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Quadriceps repair and extensor lag
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Quadriceps repair and extensor lag - April 21, 2008 11:15:43 AM
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buckeye
Posts: 175
Joined: May 24, 2007
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If the repair of the quadriceps/extensor retinaculm repair is solid, when should there be good quad function for supine SLR - i.e. no extensor lag?
How soon post-op do you consider doing e-stim for muscle re-education?
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RE: Quadriceps repair and extensor lag - April 22, 2008 8:12:16 AM
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Shill
Posts: 1097
Joined: February 13, 2003
From: Madison WI USA
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I would say that this could depend on the surgeon, type of rupture, and type of repair. If the surgeon allows quad sets, E stim should be fine, in neutral, as there should be not much difference in force here....in theory. However, the patient probably cant actually do a true quad set if E stim is being considered. I would be cautious during the ramp up phase. Perhaps isometric holds for QS, while resting in multiple passive SLR positions would be a way to start this improvement process for SLR without lag. Honestly, I never see these patients, so Im going off the top of my head. In terms of when no lag is realistic, I will hope someone else can come up with that, based on experience with this population, but my guess would be 6 weeks-ish.
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RE: Quadriceps repair and extensor lag - April 22, 2008 10:22:51 AM
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buckeye
Posts: 175
Joined: May 24, 2007
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Thanks, Shill.
Quad sets are starting about one month post-op (patient on their own) but I am not seeing the patient until two months after surgery. Unable to get a quad set in full extension but can activate the quads if SLR is attempted.
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RE: Quadriceps repair and extensor lag - April 23, 2008 7:49:01 AM
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PTupdate.com
Posts: 1478
Joined: October 8, 2001
From: Pittsburgh, PA USA
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Buckeye: Remember that arthrofibrosis from the tear, the surgery, and subsequent immobilization may work against you as well. You will really need to work on patellar mechanics and mobility, make sure patella infera is not present, and mobilize that tissue/scar tissue. I am actually typing up an article review today for my site regarding arthrofibrosis, so was glad a relevant post was here.
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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RE: Quadriceps repair and extensor lag - April 23, 2008 8:37:55 AM
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buckeye
Posts: 175
Joined: May 24, 2007
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PTupdate - thanks for the reply and great information.
Joint range is good; within about 10 degrees of other knee. Patellar mobility is good. There is some firmness at the surgical site - perhaps some scar tissue. Working on mobilization/massage at this area.
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RE: Quadriceps repair and extensor lag - April 23, 2008 8:50:55 AM
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PTupdate.com
Posts: 1478
Joined: October 8, 2001
From: Pittsburgh, PA USA
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That sounds like great ROM.....a rare occurrence in these cases.
I recently discharged a gentleman who suffered the rupture, but then developed numerous MRSA infections, had debridements, and even surgery for the scar tissue. The surgeon, who is quite physically fit, told me he dug and cut out scar tissue on a Friday night for 2+ hours, and his forearms were sore all weekend. As I did aggressive soft tissue work with him, and he went to a massage therapist 1x/week as well, it really made a difference.
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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