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Author Topic: Knee tightness - ACL and meniscus treatment.  (Read 1822 times)

Offline williamjamesmorgan

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Knee tightness - ACL and meniscus treatment.
« on: July 20, 2011, 11:47:33 AM »
Hi guys, my name's Will and I have been browsing the forums looking at all the info on here and thought that I would post a topic regarding my own treatment and experience, while asking a question at the same time.
5 years ago I ruptured my ACL (left knee) and had replacement surgery with a hamstring graft. There were complications with infection, resulting in my knee getting drained, but all-in-all it was a successful op. At the time, I was young, 16/17 and in hindsight I know that I could have done more with my physical therapy treatment, something with I now regret. A year after that I went in for a meniscus trim in the same knee because of clicking and locking.

Fast forward to present day... 17 weeks ago I twisted my 'injured' knee again and caused some damage to the lateral meniscus, which has since been treated through arthroscopy and I am 5 weeks post-op today. Range of motion has returned to how it was before, but because I have become a lot more 'aware' of my knee and general knee health lately, I have begun to question just how good the state of my knee really is.
Thinking back (before my most recent meniscus surgery 5 weeks ago), I realise that my flexion ROM never quite returned to normal since having the ACL replacement, and I could never easily get my heel to my buttock. I am now a lot more aware of this fact. I am not 100% sure as to what a good knee should be like with regard to flexion, but I use my 'good' knee as a guide. Now, passively, I can get my left knee to 137 degrees and my 'good' knee to 145 degrees (from a seated position on the floor). Is this a relatively good result?
Additionally, when flexing the leg on my own, i.e. without assistance, both legs appear to flex the same amount, with perhaps a degree of two more in the good knee.


My main concern comes when I aim to sit back on my heels from a kneeling position. When I attempt this my left knee begins to feel very tight and I experience pain within the knee as if there is a build up of pressure - and so I have to stop. I'm worried that there may be scar tissue from my previous ACL injury or whether my ROM seems okay to you guys?
Does scar tissue or Arthrofibrosis get worse over time? I am a natural competitive body-builder and have reletively strong thighs/leg muscles and I'm very active on a day to day basis. The knee feels strong and secure, but losing any more ROM is something that I can't afford to happen.

Any thoughts would be much appreciated,

Will.

Juneau

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Re: Knee tightness - ACL and meniscus treatment.
« Reply #1 on: July 20, 2011, 10:36:58 PM »
Will,
It's probably pretty common to have some scarring in a knee that has had undergone multiple surgeries. If it's extension loss, it would definitely limit your functional level but a small amount of flexion loss is probably not that big a deal. Being able to do all the sports you like pain free and having a flexion of 137 sounds pretty good to me. If your knee does not get inflamed and hot with your activities there is not that much risk that you have Arthrofibrosis and that the scarring will get worse.

If you want to work on improving your flexion you could try to stretch it carefully and see if it improves. The secret is to not push beyond the point of pain so that the knee does not get aggravated.

One of the individuals (dstarz) with severe AF has done Yoga and used a supplement called Vitalzym and has seen significant improvements in ROM. Here is a link to one of the posts that describes that experience.
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=56535.0

Some of the other people have used a a combination of 3 supplements including Glutamine. Here is a post by Don Draper that describes the supplements he has been using. I also remember reading somewhere that Glutamine is used by bodybuilders.
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=52590.45

You might also consider using a stationary bike to get your knee warmed up well before you do any serious stretching. Biking at low resistance helps with lubrication of the knee.

Good luck

Offline missmyknee

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Re: Knee tightness - ACL and meniscus treatment.
« Reply #2 on: July 20, 2011, 11:28:45 PM »
Hi William

What does your doctor say about this?  137 for flexion is pretty good , but ideally it should be equal with the good leg. However , your leg has been used to 137 for the past 5 yrs , since your aclr.  What is your extension ? Extension is the more important measure with regards to ROM. It should be at least 0 and preferably a few degrees in hyperextension....equal to the other leg.  Is your patella mobile ?  With your leg out in extension, can you move your patella freely in all planes? If you are lacking a freely moving patella, there could be scar tissue preventing it from moving or tissue on the sides that have contracted, which can affect your flexion.  Same for extension, there can be scar tissue preventing full extension. The way your graft was done can also make a difference in ROM...the placement and tension.  Also, you are still only 5 weeks out from you menicus surgery. Is it the same meniscus that was trimmed before? What was done there ? Was it trimmed , removed, repaired.......

Here is a link to the arthrofibrosis section in the Information Hub. Start with Dr Noyes tutorial, read thru esp where he talks about ROM. Then read thru the other sections in the link. knowledge of arthrofibrosis or AF for short, allows you to ask appropriate questions and make informed decisions about your knee.

http://www.kneeguru.co.uk/KNEEnotes/node/2355
and
http://www.kneeguru.co.uk/KNEEnotes/node/632

Are you still in PT ? Even though you are a body builder, You might not be doing proper exercises that just isolate for flexion.

Over time scar tissue becomes stiff, less pliable and somewhat hardened depeneding on place.

Pam
« Last Edit: February 28, 2013, 10:38:25 PM by The KNEEguru, Reason: Links updates by KNEEguru. »
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

 















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