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ACL and Meniscal Repair 1 year post op complications

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Hi everyone,

I'm 21 and I tore my left acl and meniscus skiing at the end of december 2010, and subsequently had surgery the following march. I had a meniscus repair as well as the acl reconstruction so rather than walking straight away I had to spend around 6 weeks on crutches. Admittedly I was not the best about using my crutches and probably stressed my knee too much around the 3 week mark, but I came off them at 6 weeks and started with physio a couple weeks later.

About a month into my physio I started developing a clicking in the medial side of the front of my knee. It feels like it's just in behind my knee cap on the right side. It cracks every time when I straighten my knee especially when I'm trying to contract it with force.

My knee has also been swollen and stiff ever since surgery, and is noticeably more so than my right normal knee. The swelling really inflames when I walk around to class during the day and makes me limp if it's especially bad. When I bike though, it seems that the swelling possibly decreases, and all the stiffness goes away.

Another complaint that I have is that I cannot contract my hamstring enough to pull my foot back near the range of motion that i have with my other knee. If i am to contract it my knee comes back just past 90 degrees where as my other leg can contract much further.

I've started to do more stretching and rolling out my muscles. It felt better when I was first starting to the stretches and rolling but now I feel the stiffness in my knee back. I've been to see my OS a few times, but he just keeps saying everything is fine and to keep doing physio. I haven't really noticed any improvement in months with physio and I'm looking for a second opinion now. This is a constant source of stress for me so any wisdom anyone here can impart on me is greatly appreciated.
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First Helper MonicaLO
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replied February 17th, 2012
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TrevorB,

ACL reconstructions are a big insult to the knee. Unfortunately, they are often billed as a procedure that can be done through the 'scope, and that it will fix the knee right up. Problem is, it is actually the rare patient who has an ACL reconstructed and goes back to full activities without any problems.

The vast majority of ACL patients have some type of post-op problem: be it decreased range of motion, swelling, chronic pain, continued instability, whatever.

It is not uncommon for pro athletes to take a couple of years to come back from an ACL injury. And they have full staffs at their disposal for rehabilitation. Also, when they do come back, it is not uncommon for them to have the knee shot up with marcaine (long acting local anesthetic), and other things, for games.



While in most cases, the soft tissues will be healed and the scar tissue matured by about a year to 18 months, some patients continue to have an inflammatory type reaction going on in the knee for a couple years or more.


In terms of range of motion, by this time, what you have is probably what you have. You might increase your flexion some, if the current endpoint is soft and rubbery. But, if the endpoint is solid and hard, you probably won't get any more significant amount of increase in flexion. But, you can, and should, continue to stretch and work on flexing the knee.


As to the clicking, it could be from a few different sources. Two of the most common are a Cyclops lesion. This is a problem after 'scope surgeries, where a ball of scar tissue forms within the synovial lining and can get caught between the patella (kneecap) and the femur, or within the actual knee joint.

The other is a recurrent tear or a failure of the mesicus to heal. You could have a persistent cartilage tear that is clicking with motion.



As to the swelling and inflammation, that will some times respond to nonsteroidal antiinflammatory medicines. But, they have to be taken in prescription dosages, regularly, for a long time. They don't work on an as needed basis.

If the inflammation is really significant, on very rare occasion, an injection of cortisone will be tried. However, the use of cortisone in knees with normal or near normal articular cartilage has to be done very cautiously and infrequently.


Sometimes, if a patient does not get full range of motion hack, the surgeon may have to do a lysis of adhesion. However, if you have a range of motion of zero to 90 degrees, that is considered functional, so most surgeons would be hard pressed to try any surgical procedures to increase motion.


It sounds like you need to see your surgeon, but not let him/her just tell you everything is going fine. You need to try to make him/her see that you are not happy with the results, and is there anything that can be done?

You are getting to the point where further physical therapy may not be of much help, so now is the time to ask, if anything can be done.


Good luck. Hope that your knee does get better.
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replied February 17th, 2012
Thank you so much for your quick reply Gaelic,

It is relieving to hear that my case is not necessarily abnormal. The doctor has said that my swelling seems to be caused by some cartilage damage and advised me last month that I was not yet ready to start running.

As for the clicking, if it was a meniscal tear would I not have constant pain with it? I definitely won't rule it out though since my meniscus was badly damaged, they had to use 4 sutures to repair it, and through the first couple months i reaggravated it with my knee swelling extensively as a result. Once I warm up on the bike it seems to click less. One possible reason my physio gave me was an imbalance between the muscles of my hamstring and my quads and the bone either being pulled back or forward causing the clicking.

My range of motion is fine when I'm not contracting my hamstring. Stretching i can bring my foot all the way up to my butt. Its when I'm contracting using my muscle it can't go as far as my right leg but looking at it now it probably goes to 110-120. The thing that irritates me about my hamstring is that when i contract it with resistance for say ball curls (lay on back curl exercise ball towards butt) there is always aching pain near the tip of my hamstring regardless of whether i've been biking or not. After a while it goes away though.


Would you recommend trying to get an MRI? From what I understand it would be able to see whether my meniscus repair was successful, be able to tell if there is a tear in the cartilage etc. So rather than the doctor hypothesize on what is wrong from my swelling he can see it for sure? I live in canada so I assume it would be provided under public healthcare but would take a while to get.
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replied February 18th, 2012
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TrevorB,

Meniscal tears are not always painful. Remember that the mesicus has no nerve fibers in it. The pain is usually coming from some other source, that the tear is irritating.

If the clicking seems to be under the patella, on the front of the knee, you might have that Cylcops lesion I mentioned earlier. They are fairly common after ACL reconstructions.


As to the MRI, by 14 months, it may be possible to tell if the meniscus is torn. With the MRI, it is sometimes hard to tell the difference between a tear and scar tissue (healed meniscus). Sometimes the radiologist will have to use a gadolinium arthrogram (injected into the joint), or IV, to be able to tell the difference. Early on, it is real hard to tell, but again, by 14 months, the radiologist should be able to.


If it really hard to get the muscle balance back. The quads are fairly easy to work on, so it is usually the hams that get neglected. Again, with time and dedicated work on them, you should be able to regain the strength and balance.


You might inquire as to the MRI, it should be able to give you the information you need by now. Keep working, you are not alone, your course is actually fairly common after complicated ACL reconstructions. Hang in there.

Good luck.
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replied June 7th, 2013
Hello, I had ACL reconstruction in November. I am still having pain but this is from stiffness. Every morning I get up and cannot straighten my leg. I cannot get my leg to go fully straight. Most of the pain is the back of my leg and it clicks alot also. Been to see the surgeon who says it is fine and to carry on with physio. Doesn't seem to be getting any better!
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replied July 4th, 2013
Hi
I had an ACL reconstruction using an allograft and meniscus repair in March 2013 in the UK following a ski accident. It is now July and I'm still having pain. I have not yet got full range of motion - not fully hyper extended or leg bent. I get quite a lot of pain when in extension - all behind the knee. Is this still normal after 4 months? I also get a lot of clicking through the knee but I have been told by my surgeon and physio that this is very normal. I attended physio orginally twice a week - now once a fortnight through the NHS. Gym work done so far, cycling, cross trainer, step ups, leg weights, but not quite running yet. Again, is this normal? I feel like it is never going to get better!
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replied July 5th, 2013
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KNGL,

While it is not "normal" to have these symptoms after and ACL reconstruction, unfortunately, they are common.

The "ideal" situation is for the patient is to regain a fully functioning knee, after an ACL reconstruction. Unfortunately, that is not the usual case. If you talk to post-op ACL patients, most of them have knee pain and other problems. An ACL reconstruction is not a panacea. It is not the "wonderful" procedure to make the knee back the way it was. And, again unfortunately, the surgeons will only tell you the good aspects about the surgery, and sort of skip over the potentially bad things that can happen.

The professional athletes who have this procedure, have the money to pay for a staff of therapists and trainers to work with them from day one, until they are back to playing condition.

So, all you can do is continue to work in the gym and see how things go. Sorry you are having so many problems after your ACL reconstruction.

If it just does not get any better, see your surgeon again.

Good luck.
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replied July 19th, 2013
post acl surgery complication
Hi there! I had acl reconstruction 2 years ago and my knee has been great ever since. hamstring graph. Just yesterday I was pushing some dirt around with a shovel, not very strenuous and i came across a weird feeling. I went to straighten my leg which was twisted slightly and it felt as if the was something in the way below my knee cap on the front of my knee. I straightened my foot and tried straightening again. still not right i hopped to flat ground and had a sit. after a 20 minutes of rest and massage I could straighten my knee but was uncomfortable. there wasn't much swelling until the next day. What is happening to me?
a walk-in clinic doctor thought that it could have been some connective tissue from the surgery that could have torn.
id love to hear some opinions.

matt
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replied July 30th, 2013
HI,

I am 2 weeks removed from surgery to repair my medial meniscus, remove a tear from my lateral meniscus, and reconstruct my ACL. I am aware that weight bearing should not occur for about 4-6 weeks, but I had a crutch slip away from me and instinctively took 2 steps on my recovering knee. Did I in any way re-injure, or ruin the healing process of my knee? Thank you for the help.
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replied September 21st, 2013
4 weeks in surgery and still use both crutches. The injured leg wobbles and cannot take the weight. Am doing physio, but it is depressing and so demotivating when I see little or no results. Questions like, will I ever get better just keep popping up.Are these things normal?
Sometimes I feel like the injured part is still not healed, although the surgeon said there is no issue with the new ACL. Just need supporting words.
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replied March 4th, 2014
Hello!!! I had my acl and miniscus surgery 6 months back by hamstring.....my doc told me to discontinue the pt after 1 month of surgery. The problem is after 6 mnths still i cant run as i use to, b4 my surgery.....since last 5 months i only use to walk ...and that also not regularly...when is use squat full with my hip on the touching on the ground some pain occurs for 5 6 secounds below my knee that is back of my knee. Is it normal!?....how much time i will take to run again!m
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replied March 20th, 2014
Pain after surgery
Hi, I'm relieved to hear there is still pain after surgery. I had ACL and Meniscus (partial removal) surgery Dec 0th 2013, 3+ months later, can't fully extend without pain in the back of my knee which only started a month ago; pain in the front (fat pad area) and general ache in the joint, no help from surgeon, no one knows what to do with pain. THey did an MRI and everything looks ok, but there is "fluid" under the knee cap and I have a Bakers Cyst --with this is there any thing to do--what about acupuncture, cupping, ?? I'll do anything to feel better. (Also tore LCL 2 degree; mcl 3 degree).
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replied September 17th, 2014
Hi MOnica,

How are you doing with your recovery ? I am having knee reco and meniscus removal next week. I am 43 and very worry. I am wondering how you are going now ?

Cheers
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replied March 20th, 2014
Hi, I'm relieved to hear there is still pain after surgery. I had ACL and Meniscus (partial removal) surgery Dec 0th 2013, 3+ months later, can't fully extend without pain in the back of my knee which only started a month ago; pain in the front (fat pad area) and general ache in the joint, no help from surgeon, no one knows what to do with pain. THey did an MRI and everything looks ok, but there is "fluid" under the knee cap and I have a Bakers Cyst --with this is there any thing to do--what about acupuncture, cupping, ?? I'll do anything to feel better. (Also tore LCL 2 degree; mcl 3 degree).
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replied March 20th, 2014
Hi, I'm relieved to hear there is still pain after surgery. I had ACL and Meniscus (partial removal) surgery Dec 0th 2013, 3+ months later, can't fully extend without pain in the back of my knee which only started a month ago; pain in the front (fat pad area) and general ache in the joint, no help from surgeon, no one knows what to do with pain. THey did an MRI and everything looks ok, but there is "fluid" under the knee cap and I have a Bakers Cyst --with this is there any thing to do--what about acupuncture, cupping, ?? I'll do anything to feel better. (Also tore LCL 2 degree; mcl 3 degree).
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