Cruciate ligaments :

Is there any way to avoid post-op muscle loss? - - Posted by GaryR (GaryR), 1 January 2005

I had an ACL reconstruction on my right knee about five years ago. The patellar tendon was harvested for the graft. That particular surgeon put the leg in a soft cast for 10 days to ensure no pressure on the bone graft. When the cast was removed, I was appalled at the amount of muscle loss. The leg had half the girth it had prior to the operation.

Although the leg was casted, I was allowed to walk with a crutch and to put as much weight on the leg as comfort allowed. I did this. I also did the thigh tightening exercises and leg lifts during this period. So, the leg muscles were not totally quiescent during the casting.

I'll have another ACL reconstruction, this time on my left knee. This surgeon will not softcast, but will use the machine that bends the knee right post-op. He still says I will lose muscle mass. "That's normal after a surgery."

When I asked both doctors, and my physical therapist from the first surgery, I never seemed to get a good explanation for the cause of this. The first surgeon blamed it on lack of use. The PT said the body canibalized the closest muscles for protein and fuel for healing.

Has anyone heard of any strategies to avoid such dramatic muscle loss? A good explanation for why it happens would be nice, too.

Can a high protein and high carb diet limit the muscle loss?

Any info would be greatly appreciated. This is a great forum.
Posted by JOSEY_WALES (JOSEY_WALES), 3 January 2005

Hi,

I'm now 10 months post op.

In my experience the muscle loss cannot be avoided because you basically dont use your leg properly for some time after op.  

I was also shocked to see the severity of the loss after removal of my leg support (no cast) over such a relatively short time .  However the tone was regained although, not fully until several months of rehab.

Sorry its not the answer your looking for

good luck !

Posted by libertynm (libertynm), 4 January 2005

hi JOSEY_WALES,

How many months did it take to regain enough muscle mass to feel stable when walking?

I am four weeks post op and have very significant calf wasting and some quad wasting.  I "test" my leg every so often by not using my crutches for a step or two and boy do I feel the wobble.

Sincerely,
Nesanet
Posted by GaryR (GaryR), 4 January 2005


I think I was able to feel secure walking after only a couple months.  I was able to play paintball in June and the surgery was in the early March timeframe. I was careful when playing, but I did a lot of walking and light jogging on uneven ground. Kneeling was easy, getting up was much harder than before the knee surgery.

I think I should have used a stationary bike more, and intend to this time around.  In retrospect, I didn't work the leg enough in months 3-6. I intend to this time, but I'll be sure to not twist it or do anything too severe.
Posted by JOSEY_WALES (JOSEY_WALES), 5 January 2005

Hi libertynm,

to be honest I was mobile without crutches after only a few weeks post op.   although only with a straight leg and with some degree of discomfort.
I could walk much better after around 6-8 weeks when i started physio.  I preferred not to use crutches but was advised to contiue with one until a further few weeks.

I dont remember feeling unstable due to muscular type  weakness, it was more the pain caused when i tried to bend my knee.  On flat was ok.  steps etc were more of a problem.  

Dont rush things
Dont overdo it too early
Do as your physio tells you (both at gym and at home)

Best of luck





Posted by Gab (Gab), 5 January 2005

I was walking without crutches 10 days post-op with the brace locked in full extension, then I discarded the brace at 6 weeks post-op albeit with a heavy limp.

Although I can pretty much run up and down the stairs, my thigh still looks to be about 2/3 the size of the other one.  
Posted by nick157 (nick157), 5 January 2005

I'm not sure how long you have until surgery, but my best advice would be to build the leg muscles up AS MUCH AS POSSIBLE beforehand to compensate for the seemingly inevitable muscle loss post op.

I have surgery in 2 weeks time and I'm doing this, as advised by an exellent physio. You may want to check out the below, if you haven't already:

http://www.kneeguru.co.uk/cgi-bin/KNEEtalk/YaBB.pl?board=cruciates;action=display;num=1100008326

This old Forum was so valuable that we have kept it as an archive. It is just for reference. If you want to ask questions or offer advice, there is also a current Bulletin Board which you can access from our home page.

Hunting for information is a slow process. browsing through these topics will probably raise a lot of questions in your mind. Don't forget that there is a whole site behind these forums - just click the 'KNEEguru' home button at the top left of your page when you are ready to access it.