Friday, March 19, 2021

Diablo Scott's Patella Fracture Recovery

This post is my legacy report for any fellow cyclist who suffers a similar injury and wants to know what the recovery is like (I did a similar post when I broke my pelvis). So for your reference, as of this writing, I'm a 61 year old cyclist in otherwise really good health and have never had any knee problems before, and this happened in January 2021.

Week 0:  I fractured my patella in a fall - not a bike crash, just tripped while walking and landed on my knee. It hurt a lot but I didn't think it was broken until the next day when I went to urgent care and the X-ray report said "comminuted fracture" which means the the pieces were separated from each other... not shattered, but more than just a crack.  I got some crutches and a leg brace and a referral to an orthopedic specialty place.  This was a work accident so it was all covered by worker's comp and it has been pretty good coverage... email me if you want to hear stories about that.

Week 1: The orthopedist said if I didn't get surgery, my kneecap might heal but it wouldn't be right and I'd have terrible arthritis in a couple years. I was kind of surprised because it felt like it was getting better already, but he talked me in to it. He understood I was a cyclist and that wouldn't want to risk ending my riding days because of a bum knee. He explained a little about what would be involved and that I'd have a pretty big scar and a slow recovery.  I was still kind of in shock and hadn't thought of any questions because I didn't think any of this would be necessary. They gave me the serious painkillers, and a more robust, hinged, knee brace; the hinge was locked out at 0° flex. From experience, I knew to take laxatives and fiber supplements because you know why... and sitting on a toilet is a complicated configuration when one leg is extended and stiff.  I got some pre-surgical blood work and an EKG done.

 (not me)

Week 2:  Surgery. They called it "Open Reduction and Internal Fixation" or ORIF... it's a common enough procedure you can just Google ORIF and read all about it. For convenience, I just told people they had to screw and glue my kneecap back together. The anesthesiologist said "nerve block" was the way to go for minimal pain so I didn't argue. So in the prep room they shaved my leg and stuck the needle in up near the top of my thigh. Next thing I knew I was waking up and I asked if I was all done and the recovery nurse said it was all over... it's weird how anesthesia takes away any sense of time passage.  My leg was all wrapped up so I couldn't see it and they said "no bathing, keep the immobilizer on and leave the bandages on for one week. Apparently it takes time for the glue and the screws to cure or something so the less you move the better the results will be.

1 Week Post Op:  I took off the wrap and the bandages - there was some bloody gauze and stuff but not awful. The staples in my knee looked like a big zipper, but the skin was healing. I had purchased a bag full of first aid supplies for this event. It was nice to be able to clean up with some of those hospital bath-wipe thingies. Then I put on some antibiotic and new gauze and stretchy tape pretty much like it was before.

2 Weeks Post Op: Back to the ortho place to have the staples removed - didn't hurt at all but I couldn't see exactly how they did it. That's pretty much all they did; said it looked normal, keep the leg immobilizer at zero bend but I could take a shower. I can drive my pickup a little bit... like around town, but wouldn't be able to make a long trip. Made another appointment for 4 weeks later... 6-weeks post-op.

4 Weeks Post Op:  I was getting really tired of not being able to bend my knee. I can put weight on my leg but it feels unstable laterally so I'm completely dependent on the crutches. Swelling is still pretty bad and I can't get comfortable, but it doesn't really hurt and I'm totally off meds, only take an ibuprofen if I wake up at night feeling sore... and I always have the ice pack on at bedtime.  I've lost a lot of muscle and my whole leg looks funky.

6 Weeks Post Op: Eight weeks on crutches... people comment on how adept I am at opening doors and going down steps.  Ortho follow up includes X-rays and the PA complimented me on following directions (to not do anything).  The screws are snug and the glue is cured and that's the best result.  They unlocked 20° of freedom in my immobilizer brace and said my goal will be to slowly achieve 90° of flex over the next four weeks. They give me appointments for four PT sessions and another follow-up appointment in four more weeks.  They also ordered me a compression sleeve to help with the swelling but said just wrapping it up with the ACE bandage is almost as good.

7 Weeks Post Op: First physical therapy. The therapist (Brittany) had me take off the brace and bandage, and then she measured my flexibility - she said I was ahead of schedule on my range of motion. Then she gave me some exercises and stretches and measured me again and I did pretty well. She said when I can do  90° I can try walking without crutches. Then she gave me some take home instructions and had me do cold therapy before I checked out. I'm definitely feeling better about all this and I can kind of see the finish line in the distance. Another PT appointment this week, then two more next week.  

At the second appointment of the week, she gave me some more exercises and put me on a machine that was almost bike-like. She was right, I couldn't quite do a whole revolution; just "half circles" but it was a nice gauge on how far I had to go and it felt pretty good too.  I just went back and forth and stretched the knee and remembered how it felt on my real bike to get out of the saddle and power around a steep switchback.

Get yours HERE

After all the new exercises she measured my flex at 80° so I'm still just a bit ahead of plan for recovery. I missed the first poppies of the year on Diablo, and next week I'll miss the March equinox ride... two more pages that will be missing in my big book of lifetime experiences.

My smartwatch keeps giving me the message "You seem to be stressed out. Let's do some meditation"

8 Weeks Post Op: Those extra stretches Brittany gave me really worked.  At today's PT she worked me for a while and then she measured me at 90° and then I got on the chair bike again and was able to do some full revolutions for the first time and boy that felt good. I'd get most of the way around and then I'd help it a bit with the hand pedals and get through it, and it got easier the more I did it.

We also measured my knee for a compression sleeve:  my good knee is 15" and my broken knee is 16" and those both are in the range for a size medium so I should be getting a medical grade one for the swelling from the insurance company, and then I used my REI dividend to order this athletic grade one which I think I'll be able to ride in and will help with my stability.

Get yours HERE.  

9 Weeks Post Op: Brittany measured 95° bend, and I did the chair bike with the longer crank setting so it was really pushing my knee at the top of the stroke. She said we're going to start working on strength exersizes next, but she doesn't want me to do too much until my 10-week follow-up with the surgeon so they can approve. I brought home a rubber band thing to add some resistance to my feeble workout. Some of the other people in the PT room were really messed up, so I thought it was my duty to be a good example and show a positive attitude.

10 Weeks Post Op: Brittany measured 100° bend on my own effort, and 102° when she put me in her torture hold. Also I could do 75 RPM on the chair bike.  Took a while to warm up but then it felt pretty good. PT Curtis said he really likes to see patients get better as well as I have been doing.  Still seems REALLY slow though... and I'm not near getting on a real bike yet.  Doctor follow-up next week - hopefully they'll give me a good review and schedule for getting back to normal... then I go to two-days per week PT after that.

12 Weeks Post Op: Follow-up at the orthopedist office on Monday, and they took a new X-ray:

Three screws in kind of an H pattern. The view on the right is from the side so there's one screw behind the other, and then the cross screw which is farther back. PA Gayle said ideally the cracks would fill in with new bone but realistically it never happens all the way.  She also said it's time to work on strength exersizes and reduce reliance on crutches and brace... but not to go too fast and not to do any "explosive exersizes"... I confirmed that meant no trampoline jumping or repelling down cliffs.

Then on Tuesday, Brittany my physical therapist gave me a whole bunch of  new exersizes to do - mostly involving leg lifts and weight-bearing motions. I also did the chair bike and got that baby up to 50 Watts and 90 RPM. For the first time, it feels like I'm really doing some muscle work rather than just stretching and range of motion type stuff. So by next week I hope to be far less reliant on my crutches and brace.

13 Weeks Post Op: Brittany and Curtis at the PT place are really working me now. They also got a new bike which is more like a spin bike -  not really intended for serious workouts, but my position and hip angle are closer to a real bike, and the leg motion is closer also, and it's easy to mount.  I could pedal pretty fast, but not with much resistance.  Then they had me doing a bunch more strengthening things and they said my swelling looks much better.  One baby step closer to normal.

14 Weeks Post Op: New PT guy Eric had me doing lots more strength exersizes, like leg lifts and squats and steps... very slowly and they HURT but it kind of feels like the right thing to do. I'm getting pretty good at walking with a single crutch when I'm wearing my brace, but without the brace it feels like my leg is a noodle waiting to bend backwards.

16 Weeks Post Op:  I'm finally to the point where I can do strength exersizes hard enough that my muscles actually get tired.  I'm much better at the step exersizes too - although they hurt. And I can't yet do all the leg extensions they want me to do - they just hurt too much.  I don't wear my brace much anymore, and sometimes I don't even need my cane... I can hobble around the house unaided, and wander around outside with just a little help.

At home, I've been riding my daughter's (step through frame) bike on the cheapo garage trainer and it feels good and I can use a decent amount of resistance; but I cannot pedal while standing - I just can't get the bad leg over the top of the stroke when I'm out of the saddle.  I think that'll be the indicator that I can ride my urban bike around the neighborhood. I haven't ridden for real for four months now.

Had another ortho appointment and she said she's very happy with range of motion and swelling and all that stuff. She said the lumpiness in my knee is partly internal stuff that will stay that way - it'll never look the same as the other knee. She took some more X-rays and gave me my walking papers.

17 Weeks Post Op:  After a few test runs of getting on and off my bike, I took my first ride since the fracture; 10km around the neighborhood, and it felt glorious. No pain at all. I have to plan my stops farther ahead though... I need to be going very slow when I plant my right foot down. I also don't think I  could handle any kind of emergency fast action like an acceleration or sharp turn to get out of trouble... so it's just the neighborhood for another few weeks at least. Regardless of all that, this was a milestone and it felt GOOD.

18 Weeks Post Op:  I've been riding my commuter fixie about 10k every day. I still can't get out of the saddle, but I can push kind of hard once in a while with the bad knee. I got some wider comfier tires for him but haven't put them on yet; when I go over bumps I get a very uncomfortable jolt to the kneecap. The PT folks have been giving me some unusual and difficult balance exersizes, like standing on an uneven lumpy thing while I shift my weight around and bend over.  Also they have me doing enough exertion type exersizes that I feel like I'm actually getting a workout. The step-ups and the straight leg lifts still really hurt though.

20 Weeks Post Op:  This week I tried riding Diablo - pain and weakness prevented me from doing the full ride but it felt OK and it was nice to have a new accomplishment.  I practiced a bit with my SPD cleats and road bike around the neighborhood and then drove to The Mountain and made it to The Washout. I suspect at my next follow-up they'll tell me PT has done as much as they can and I should just self-therapize from now on.  One thing the PT folks do is attach the "e-stimulator) to my leg and watch my muscles twitch as I do leg lefts... strange feeling.  Swelling is under control, muscle is coming back, flexibility is not there but doesn't stop me from much. Pain is tolerable and riding is fun but a little scary. 

Healthy knee (L) and healing knee (R)


  • Here's a report from a guy who had a similar (but worse) injury and surgery to mine, and he did a 200km event 15 weeks post surgery, and went on to do Paris-Brest-Paris.  I do need to have some kind of "I'm back" challenge to achieve.


Did you know Phillipe Gilbert broke his kneecap in a Tour de France stage? Finished the stage but dropped out the next day.

  •  His legs (left) look amazingly like mine! (right):

  • ________________________________________________________ 
    Update September 2023 - 2-1/2 years after surgery.

Still lumpy and crunchy and somewhat unstable, but it doesn't hurt very much very often. This is probably as normal as I'm gonna get.

Thursday, March 11, 2021

Scott's Patella Fracture Update

Today is 8 weeks since the accident, and 6 weeks since the surgery. I've been in a leg immobilizer for that whole time, locked into full extension; my knee hasn't bent at all in 8 weeks. Also losing muscle and it looks pretty funky.

Yes... that is straight.

Today at my follow up appointment they took some Xrays and congratulated me for following their instructions to not bend my knee and it worked because the screws and bondo are all holding everything into place. I didn't get a copy of the Xray but I saw it and it looks like they got three screws in there. Then she (PA) unlocked 10 degrees of freedom in my brace so now I can bend my knee 10 degrees and she said I should do lots of little bends and work my way up to 20 degrees by next week. She thinks I can be at 90 degrees in another month... A MONTH!

That's a lot longer than I was anticipating going into this, but in the long term it's better to do it right than do it fast. I'll project my next Junction ride will be before the end of April... jeez that sounds forever. Maybe I'll have a COVID vaccine by then too.

Snow on Diablo, and I'm enjoying it vicariously through my Strava friends.  OK, that was getting close to feeling pity for myself... no more of that.

Thanks Linda