01 August, 2014 / Shawwal 4, 1435

QTR - a patient’s perspective

Published Jul 20, 2011 06:55am

As years roll by, one tends to become more cautious while making physical movements for the obvious reason of avoiding getting hurt. Besides losing agility and firm-footedness, a slow-down prematurely is generally conspicuous. One senses deterioration in body parts usually due to radiating pains and discomfort, but sometimes, because of certain medical conditions, a diseased area may not forewarn the onset of a preventively curable malady subsequently leading to a serious complication.

I think that the knee is one of the more important parts that can spring a surprise and at the same time, bring about a very long, torturous disruption in one’s life. I got a taste of it when I experienced a sudden abnormality, causing the left knee to lose the ability of withstanding my body weight. Repeated falls made things worse. That evening, I consulted an orthopedic surgeon, who thought initially that I had a fracture somewhere in the leg. A couple of days were spent comparing x-ray results, when the results were negative; he concluded that I had a Quadriceps Tendon Rupture (QTR) and advised immediate surgical repair.

After frantic searching on the Internet, it dawned on me that the repair meant an operation that would depend heavily on the progress in healing and most importantly the post-operative care. Time needed for the first-stage recovery was around 5-6 months. First a complete bed rest for many weeks then only restricted mobility within the four walls of my house generally limited to the bath room, dining table and the bed. Even just the thought of being inactive for such a long period made me really sick.

Surprisingly, QTR is not common in the sub-continent. Besides old age, it may be a sportsman’s mishap. It can occur in 40s where a 100 per cent recovery is more probable. However, in my case (65th year), the tendon did not send warning signals through pain; I only experienced a slight swelling of the knee occasionally. The swelling was attributed mainly to the osteoporosis I had been carrying since my early 40s – a normal aging degenerative process which I had repeatedly been advised to live with. And that is where I think the fault lies. I have a very strong feeling that there are many cases in which a diseased tendon is the cause of a fall with resultant damages, like fracture etc.

Since in our case proper documentation is amiss, we do not have statistics stating how many ruptures are caused by osteoporosis or similar disorders. In short, in my opinion, tendons, ligaments and cartilages should be given much more importance than what we see in the profession as a matter of routine.

This quadriceps tendon links Quad muscles (around femur) to patella. (It extends itself onwards to lower leg and is called patella tendon there but that part is beyond the scope of this article). It is the strongest tendon. It is load bearing and helps balancing while standing, walking and playing. Once broken, forward movement of the lower leg is instantly gone and the leg tends to bend inwards causing a slight imbalance, and bringing down the entire body's weight mostly on one foot (the left in my case as mentioned earlier). Therefore, the moment forward movement seems restricted, no attempt should be made to stand up till a four-legged walker is made available and a knee immobilizer is arranged so as to avoid bending the knee. It is advisable that as soon as QTR is identified and confirmed, the knee should be operated on. This will reasonably enhance the success rate of the operation. Additionally, as a matter of precaution, the other leg should not be over-used and any or all activity should be made keeping the strength of the other knee under consideration. Thus, the load of your body should also be shared by hands as well, where it is possible. At times, one will have to resort to the all-four condition as the only solution for a particular type of movement, e.g., single or double step negotiating. Protecting the other leg against fatigue is extremely important.

Patients ought to expect more from their doctors. Present-day medical experts are generally quite updated and more knowledgeable. Prodigiously, every doctor may follow his own post-operative treatment regime (in addition to the standard procedure). In this particular case, with better equipment and advanced techniques available, I would recommend that tendon rupture should carefully be linked to osteoporosis and also other causes of tendonitis such as lypomas or neurofibromas etc.

Awareness on the part of patient would be helpful but it is the doctor who has to turn to more detailed examination of a problematic knee. A knowledgeable patient and inquisitive doctor together can prevent an accidental tendon rupture, thus providing immense protection and reduction in pain, hassle and avoid crucial time in cases where patients who are still active in life’s later years. A smart doctor would ask for a MRI report at a much earlier stage to ensure that the tendon and its surroundings are in perfect health. In case the report is not favourable, he can guide the patient to take precautions in accordance with the observed extent of the damage to one’s tendon. On the patient’s part, this may include curbing various habits and restricting strenuous plans likely to cause injury. As per requirement, medicine and other forms of timely treatment can also be suggested to successfully delay the inevitable.

In conclusion I suggest that people after crossing the age of 50 should become more wary of ailments they are likely to face. Conventionally, we do care about heart disease, renal dysfunction, fatty liver and gastro-intestinal disorders; it is time to see the damaging effects of osteoporosis and the likes which can disrupt a normal, healthy lifestyle.

I do earnestly hope that sharing my experience will help someone become just that much more vigilant; and help you brace for the possible impact with lesser damage.  

Sohail Ahmed is a retired PTCL Chief Engineer and has shared his experience in human anatomy through this blog.

The views expressed by this blogger and in the following reader comments do not necessarily reflect the views and policies of the Dawn Media Group.

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Comments (14) (Closed)


Arsalan Ali
Jul 20, 2011 01:53pm
Good Article very informative.
N.G. Krishnan
Jul 20, 2011 04:55pm
"I do earnestly hope that sharing my experience will help someone become just that much more vigilant; and help you brace for the possible impact with lesser damage" Very well said Sir. Your observations are true not only of QTR, but also many other muscular pain especially after 60s. Shooting pain in the left could well mean an imminent heart attack. Ignoring the symptoms trying to over come the pain with across counter pain killer medication could well be flirting with death. Most of muscular pains could be treated by an expert using myofascial release approach is a form of soft tissue therapy used to treat somatic dysfunction and resulting pain and restriction of motion. Attending to the unexplained pains could well mean avoiding serious complications later. The saying "stitch in time saves nine" is very true in this context.
Dr Mansoor Ahmed
Jul 20, 2011 05:53pm
I'm sorry to say, but the entire article is quite inaccurate. I wonder what sort of an orthopaedic surgeon you have see Sohail Sahib. No Orthopaedic Surgeon would put you on bed rest for a Quads Tendon Rupture. And since when has the QTR got anything to do with Osteoporosis??? I'm sorry i dont have much time, but there are other discrepancies as well. Nevertheless I must commend you one making a good effort.
Forbidden Fruit
Jul 20, 2011 09:23pm
Dr. Saab, your attitude is a classical "Doctor attitude!" I'm young but terribly scared of old age, not because of the slow-down, but because of the doctors and their disturbing attitude! Our doctors are so quick to criticize patients for every trivial thing and equally reluctant in giving a "detailed advice!" The exact same thing you just did. The article was useful, even with its alleged flaws while your comment was plainly inconsequential!
Forbidden Fruit
Jul 20, 2011 11:20pm
Dr. Saab, your attitude is classical “Doctor attitude!” I’m young but terribly scared of old age, not because of the slow-down, but because of the doctors and their disturbing attitude! Our doctors are so quick to criticize patients for every trivial thing and equally reluctant in giving a “detailed advice!” The exact same thing you just did. The article was useful, even with its alleged flaws while your comment was plainly inconsequential!
Omair z
Jul 21, 2011 12:13am
usually QTR can be palpated?
Saqib Sohail
Jul 21, 2011 03:56am
Being more familiar with this particular case, I would say that the article omits the details about the extent of damage of the internals of the knee. Although I am not a doctor myself, I am surprised at Dr. Mansoor's brash comments without knowing the details about the case. Although, I do agree with him that your article seems to make a connection of QTR and Osteoporosis which I believe wasn't your intention. Coming back to the article, the diagram is very uninformative. Isn't there a muscular diagram that you might have come across. From your personal example, would you make the claim that kidney patients and people who suffer from Oedema should be more careful about the damage to their joints?
Dr. Umair Bajwa
Jul 21, 2011 04:54am
Being an Orthopedic Surgeon in Germany I must state that from a patients view this article is well written and understandable. I fully support the author´s view that MRI should be done on a much earlier stage concering joint problems. That is the standard procedure at least here, I don´t know how the standardized policy in Pakistan is, as I never had the chance to work there yet. Also I support the author´s point of view that a very special post-operative treatment and rehabilitation is required. It is the job of the dealing doctor (orthtopedic surgeon) to explain and accompany the patient thoroughout the healing process. Referring to Dr. Mansoors comment, certainly osteoporosis has nothing to do with QTR, but there is no need to call the whole article as inaccurate. I think what patients in Pakistan really need in general, is to be taken more serious by the doctors and to face lesser arrogant behaviour. Treat with love & handle with care ;)
Igloo
Jul 21, 2011 06:18am
Good article. Its funny how we take so many things for granted.
Hamza
Jul 21, 2011 07:37am
Interesting. I have over 20 neurofibromas and counting. I suppose I wouldn't know which one of those is a potentially damaging one for my tendons and/or ligaments.
SA
Jul 21, 2011 03:39pm
Thanks. The article is written based on well-supported practically implemented/implementable data.
SA
Jul 21, 2011 03:43pm
Yes Omair. The first check to confirm is that right above knee the area is palpable, meaning that tendon is broken and muscle is displaced upward. At the same time, patella is pulled downward, a bit.
sohail
Jul 22, 2011 03:01pm
Thanks very much doctor sahib. In fact the ruptured tendon had a few pieces of bone (obviously patellar) on its edge. That came off much prior to the happening, historically a most probably reality my particular case. The impulsive load of stepping downstairs caused the remaining tendon (with much smaller effective area) to snap off. That is why I would like to keep this aspect in mind that bone degeneration should be taken into account; it can either be osteoporosis or osteoarthritis or something like that. I must admit that oedema can also weaken the tendon but that can happen on many accounts. I do not mind Dr. Mansoor's comments. Regards.
Naila Ahmed
Jul 24, 2011 10:25pm
Very informative article. It covers possible causes, prevention and what to expect in case of QTR and its treatment and recovery in a very accessible manner.