I'm hoping someone can give me some insight into the issues I am having with my knee injury.  On June 2nd, I fell and dislocated my knee joint resulting in a ruptured ACL LCL and IT Band and tears to the PCL and MCL.  I had Posterolateral Corner Repair 10 days later on June 12th.  I was in a fully locked ROM brace for 6 weeks post op.  The brace has been unlocked to allow 90 degrees but I am barely able to get 15 - 20 degrees.  It doesn't matter how hard I try, I just can't get it past this.  Running out of ideas as to what to do next.  Really hope someone can help.  Thanks, Raewyn, NZ

Hi,

I also had a PLC reconstruction and was locked in full extension for a while. Fortunately I was given special passive manual therapy by my physio and we gradually restored my flex. If you have had no physio for 6 weeks it will take time to restore the bending capacity. Be guided by your physio and do not try and push it yourself as you will only end up frustrated and then look through the internet for "reasons" why you have a limited bend.

A trick my PT guy gave me was to put my foot in a plastic bag (while sitting) and slowly, but constantly slide the foot back and forth while sitting in a chair. I also used the same trick to let gravity do the work by lying on my back with my feet resting against the wall (or a door). I then let gravity slowly but surely pull my foot down. With both tricks I never overloaded or actively bent the knee, nor was the foot ever without support.

Don't give up it will come back. Initially it will be painful to actively bend the knee but as it becomes accustomed to the flexing, the pain does subside. But if you still have other damage in there, it could be that you have a physical blockage in there which your doctors should address.

Good luck, you are in for a long haul but it does get better. Set your targets to lower easily reached and achievable ones such as improving the flex by 5 or 10° in a week. Using long term goals only leaves you worried and desperate and in the long run have a negative impact on your recovery because it does take so much longer than the doctors first tell you.

Sue 

I slipped on black ice and then had to teach skiing for 3 days - when which part happened is hard to say. Once I was operated on, I was back skiing (in a brace) 5.5 months later. I was initially signed off work for 12 weeks but was actually able to return after 6 weeks, but I am a desk jockey these days. Had I still been teaching I would have had to had the full 12 weeks off.

I was not overly ambitious with my rehab but I did all my exercises at least 3 times a day and had intensive physio with really good sports physiotherapists. Having been through the mill with my right knee, when my left knee went, I knew how to pace myself and what to push for.

Set lots of small milestones rather than focussing on a distant end result - it is less frustrating and you can actually make more progress as you tick each one off.

Sue 

Hi Lenore

Thanks for your response. I began physio 6 weeks post surgery. Nothing was done prior to that. I have been working on it very hard but can't get past 45 degrees. I had a follow up 3 weeks ago and am now waiting for a date to have a manipulation done. I've been told that I will never regain full range and will have post traumatic arthritis. For now I would be happy with enough bend to be able to drive and function normally again.

I agree with Lenorem, you now need a second opinion and with someone who knows about how messed up knees can be sorted out. By messed up I mean knees messed up by other surgeons. 

I had to fight for 2.5 years before I was listened to and was able to get to a surgeon who knew what he was doing. From then on it was a smooth ride. I cannot believe that you went 6 weeks with no physio, that is just criminal neglect in my opinion. Even though I was non-weight bearing and locked in full extension, I had physio from day 1 post-op. The physios did all the work passively and made sure that the swelling was taken care of properly.

I see you are in NZ which means that life is not quite so straight forward as in bigger countries, but at least your medical care is not denied because of insurance or money issues. Do some research about the sports specialists in your country and in your immediate area. Try looking to see who works on the top rugby guys as the type of injury you have is similar to the type that some of them suffer. Do lots of research before you submit to an MUA or any other treatment by your current surgeon. I had an MUA as well which did not turn out to be painful just a pain in the backside because it is a general anaesthetic. My physios were also in the operating room and guided my surgeons by showing them how my ROM was blocked.

Whilst some of your problem could be scar tissue build-up, I don't think you should jump to the conclusion that it is arthrofibrosis. Genuine arthro is thankfully quite rare and is due to a genetic flaw which makes your body keep on producing scar tissue and never switches it off. While an MUA can break up any blocking scar tissue, it needs to be done properly and followed up with good focussed physiotherapy. The two go hand in hand and, if they do not offer you an experienced physio at the same time, do not go through with it. Another problem could well be related to the other torn ligaments, have you had the ACL reconstructed yet? Often incorrect placement of the graft causes big problems with ROM - that's what caused my problems. They could have done an MUA every day and still not achieved anything permanent as the graft was too big, too straight and in the wrong place. It was also incredibly tight apparently so I could not get full extension.

Good luck and sing out if you need any help with the research. Maybe contacting the big clubs may help to get you some good names, you never know there may well be someone not too far from you who works with a top club on your island.

Sue 

Great to hear you have a good physio you trust and respect.   Hopefully she will get you back to full range of motion after your MUA.  After reading your history again I realize you're not that far postop.  You may be able to safely do an MUA without surgery to remove the scar tissue as long as it's gentle manipulation.  I'd still get a second opinion from a more experienced OS though. 

Plenty of people go without surgery for a torn ACL.  It depends on how active you are.  If you plan on doing any kind of activity with twisting motion of the knee it will probably cause you a lot of problems. 

Ditching the brace and crutches is a good milestone.  Keep up the good work.  I look forward to seeing your forward progress.