Full knee extension after ACL surgery?

[sahibvirk]

Tomorrow I will be 5 weeks post op from my ACL reconstruction surgery using hamstring tendon.

My flexion is good but I am having  problem with extension. I can extend my knee till 0 degrees but have not yet achieved that -5 degree extension or as much as my normal leg can extend.

I have read it on many websites that full extension is very critical to healing. At one site I read that if it is not achieved in one month then it can neve be achieved. Somewhere else I read that after 6 weeks it is very difficult to achieve it. I m very much in fear due to this. But my phisio seems to take things very easy.

Q1. But my first question is that does full knee extension (that I keep on reading about everywhere) mean that  0 degree extension that I have already achieved or does it mean that negative extension of -5 degrees that I have not yet achieved?

Q2. And if it means that -5 degree extension then is there any chance that I might still be able to achieve it since the websites say it is difficult to achieve at later stages?

Q3. Last question is that is it okay to be changing your phisio just 5 weeks post op?
Please Help!

[cbrmedic]

what your extension on your good leg? not everyone has hyperextension. even close to 0 degree, you can still walk normally, from my experience extension is hardest to achieve 

[sahibvirk]

well I definitely have hyperextension
of about 5 degrees
n my operated leg is 5 degree short of that
what do u say, can i still avhievw that missing 5 degrees

[Kaputt_Knee]

Full extension is 0° anything more is a bonus. Your knee has been reconstructed and is no longer exactly as it was before.

Sorry but you are only 5 weeks out. I think you are being unrealistic in your expectations. A lot of people do not get full extension in that time, so your current physiotherapy regime is working well.

With full extension you can now walk normally without a limp. This helps in the entire bio-mechanical feedback system and you can start to concentrate on regaining flex. That also may not match your other natural knee.

Rehab from an ACL reconstruction is a marathon and certainly not a sprint. You've done well so far, so don't mess it up by being impatient and/or unrealistic.

I have started to get some hyper-extension in my left knee but it has taken me nearly 3.5 years since my revision. In my other leg I have gained a little over the years. It came very gradually as I returned to my sports.

That's my 2 cents worth. Having been here a while now, I've come across impatient patients before. If they remain impatient, they usually turn up again with more problems!


Sue

[Rennschnecke]

A1.  People use 'full extension' to mean different things.  For some it is 0 degrees that you already have; for others it is extension matching your unaffected leg so that you will walk evenly.  I found that even a small deficit of a few degrees affects my gait. and I gave up running as it was really a fast limp, but I also had other complications which indicated stopping running, so it's an unknown whether it would have improved over more time.

A2.  Whether you can get the deficit back later depends on why you have the deficit.  If it is due to lack of quad strength then it is likely to come back as you get stronger.  If it is due to shortening of soft tissue then it may also return with stretching.  If it is due to structural factors, e.g. positioning of the graft, then it may not come back.

A3.  I think you should give your physio a chance.  Are you generally progressing?  At 5 weeks it is still early days on a 6 month recovery programme.

If your physio is not too worried but you are, have a good talk with them.  I would only be concerned if they are not checking your (hyper)extension at every session and working on it as well as giving you things to work on to get even extension.  As Sue says, once your knee has been operated on it is no longer the same.  There will be some scarring within the soft tissues of the knee and no matter how good the surgeon the placement of the graft will not be exactly the same.  Also bear in mind that your surgeon has to anticipate how your own tissues will respond over time.  They tighten the graft in OR so can check tension on the day, but they have to guess how your body responds and what the tension is likely to be like in 6 months or longer.  Sometimes grafts can loosen up.

Just keep plugging away at the rehab!