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I had surgery yesterday to repair a ruptured quadriceps tendon. I'm in a special brace that holds my knee in some flexion but I was told by my surgeon that I could put as much weight on it as I want to. Now I'm seeing the hospitalist before being discharged and being told not to put any weight on it at home over the weekend until my physician sees me next week. Whose orders do I follow?

There are different ways to repair a complete quadriceps tendon rupture. The surgeon may use drill holes, screws, sutures, suture anchors, or wires to reattach the tendon to the bone. It all depends on the location of the rupture, the condition of the tissues, and the extent of damage. It may be necessary to reinforce the defective tendon, especially if the patient is older with obvious signs of tissue degeneration. The leg is protected in a brace or cast that holds the knee in 30 degrees of flexion. That means the patient can't straighten the knee all the way. This position allows the tendon to heal without any pulling on the fixation site from the muscle contracting. After surgery, patients may begin walking on the leg right away. That's a fairly new approach based on studies that show early mobilization actually helps tendons heal. Some surgeons tell their patients to put full weight on the leg. Others recommend only partial weight-bearing for the first six weeks and then progress to full weight. A follow-up look at patients who have a repair or reconstruction of tendon ruptures can develop problems. Some patients don't get their full motion (extension) back. That means they won't have full strength or full function of that knee and leg. Even those who do get their full motion back don't get full strength. In fact, studies show that half of all repaired quadriceps tendon ruptures result in quadriceps muscle weakness even years later. Rerupture of the tendon is always a concern. There are some early studies that suggest that early motion with some tension on the healing tendon tissue may stimulate faster recovery with better results. There haven't been enough comparison studies done yet to show clearly which approach works best. You may want to double check with the hospitalist about this point. If necessary, ask him or her to clarify your surgeon's orders and intentions for you before going home.

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