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Author Topic: Knee flexion week 5  (Read 925 times)

Offline vap4

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Knee flexion week 5
« on: July 27, 2012, 10:07:02 AM »
I finally had my surgery on the 24th of June. Had a hamstring graft. Just had a ACL reconstruction and had some meniscus cleaned up. Doctor found a grade 2 meniscus. I've been regularly going to my PT (3 times a week since surgery). I wasn't provided with a ice machine or a CPM machine. I will be reaching the 5 week mark on Sunday and my ROM is limited to 90. My quad strength was really weak after my surgery which was expected but now I've regained most of my quad strength and am able to do 20-30 reps easy of straight leg raises with 3kg ankle weights on. I don't have much pain either but I'm just really worried about my ROM. I was expecting it to be around 120 by now. It was 95 last week and has gone down now. My OS is known round here as a sports medicine specialist, not sure if I can attribute the lack of ROM to  improper graft placement or the fact that maybe I need to change my PT. Most of the protocols I've read state that usually by the end of week 6, ROM should atleast be 135.  I have tried to find more information but I m lost. Really regretting going in for surgery now.

Offline Kaputt_Knee

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Re: Knee flexion week 5
« Reply #1 on: July 27, 2012, 11:14:18 AM »
First of all stop panicking!  ;)  ;D

Everyone is different and you had some meniscus work done as well which changes things. There is no fixed plan that each and every ACL reconstruction rehab should follow. And anyone who says there is, is talking out of their backside. I've been through this 5 times and never had an identical rehab path either in terms of the surgeon's protocol (2 of the ACLs were performed by the same surgeon), nor in my body's response to the surgery.  8)

How is the swelling in and around the knee? This can go up and down and it will always cause variation to the flex more than it does extension. A common cause of increased swelling at the stage you are at is often due over-doing the exercise regime and not elevating and icing after each period of exercise. Concentrating on regaining quad strength this early on in your rehab cycle also seems a wee bit excessive. Your graft is entering its weakest phase now in the revascularization process, this is approximately between the 6th and 12th week post surgery. As it coincides with the period that many no longer have as much pain, it is not uncommon for patients to push too hard now and mess up the graft by either rupturing it again at worst, or simply stretching it by pushing it too hard.

You do not mention anything about your extension - that is the first and most important aspect to regain. Without full extension you cannot walk without a limp. Most protocols prioritize full extension before flex. Once you are walking with a normal gait (even if you are still on crutches), the flex tends to improve quite quickly as the normal walking gait helps reduce swelling even more.

It would help people to offer advice if you say where in the world you are - I am assuming you are maybe in the UK simply because of the time you are posting, but you could just as easily be an early riser on the east coast of North America or a night owl from Oz! This is an international site which is one of the things that makes it interesting to read about all the different rehab protocols. Not everyone uses an ice machine of any kind nor a CPM, so your surgeon did not deny you access to essential tools  ;) I was just as happy with a couple of bags of frozen peas and a plastic bag on my foot to aid my efforts in polishing the wooden floors in my apartment  ;D Made the heel slides way easier. I also used it for wall slides by lying on my back on the floor and placing my foot against a wooden cupboard door, then letting the foot slowly slide down the door until I had a 90° bend then I would hold it there for about 30 seconds to get the quads engaged before sliding it back up to full extension.

Sue  :)
1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee

Offline vap4

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Re: Knee flexion week 5
« Reply #2 on: July 27, 2012, 04:49:02 PM »
I live in Dubai, used to stay in the UK. Wish I would've gone back for my surgery now. I've been off crutches and for the past two weeks but still walk with a slight limp. Not too sure about extension to be honest. My PT hasn't measured my extension so no idea.  I had normal gait and near full flexion before my surgery. My PT also has been emphasizing extension and has told me to do weighted(1kg) lying prone extension. This is extremely painful but I've been trying to push through the pain barrier in order to gain full extension. In PT I've just started using the step up board with 1kg weights and have been doing bridges to work on my hamstrings. At home I do straight leg raises with 3kg weights on. 3 sets of 20 reps each, 2-3 times a day and a exercise for my flexion whereby I lie on my side and try to bend my leg as much as I can and then apply over pressure. I also regularly roll a towel and put under my ankle and try to press the knee in order to gain full extension. My PT told me there is no real need to ice my knee but I've still been regularly icing my knee. Thank you for your reply it has really calmed me down a bit. I see my OS after 9 days. Have loads of questions to ask him. Thank you again for your help.

Offline vap4

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Re: Knee flexion week 5
« Reply #3 on: August 24, 2012, 09:11:35 PM »
Well its bein a month since I ve posted, and I m currently exactly two months post op. My flexion is just 10 degrees off from my normal leg. I finally have some visible quads. My strength is also considerably up and am back in the gym training my upper body. The main problem I'm going through is that while my acl recon leg straightens out, it does not have the same amount of extension as the strong leg. I've brought it up during my Physiotherapy sessions but my therapist jus dismisses it. I was wondering if this is normal or is this a cause for concern and I shud contact my OS. During my last meeting with my OS which was 3 weeks ago I'd also brought up the extension issue and he dismissed it, saying that while I am a few degrees off I do not need to worry and I ll eventually get there. But 3 weeks have passed and there hasn't been much of an improvement.
« Last Edit: August 24, 2012, 09:57:39 PM by vap4 »

Offline Kaputt_Knee

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Re: Knee flexion week 5
« Reply #4 on: August 25, 2012, 06:22:01 AM »
Can you walk without limping? If you can then the last couple of degrees will come gradually. Remember you are just coming up to the end of the 10th week post operation. The rehab from this procedure is a long slow haul but usually the progress is a steady upward curve. If no one else is worried about it, why are you fixated on things that are not yet important?

Your graft is at its most vulnerable from roughly 6 to 12 weeks after the operation. This is the period when, if you push too hard too soon, there is a big risk of failure or stretching. It sounds like you are getting excellent advice and rehab physio so have a little trust and faith in your carers. Just because you are in another country, does not automatically mean inferior treatment!

I understand your fears, I was also nervous when I had my recon done here in Germany. Despite speaking fluent German, I was never sure just how much my carers and I were really understanding each other, but my treatment was way better and more intensive than I could have hoped for under the good old NHS!

Sue  ;)
1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee