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Author Topic: ACLr Complication - cycling and AF  (Read 130 times)

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Offline kcfoot

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ACLr Complication - cycling and AF
« on: July 02, 2018, 07:43:43 PM »
Hello all - long time lurker. Seeking advice.

32M underwent aclr on left knee after BJJ accident on 1/23/18. Had progressed accordingly until about week 8 went I was sudenly very short on flexion. Extension was ok.

Surgeon opted for LoA, which I had on 3/14/18. I had immediate improvement.

My ROM is now -2/-4 to 135-143 range.

My issues began about 2 weeks ago. I Think I am prone to athrofibrosis but due to extreme diligence was able to keep at bay. However. In retrospect I believe PT may be my issue.

I always has a “stiff knee” eg in the morning my cold ROM would be +2-4 to 100 and after warm up on my bike and stretching I would be “normal”. I was concerned about this and PT responded by increasing aggressive stretching and durations. This, combined with starting my running protocol is probably what tipped me over.

With the worsening morning stiffness I was actually limping again. I decided to see surgeon who recommended steroid injection.

Cortisone worked like a charm. I went to a “normal knee”. I woke up cold with -1/2 and 140. While this is far from my normal leg, the smoothness and lack of pain made me so happy.

Fast forward to last week where some aggressive single leg jumping at PT caused some bad inflammation which then triggered the return to the stiff and clunky knee. So I made it for 2 weeks on the cortisone. I probably should have realized being too aggressive would just land me back where I was. Hindsight is 20/20.

Anyway, I am waiting to see when I can get the cortisone again, with a new plan of my slower and controlled PT (going to a new one).

My question is, my knee will feel 80-90% after cycling, but shortly after it returns to the swelling. Does anyone know how to prolong that sensation or have similar issues?

Sorry to ramble

Offline LisaWilliams38

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Re: ACLr Complication - cycling and AF
« Reply #1 on: July 04, 2018, 03:14:27 AM »
I'm sorry for the situation you are in but completely understand. I am one of those people who inflame easily and have a history of slow rehab/physical therapy. I make huge gains in muscle strength very quickly, but the leg press/balance work, and too much standing flares my inflammation very rapidly.

Granted, I've had 10 knee surgeries now, 5 of which have been pretty major. I've been with the same physical therapist for the last 4, and he'll often sit me down and tell me we're done, as he can see how fast my knee is puffing up.  ;D ...and it's happened on both knees.

I am also VERY slow to gain back flexion plus am an prone to scar tissue, so we have to balance being too aggressive with bending with being too lax too. It's this constant battle, and we just take it session by session. Personally, my surgeon won't even let the physical therapy assistants work on me anymore , as they flare me up after every bending session...and so many of them are all about "no pain, no gain."

So now I only go on the days my PT is in THAT clinic (at his and my surgeon's request). We all 3 agree that WE know my knee best, and we all want to keep any more complications to a minimum. My PT  had to call down one of his assistants just a few weeks ago when she flared me up AGAIN---and I complained quietly to him the next visit, as she hurt me BIG TIME-- I'm already used to PT Hell, and he knows if after these last few yrs, so if I complain, he knows it must have been bad, as I never complain. Thus, the surgeon says no more assistants messing up his handiwork (ha)!!!

I truly feel for you. The ups and downs, back and forths, it's quite the mind game. My PT has worked wonders for me, but it's SOOOO slow some weeks, and he occasionally has to cheer me up and remind me that it's a marathon, not a sprint. :).

My surgeon also said some of us just swell A LOT more than others. He knows me well enough now after 8 yrs and 6 surgeries to know I'm doing my part, even if my body is rebelling at times. I forgot to add that because of all of my articular cartilage degeneration (at a rapid rate, for no obvious reasons), I'm not even ALLOWED to jump or run unless my life depends on it. Cycling always helps, but standing in one place for too long swells me faster than ANY walking. PLus, I'm not allowed cortizone because we've done too many specialized articular cartilage repair procedures---- they're afraid the cortizone might break down the new cartilage. I DO get Hyaluronic Acid injections every 6 months (a set of 3) in the worst knee. He said we may have to start that in this other post-op knee after this rehab is over. Time will tell.

Sorry if I'm forgetting something or not much help----just wanting to say I understand the frustration of chronic inflammation and the lack of a rhyme/reason to it sometimes.

--Lisa
 
« Last Edit: July 04, 2018, 03:23:56 AM by LisaWilliams38 »
'98 R plica
'99 L resect discoid meniscus
'01 L  meniscus tear
'02 R  meniscus tear
'10, R meniscus tears, Bursectomy
'13, R 3 meniscus tears, Grd 3 Biocartilage fil
'15 R Oct-ACI harvest,
'15 R Dec-ACI implant
'16 R Mar-lysis of adhesions
'16 R Mar-MUA
'18 L 3 menis tears, Grade 4 Biocartilage fill

Offline DogfacedGirl

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Re: ACLr Complication - cycling and AF
« Reply #2 on: July 05, 2018, 01:12:08 PM »
Hi,
I probably have the same feeling of my knee feeling good while I'm exercising, in my case walking (my knee doesn't bend enough to cycle), but I get more pain afterwards, which can be pretty bad.
I suspect what is happening is when a person exercises their body produces opioids (endorphins) that stop pain. It always does that even under normal conditions because exercise causes tissue damage, and it is a way to make the person feel good and make moving possible. But afterwards for anyone with arthrofibrosis the tissue damage causes an excessive inflammatory response, and hence the pain and swelling, and often reduced ROM as well. We have a kind of inflammatory memory so the smallest things can set us off, which is why we need to be so very careful. For quite a long time, it seems!
I'm not suggesting that you take opioids either, they obviously have problems associated with them!

Lisa, it's interesting to hear your story too, and that standing is the worst thing for you. I'm the same, I would much rather walk for 15 minutes than stand for 5! But I very rarely hear anybody say that. I'm also the same in so far as I never run or jump. I've just started taking metformin which should help settle everything, it will be interesting to see how it goes. You might both want to look into it, it has a long and good safely profile, I can provide more info if you would like it.

All the best to you both,
Kay
1999 Osteoarthritis both knees, chondroplasty
2004 MACI graft L knee
2005 MACI graft both knees
2007 MACI graft R knee
2007 Patella baja
2011 TKR both knees
2011 arthrofibrosis

Offline kcfoot

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Re: ACLr Complication - cycling and AF
« Reply #3 on: July 10, 2018, 08:32:59 PM »
Thank you for the replies.

I do consider myself lucky. I think this forum was an immense resource early on to help me realize some signs and symptoms.

As a result, while I wake up really stiff, 20mins on the bike and some stretching allows me to function pretty highly. I’ve been cleared to jog now. Progress is just slow.

It’s just after 3-4 months of this, I wonder how long that will last.

This was more a rant, so thank you all for replying. I wish everyone the best. I think the main thing I’ve learned is to do your very best to focus on your own recovery journey and not compare yourself to others.

Offline LisaWilliams38

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Re: ACLr Complication - cycling and AF
« Reply #4 on: July 14, 2018, 04:29:26 AM »
kcfoot---I've also been told some of the relief we get after cycling is due to the fluid in the joint being "moved out" due to the constant moving of the joint. It's healthy to push that fluid out and it lets the joint move more properly. But yes---sometimes too much can cause bigger problems, My issue currently (following my Microfracture surgery on May 16) is that if I forget AT ALL to ride my bike in the morning for just 8-10 minutes, my knee hurts more ALL DAY LONG. It's happened twice now, and that was the only reason for the pain being worse those 2 days. I had had 2 very busy mornings and just never got around to loosening up on my bike. Once I rode for 5-8 minutes, my knee was much happier. :) I am sorry your recovery has taken so long, but all I can add is patience really does pay off. I just wish it was easier to come by. I struggle with it constantly.

DogFacedGirl---it's so nice to find someone who actually understands how much I HATE standing.  ;D My husband caught me shifting my weight back and forth constantly while we were standing in the kitchen tonight before supper. He asked what was wrong----I told him "Remember I JUST got back from physical therapy where we beat the crap out of my knee for 90 minutes???!!!!" ::) He just forgets sometimes, as he's so used to seeing me shift my weight back and forth. People have asked me why I can't stand still, and I try to be nice and say "After 9 knee surgeries, I'm just lucky to be standing."  ;D ...and now I can change that to TEN!!!! Thanks also for the info on metformin. I plan on looking in to it.

Anyway--I hope both of you are doing well at the moment. :)

--Lisa
« Last Edit: July 14, 2018, 04:31:44 AM by LisaWilliams38 »
'98 R plica
'99 L resect discoid meniscus
'01 L  meniscus tear
'02 R  meniscus tear
'10, R meniscus tears, Bursectomy
'13, R 3 meniscus tears, Grd 3 Biocartilage fil
'15 R Oct-ACI harvest,
'15 R Dec-ACI implant
'16 R Mar-lysis of adhesions
'16 R Mar-MUA
'18 L 3 menis tears, Grade 4 Biocartilage fill















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