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QTR - a patient’s perspective

July 20, 2011

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.