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Discomfort behind kneecap 3 months after ACL reconstruction.

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June 16th, 2011
I am 20 years old and ACL reconstruction and partial meniscus removal surgery in mid-March using my patella tendon graft. I am now 3 months post op and when I do body squats or partial 1 legged squats with my surgically repaired leg, I feel a discomfort and possibly pain behind my kneecap that prevents me from going any lower. This only occurs when I do standing exercises. Leg presses and bike are no problem. My confusion arises when I go to my PT sessions and warmup my quad/hams with the bike/treadmill, it doesn't hurt as much and I am able to do everything the PT asks me to. But when I am at home and decide to do body squats or 1 legged partial squats, I am not able to go as low as I go during PT because the discomfort becomes more apparent.

I was wondering if this is normal for ACL surgery patients 3 months post op or have I stretched/tore the new graft? Also, how can I tell if I have stretched my graft or tore it? Will I feel the same pain as I did when I originally tore my ACL or will I not notice since the graft is still dead tissue at this point? My ultimate goal is to get back to playing basketball at 100% which is how I tore my ACL in the first place.

Thank You
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Gaelic
replied June 17th, 2011
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RQ99,

Squats place an extreme amount of pressure on the back side of the patella. The vector forces when doing squats, puts almost all of the stress directly back against the femur. They are usually not recommended in anyone with a knee problem, and no one should ever go past ninety degrees.

Retropatellar pain is common in almost all ACL reconstructions, but more so is ones that use a B-T-B graft. Though the patellar cartilage is not violated in taking the graft, for some reason, retropatellar pain is common.

If the graft was loose, or if you tore the graft, you would have symptoms of laxity. The knee would shift in the anterior-posterior direction. It doesn't sound like you have that problem. When you see your PT you can have him/her check the knee for stability.


Retropatellar pain is very common in the human population, not just in people who have had their ACL's reconstructed. So, it is something that you will probably have to learn to deal with throughout your life.

Tell your PT so he/she can develop a strengthening program that doesn't involve so many squats.

Keep up the good work, it takes a concerted effort to get back after a significant injury. But, you have a goal to work for. Good luck.
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