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Victor Martinez the Road to Recovery

(Victor Martinez consented for the use of photos and medical history by Muscular Development Magazine)

I know that Victor Martinez has many memorable experiences to look back upon. These likely include his overall victory at the 2000 NPC National Championships, his victory at the Night of Champions in 2003, and his amazing 2007 competition season. However, the images of Wednesday, January 16th2008 will always be vivid in the mind of Victor Martinez. On that day, while warming up with lunges, Victor felt a pop and subsequent excruciating pain in his left knee. He immediately fell to the floor and watched the 2008 Arnold Classic trophy slip through his fingers. While preparing for what most thought would be a dominating season in 2008, the soreness and pain of everyday training became a life-altering injury.

Although he was unable to stand on the left, Victor used his awesome strength in his right leg to carry him to his car and drive to the emergency room. At this visit, he was given a knee immobilizer and pain medicine. He was then informed to follow-up with a knee specialist. Victor found The Hospital for Special Surgery (H.S.S.) in Manhattan. Ranked by U.S. News and World Report as the best orthopaedic hospital in the country, Victor found the right orthopaedic surgeon for the job. On Thursday, January 17th he went for a consult with Dr. Russell F. Warren. Dr. Warren is a Professor of Orthopaedic Surgery at Weill Medical College of Cornell University and H.S.S. He is the team physician for the Super-Bowl bound New York Giants. Victor made the right choice, as Dr. Warren is a very successful surgeon with meticulous technique. I have “scrubbed-in” with Dr. Warren on sports cases as a Fellow at H.S.S. and his years of experience are invaluable.

Victor hobbled into the office on Thursday morning with the aide of his friend and trainer Victor Munoz (www.pro-edge.net).

I must admit it was quite a comedy to have 3 Victor’s in one room. We came up with new names: “Big-Vic” (Victor Martinez), “Victor-M” (Munoz), and “Dr. Vic”.

First, Victor went for x-rays of his knee. This was difficult because it meant removal of the immobilizer and positioning to take the pictures. It was evident at this time that his injury was quite severe. Most notable was his large knee joint effusion (fluid in the knee). Next, Dr. Warren and I examined Victor’s knee. It was clear that his extensor mechanism was disrupted and he had an inability to extend his knee. Luckily, his knee had a stable ligament examination and did not show signs of dislocation. After the physical examination we reviewed the x-rays. At this point the diagnosis was verified. Victor Martinez had an Acute Patellar Tendon Rupture.

Rupture of the patellar tendon is a relatively infrequent injury and is probably less frequent than rupture of the quadriceps tendon. The vast majority of these injuries are unilateral. Cases of bilateral ruptures have been described in association with systemic disease states such as diabetes, lupus, chronic renal failure, and chronic corticosteroid use. Although use of derivatives of testosterone or of 19-nor-testosterone has been implicated in numerous case reports of bilateral quadriceps tendon ruptures, there are very few reports implicating these anabolic steroids in patellar tendon ruptures.

Technically, the term “patellar tendon” is a misnomer, since the “tendon” is actually a ligament connecting one bone (the patella) to another (the tibia). During active knee extension, forces generated in the quadriceps muscles are transferred in a convergent fashion via the patellar tendon and retinacula to the proximal tibia. The greatest forces in the tendon occur with the knee at approximately 60 degrees of knee flexion. Because of its arrangement of collagen fibers the patellar tendon most commonly ruptures near its proximal insertion site, rather than in its midsubstance. The patellar tendon is very strong and some scientists suggest that it takes forces over 15 times that of bodyweight to rupture a healthy tendon. Of note, the force generated while ascending stairs is believed to be approximately 3.2 times bodyweight. However, in chronic disease states or patients with a history of tendon degeneration (chronic patellar tendonitis) the tendon may rupture under much less stress. An MRI can be useful to assess the degree of tendon degeneration prior to surgery.

Restoration of the extensor mechanism is required for optimal return of function after a complete patellar tendon rupture. Non-operative treatment is ineffective. This applies to the athlete as well as the non-athlete, regardless of age. Surgical repair should be performed as soon after the injury as possible. The best results are obtained if repair is done within 2 weeks of injury. Persistent atrophy and loss of knee flexion are the most common complications of this injury. To overcome this, an aggressive postoperative rehabilitation program emphasizing early range-of-motion and quadriceps strengthening exercises is recommended. If stiffness occurs, manipulation of the knee under anesthesia may be considered at about 8 weeks postoperatively. Otherwise, the risks of any knee surgery apply: infection, blood clots, medical and anesthetic risks.

The rehabilitation from this injury is extensive and varies from patient to patient. In general, it begins with toe-touch weight-bearing with crutches in a brace locked in extension. Patients come out of this brace a few times per day to apply a continuous passive motion (CPM) machine. The CPM flexion angle is gradually increased over a 6 week period to obtain full motion. Then the patient begins gradual strengthening and progress toward full weight-bearing out of the brace. At 12-16 weeks resistance exercises are advanced. Return to full activity after this injury may take up to 6 months. Return to full athletic activities should not be allowed until the patient demonstrates full range of motion of the knee and 85% to 90% of the strength of the contra-lateral extremity on iso-kinetic strength testing.

All of that being said. Victor had his MRI and went to the operating room on Friday, January 18th. Victor arrived at the hospital once again with Victor Munoz. He had a positive outlook the entire time. As a patient he was friendly and respectful. All of the nursing, anesthesia, and OR staff remarked that he was such a pleasant patient. The first part of the process was to obtain intra-venous access. Next, his left leg was fitted for a custom knee brace. Then in preparation for the operating room his knee was shaved and scrubbed clean. After all this and a long day of waiting, Victor was starving and wanted food! But, no eating or drinking prior to surgery!

Victor went back to the operating room and combined spinal epidural anesthesia was performed with sedation. Victor slept most of the time and was very comfortable. Dr. Warren performed the surgery. We found a complete rupture of the patellar tendon. The tendon was repaired without need for augmentation with graft. Victor awoke from sedation without difficulty and he went to the recovery room. He was very comfortable and even had his sense of humor back! (hammin’ it up with my fiancĂ©e Jennifer)

Victor has a mountain of rehabilitation to climb. His CPM has already begun and he is on the road to recovery. He is a champion through-n-through and will fight to get back on the world stage. Let us all wish him the best of luck in the coming months and show him the amazing support of Team MD.

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