Bashir Zikria knew he was too old to dunk a basketball. But the younger guys at the gym were teasing him, so this was a matter of pride.
“Still,” he says now, “you might expect an orthopedic surgeon to know better!”
He recalls, “They were in their 20s, talking trash, so I bet them I could at least get close to dunking the ball. Bad idea,” says the director of sports medicine for Johns Hopkins Orthopaedics at Good Samaritan Hospital. "The first jump, I think I came close to reaching the rim. The second time, forget it. I slipped and I felt it pop.”
He knew exactly what it was the second it happened. “I tore my patellar tendon.”
That’s the tendon that links your kneecap, or patella, to your shinbone. The pain sent him to the floor. He crawled off the court and called his office.
A Regular-Guy Injury
This type of tendon tear made sports news in 2014 when Los Angeles Angels’ ace Garrett Richards tore his while covering first base on a ground ball. But what happened to Richards is a rare thing for big-league pitchers.
“I’ve seen this injury more in weekend warriors than in professional or college athletes,” says Zikria, who’s also a former team doctor for the Baltimore Orioles. “In the last 3 months I treated two guys who were playing basketball; one 42 years old, the other 31. I’ve also treated people who have fallen down steps, and a woman who was dancing when her patellar tendon popped.”
It mostly affects amateur athletes in or near middle age. It’s caused by “explosive-type sports, any running or sudden acceleration," says Scott Gillogly, MD, former team doctor for the Atlanta Falcons.
Will You Need Surgery?
Tears can be complete or partial. A small rip probably won’t require surgery. You’ll wear a brace and do physical therapy for 3 to 6 weeks while the tendon heals.
A larger tear might need a surgical repair. A total rupture always means a trip to the operating room. Like Zikria and Richards, you won’t be able to stand or walk after it happens. When the tendon gives way, you can’t move your knee.
“I don’t care if you’re a 26-year-old starting pitcher or a 50-year-old housewife. It needs to be repaired and rehabilitated,” says John Wilckens, MD, former orthopedic surgeon for the Baltimore Orioles. “We are talking about some serious repair.”
Zikria had his surgery 2 days after the injury.
During this 60- to 90-minute process, a surgeon uses a strong thread, or suture, to sew the torn tendon back together. He may reattach it through small holes drilled in your kneecap.
Or he could choose a newer technique where the tendon is attached to a screw placed at the bottom of your kneecap.
Move Early, Move Often
Rehab starts on the table. While you’re still asleep, the surgeon tests his repair work by moving your knee.
When the job is done, you’ll be fitted with a long brace or knee immobilizer. It runs from the center of your thigh to mid-calf and holds your leg still. It locks into place to keep the joint from moving. “Generally, you’re in full extension, with your leg out straight,” Gillogly says.
Within the first week you’ll begin to bend your knee by adjusting the brace settings. This puts a little tension on the repair. You can move it more as your knee gets better. “We think that stimulates healing,” Wilckens says.
A Timeline for Recovery
Your knee will get better, but it may take longer than the average sports injury or broken bone.
Full recovery can take from 6 months to a year. It depends on how healthy you were before and how much effort you put into the process. You should plan for at least a week off work if you have a desk job and 4 to 6 months if you do manual labor.
Keep in mind that everyone heals at a different speed, so these dates aren’t set in stone.
It helps to know what to expect right after surgery and during the weeks of physical therapy that follow.
Surgery to 2 weeks: You may have the operation as an outpatient, or you might be in the hospital overnight. The doctor will give you medication for pain. He’ll probably have you ice your knee three to five times a day for 10 to 20 minutes a time.
You’ll go back to the doctor in about 2 weeks to get your stitches out. You’ll use crutches when you stand or walk and put only as much pressure on the leg as is comfortable. Doctors call this “weight bearing as tolerated” (WBAT). You’ll do slight exercises with your knee, not bending it more than halfway. You might also work your ankles, quadriceps, hamstrings, glutes, and even do some cardio.
The doctor may have you use a gadget called a continuous passive motion machine, or CPM. You put your leg in it without the brace on and the device gently moves it for you. This helps it heal faster, but you use it only during the first 6 weeks after surgery. If your insurance covers the cost, you may get one for home use. If not, your doctor should have one in his office. He’ll want you to be in it several hours a day if you can.
2 to 6 weeks: You’ll get around more. You could add exercises like heel slides, leg lifts, and weight shifting. After 6 weeks, your leg should be able to handle your full body weight.
You may be able to drive if the surgery was on your left leg, your car has an automatic transmission, and you aren’t taking narcotic drugs for pain.
6 to 12 weeks: By now you’ll be walking well without crutches, but you’ll still wear the brace most of the time. This is when more serious physical therapy begins. You’ll start using a stationary bike. You’ll add core and knee-strengthening exercises, plus upper body weight training.
After 12 weeks: You’ll learn to walk without a brace. Your leg should work properly when you stand on it. You’ll add stretches and exercises to strengthen your hip and quad.
If surgery was on your right knee, you may be able to drive a car with an automatic transmission when the brace comes off.
After 4 months: You’re near the finish line. You’ll have good control of your knee and no pain with movement. You can jump, run, and kick.
Zikria doesn’t want his patients to get back into a weekend game until the knee is 80% to 85% as strong as the other one.
Will It Be as Good as New?
There will always be a little bit of a difference between the good knee and the injured one.
Zikria says he feels it most when he walks down a flight of stairs. “Going up is pretty easy now, but I feel pain going down. I’m not as strong on my left side as I was before.”
Yes, you can get back to normal, he says. But “you’ll always know you had the injury.”