Regaining ROM years after surgery?

[tjand72]

I had a lateral meniscal transplant 8 years ago while in high school.  Being young and dumb, I slacked off on my post-op rehab and now have a flexion of maybe 105^o and extension of about 10^o or so.

As far as flexion goes, there is obviously pressure in the knee at my max flexion.  I assume that this is normal.  As for the extension, however, there is no physical discomfort, but I can't even get 0^o when pushing on my knee while it is extended on the floor.  It simply won't go any farther.

Is there anything I can do to increase my ROM so long after surgery, or am I stuck with this ROM since I was a slacker years ago?

[tanyap]

I wasnt a slacker but I could never get a high flexion measurement after my surgery 20 years ago - extension was fine - but in flexion i felt like i was 'pulling' on things and it was too sore. However - over time I did manage to get full ROM back - I just kept at it - I think flexion is easier to get back later as its tight structures that prevent it and over time you can slowly stretch those structures (i used to kneel on the bed and with bum to heels lie my upper body backwards til i could lie right back - took a good while!!).

extension I cant answer - but presumably some progress could be made?

[Jaci]

Hello,

At 8 years post-op it's highly unlikely that you'll be gaining ROM on your own, especially extension. It's very possible that you have some scar tissue (a common problem after surgery like meniscal transplant) and tissues surrounding your knee have tightened up (contracture)-- neither of which you are likely resolve on your own at this point. It's possible that PT would have helped some at the early stages of recovery from your surgery, but the longer scar tissue remains in the knee and the longer your motion is limited then the greater the chance that you have changes to the tissue structure. You want to avoid forceful PT, since it could result in damage to articular cartilage or other structures due to increased compressive forces from limited ROM. 

Did you have any post-op followup with the doctor who did your surgery? At the time what did your OS say about your ROM limits?

Chances are you had limited ROM at some earlier point post op, such as within the first 6-12 months- post-op. If so, excess scar tissue is a very likely a culprit. Excess scar tissue is a condition called arthrofibrosis. Here's a link to a section called the Community Hub, you'll be able to find additional info from there, including: guided learning (tutorial written by one of the top experts on arthrofibrosis), literature review (interpretations of medical journal articles), and links to postings on the bulletin board.

http://www.kneeguru.co.uk/KNEEnotes/node/632

If this link doesn't work-- Look for "Community Hub" in the upper right-hand corner of this page. Click on it. Then look for "Key notes" in the index along the right-hand side of the page-- click on Arthrofibrosis.

Probably time to make an appointment with a good OS, preferrably a knee specialist who has significant experience with scar tissue.

Best wishes,

Jaci