to your tolerance level of magnesium intake, and stay there for a while.

Then a lot of self-massage (of find someone to do it for you) to open up those too tight structures.

Then, if you have an actual site of injury, get a thumb on it and rub it until it turns from dry, crunchy, fragile tissue into soft, squishy, gummy, mobile tissue.

Mar 01, 2010
PART 4 - Thanks - Quad Tendonosis options a year after acl surgery
by: Anonymous

I wanted to thank you for your response and update you. I ended up having the surgery last week.

After meeting with a couple of the top orthopedics they thought it best to get it done.

I am taking your magnesium tip with me as I begin pt and hopefully when I hit the court again.

Maybe that is what got me into this into the first place? There is no telling. I had so many tests done (xrays, mri's, ultra sounds) over the past year and the only thing that was ever concuded was that I had a degenerative quad tendon with calcium deposits.

During the surgery the doc found even more calcium deposits with several microtears near the insertion into the patella.

I am hoping that I will be able to come back from this but we will just have to work hard and see what happens. I just wanted to update you in case you ever hear of a case like this you can revert back to my experiences and help someone else.

Let me know if you would like to know how all this works out and I will keep you updated throughout the process.

Thanks again


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Joshua Comments:

I'd love to hear how this turns out. Update as often as you like.


Ice packing, 5 minutes on, 5 off, will help decrease pain and help things heal.

Definitely keep your Magnesium up.

Massage the quads often and a lot, to get it as soft/loose as often, to keep tension off the surgery site.

Good luck with the healing, and do let me/us know how it goes.



Feb 27, 2012
Quad Tendinosis
by: Anonymous

How has your recovery been from this surgery? I have the same problem and have a surgery scheduled for next week.

Nov 12, 2012
Did it help
by: Anonymous

Did the surgery help or not?????




Nov 12, 2012
March 2012 Quad Tendonosis Surgery
by: Anonymous

I had the surgery in March '12. The Quad tendon was sliced vertically down the middle and the dead tendon was removed.

The bone under the tendon was lightly scored to stimulate healing. The doctor said after opening it up and seeing the damage to the underside of the tendon that this would not have healed with continued physical therapy alone (I had previously tried PT for ~1yr).

I spent 1 mos in an immobilizing brace post surgery and have been doing PT 2-3x week for the past 7 months. Progress is slow but encouraging. My right quad is still only 50% of full strength. I have been working the full range of motion with weight now for about 1.5 months.

I am hoping that in 2 months I will be back to near full strength...TBD.

If you have the same injury and want to email, post your email and I will email you.



Nov 12, 2012
Surgery years later
by: B smit

Hey guys,
I am the original commenter on this thread. I had my surgery in February 2010. I was a professional basketball player in Europe up until the tendon problem. I do not want to be discouraging- only want to share my story.

I had the surgery at the Andrews institute in gulf breeze Florida and did 10 months therapy under world class physical therapists, trainers, doctors etc. all the way down to my meals being planned for me.

Unfortunately, it is nearly 3 years from the date of surgery and I still deal with this daily. I have come close to a comeback 2x over the last 2 years to making a come back but I jut never got over the hump. I am currently trying to come back once again bc I have learned to deal with and control the pain as best as possible.

I take an antiinflammatory 3x a day everyday and I'm only 27. This has helped me quite a bit though. I am playing at a pretty high level right now but the fact of the matter is I missed a tremendous amount of time and teams are not looking to sign a guy with this much baggage unless they he desperate.

With that said, it is not impossible. The problem I run into is it still is a day by day thing with the pain. Some days it's severe pain when the knee is loaded and bent an some days I feel really strong and I am dunking the basketball any way you want it. (6ft tall).

This problem has changed the course of my career/life dramatically and I am not sure if surgery was the right way to go or not. It did not change much but made my leg weaker. Everybody who has had knee surgery can understand your knee is never the same when they cut. Although you can recover- still different.

Every case is different but I think I will live with this the rest of my life. Good luck everybody!





Nov 12, 2012
Tendonosis and bone spur in knee
by: Anonymous

My email is thegamer1587 at yahoo dot com

I am considering the surgery. I've tried every other conservative approach with no luck. My story is, I'm 26 now and originally starting having pain 4 years ago directly above the kneecap. I used to be into heavy lifting including squats which I'm sure is my cause of this.

The thing about my pain is that I have a size able bone spur at the exact place on my kneecap where I feel that the pain is coming from.

Is it likely that this is my root cause and is digging into the tendon? Or just a side effect of the tendonosis?

In the past 4 years I have lost most of my strenghth in my bra leg. It hurts to run, sit down, walk down stairs etc.... Anytime I try and do the slightest amount if physical activity the knee feels terrible for the next few days.

anyways, I've been researching this for quite sometime and CAN'T believe that I finally got a reply from somebody on this subject!


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Joshua Comments:

Bone Spurs are symptoms, they are caused.

Bone spurs don't -have- to cause problems, but depending on where they're at, etc, they certainly can and do.

Same with Tendonosis.



Nov 12, 2012
Mar 12 Surgery
by: Anonymous

My original injury was soccer -- shoved at full speed from behind and landed directly on the quad tendon with 100% of body weight. It felt like my femur pulverized the tendon between the field turf the femur. 1 day later the knee swelled considerably, but was mostly recovered after 2 weeks.

Fast forward 1 year I was getting moderate pain in the tendon, but more concerning was the loss of strenght in the quad. Seemed no mater what I did I couldn't get the quad back above 75% strength. Decided to roll the dice with the surgery hoping for full recovery.

Right now not even back to 75% -- maybe 50%, but a lot of progress in past month so hoping with 1-2 more months will be back to 80%+.

The gamer -- will email you. B smit -- email gamer if you would like to be added to the conversation.



Nov 12, 2012
Reply
by: Bsmit

I've been through it all to the highest level. I tried every conservative approach and every invasive approach as you will read my previous posts dating back to 2010. The bone spur could very well be causing some additional pain.

However, I learned that the microtears in the tendon are the reason for the bone spur in the first place. Tendon bleeds (inflames) then eventually turns to calcium and dead tissue which is why tendonosis is no longer known as inflammation.

I would consider having the surgery but definitely exhaust everything else bc my pain went nowhere! I don't know the complete medical guide to this but it has to be approached with a long term plan bc I can tell you there is no quick fix to this issue.

Again, I am able to play basketball at a high level again, but it is not bc I have no pain but more so bc I have learned to deal with the pain and CONTROL it!

I know you're in severe pain and your symptoms sound much like mine. The stairs were terrible and I would be lying to you if I left out that they are still not fun!



Nov 12, 2012
Joshua
by: Anonymous

Joshua,
Do you have any tips on how to deal with this quadriceps tendonosis other than surgery? Any helpful exercise, massages,stretches?

The only exercise i seem to be able to do without pain is quad sets which don't to a whole lot. The muscle in my bad leg has gotten too weak, I could stretch the quad in that leg for what seems like an eternity.

Thanks, Corey


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Joshua Comments:

Hi Corey.

Well, my first thought is, if you can do a quad exercise and it doesn't hurt/cause more pain, then perhaps you don't actually have quadriceps tendonitis, maybe you just have pain in that spot/area?

I'd need to know more:

1. Describe your symptoms.
2. Location of symptoms.
3. What makes it worse, what makes it better.
4. What do you mean, your bad leg has gotten so weak, specifically?
5. What happens if your stretch your hamstrings. Or your adductors? Or your abductors?

I don't think you've commented earlier in this thread, perhaps I missed it under an 'anonymous' posting.




Nov 16, 2012
Quad tendonosis
by: Corey

Hi Joshua, thanks for replying!
My symptoms are significant quad weekness in my left leg with a constant achy/nagging pain right at the top of the kneecap.
I can't do quad exercises without pain. If I do some VERY light exercises it sometimes feels ok that day but then aches badly for the next few days.
My most noticeable muscle loss in that leg is the vmo muscle, it has shrank significantly and feels like jello.
The only thing that seems to be providing a little bit of relief has been cross friction massage, but it seems to only last for a few hours.
As far as stretching, the hamstring and the quad are both already so loose I could stretch them out all day with no problem, and as far as the abductors, I must admit I'm not sure what they are or how to stretch them.
Any advice would be greatly appreciated, I have been dealing with this for 4 years and its is extremely depressing, especially because I'm only 26 years old.
- Corey

Nov 16, 2012
Quad tendonosis
by: Corey

A few other things I forgot to add in my last comment, I was the the guy commenting earlier. I've already tried physical therapy and 1 prp (plasma rich platelet) injection.

When I do attempt to work out the quad very lightly, the muscles in the leg all twitch, not sure why, but it's weird.

If I do attempt quad exercise, the next day the muscles in that leg never get sore, but the tendon always gets extremely sore.

It almost seems as if the muscles quit working and now the tendon is doing more work than it should to compensate? If that makes any sense?

Definitely not a medical professional so please excuse some of crazy drescriptions. I'd be glad to provide you with any more info you may need to help. I'm willing to try about anything to avoid a risky surgery with no guarantees.
- Corey


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Joshua Comments:

Hi Corey.

Yes, that makes sense.

Well, good news/bad news, you don't just have tendonitis/tendonosis.

You might have one or both of those, buy you have more of a function problem than a soft tissue problem.

I have ZERO faith that surgery on a tendon is going to fix your problem and get the muscles working right again.

Tendonitis doesn't have your muscles stop working, or twitch, etc. Well, not directly. Indirectly, there are a LOT of factors involved in everything you describe.

Ultimately, it's a function of 'something's too tight and not firing properly'.


Do you have a history of injury (of any kind, at any point in life?)



Nov 16, 2012
Quad tendonosis
by: Corey

I really don't have a specific injury to the leg that I'm aware of. I first noticed the problem beginning while doing some very heavy squats, I figured like every other injury some rest would help it. But it has only gotten worse.

I also have developed a noticeable bone spur on the top of the kneecap right where the quad tendon attaches.

I'm sure my muscles were probably imbalanced from doing to many squats, but only the left leg has this issue(thank god).

On the bad leg, the hamstring is pretty much as strong as the igo of leg. But the quad.... Not so much. If I attempt single leg raises or leg presses at the gym, the pain free leg can do triple what my bad leg can do.

I've even tried to workout the leg through the pain and I always end up regretting it for a week afterwards.

I'm sure thy strenghthing the quad would help Atleast a little, but I can't figure out how to do so without pain. The only exercise I can with that quad that gives no pain at all, are quad sets.... Which isn't much of an exercise. The leg actually does seem to feel betters for the brief period afterwards while the muscle is pumped up.
Sorry for the very long post!

Please help....


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Joshua Comments:

Say more about the bone spur.



Nov 22, 2012
Bone spur not a problem the doctor said
by: Corey

About the bone spur, both of the orthopedic doctors I went to in the past wouldn't even acknowledge it until I pointed it out.

The doctor who was willing but reluctant to try the debridement surgery said that he didn't think it was a problem, but if he noticed it was during surgery he would remove it.

As far as surgery, the doc offered it but even went as far as to say he wouldn't recommend it basically unless I couldn't walk!

Is it possible that my extremely weak vmo muscle is more of a problem here than anything? I've been trying to work on it, but haven't had much luck.

Would it be possible for me to personally email you a picture of the muscle loss I'm speaking of as well as the bone spur?


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Joshua Comments:

Hey Corey.

The VMO is more a symptom of something else. Something is CAUSING the VMO to not be able to fire optimally.

The question is, what's causing that lack of power/innervation to that muscle. Maybe it's too tight so can't fire, maybe neurologically speaking, the brain won't let it fire because it thinks it shouldn't or doesn't need to. Maybe you have something out of alignment and a nerve is getting pressed on just right.

As far as the bone spur, if it's not big it's probably not a problem. You could send me pictures to pictures at tendonitisexpert dot com, sure. But even big spurs aren't necessarily causes of pain, so all I'll really be able to respond with is 'gee, that's big' or 'well, that doesn't look so bad'.

Unfortunately I don't know how much I can help over the internet. You'll probably need to find a really good sports chiropractor or osteopath (generally I suggest osteopath's over chiropractors), or a kinesiologist that can do good muscle testing to see why that muscle isn't firing.

Either the Bone Spur is sending a danger signal so the structures won't fire, or something else is. The cause is likely outside my sphere of easily being able to identify it, so good news/bad news, you need to find the right guy/gal. Which might take some time/effort.

But I'm comfortable saying that talking with doctors/surgeons isn't going to find you the answers you're looking for.

I'm happy to help/advise as I can.




Jan 11, 2013
Same issue with Quad Tendonosis.
by: Mike

Has anyone ever been healed from this? I have had for a month already and have had trouble finding info on this.



Jan 15, 2013
March '12 Surgery and brace immobility resulting in zero quad strength
by: Anonymous

Following 1 year of PT with limited results, I had surgery for this in March '12. My quad tendonosis was not post ACL and was for reasons unknown -- possibly direct trauma to quad tendon. I was in a brace unable to bend my leg for one month and then started PT from a baseline of zero quad strength (full atrophy).

I've been doing PT 2-3 times/wk since along with occasional additional workouts/bike time. At 7 month post surgery I was at 25% of non-injured quad strength as measured by Biodex. At this point I was quite concerned I would not make a full recovery. Since then my strength has been on a much better trajectory. 35% at 8 mos, 45% at 9mos and currently at ~55/60%. With this level of strength I'm able to start reengaging in athletic activities. I'm thinking/hoping this will be a full recovery if I stick with the PT for 3-4 more months.


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Joshua Comments:

Ouch.

1. Did you have a direct impact to the quad?

2. Why do you say it was tendonosis, specifically?


For that scenario you may want to consider The ARPwave System.

There's some serious electrical disturbance there keeping muscles from being able to fire optimally.

Definitely also see: Magnesium For Tendonitis

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