Advertisement - Hide this advert





Author Topic: ACL Revision-How Soon to Full Extension??  (Read 2287 times)

0 Members and 1 Guest are viewing this topic.

Offline dtoneill

  • MICROgeek (<20 posts)
  • *
  • Posts: 3
  • Liked: 0
ACL Revision-How Soon to Full Extension??
« on: May 18, 2005, 11:30:34 PM »
Hello All,

I did some searches on this in the archive and found some related answers, not a lot.

Just looking for real world feedback: I'm 39, 5 weeks post op on my second ACL (allograft). I also had a meniscus repair at the same time. I still have moderate swelling, not too bad. I can get 125 degrees flexion and am at -3 extension. I can get full extension (0) with PT's help and if I work it myself but it won't stay there. That final 3 degrees is keeping me from walking with a normal gait.

My OS today said I should be walking normally by now and told my PT to be more aggressive on extension, as that's what's causing my gimp. No one seems worried about flexion.

Just wondering if any revisioners out there can share their experiences in how long it took to get that flexion so that you got your normal walk back?? I'm starting to stress.

Thanks for any feedback! Dianna/Atlanta




age 39
4 rt knee ops since '84: acl recon patellar tendon '90, acl revision allograft '05, other ops were meniscus repairs.

Offline Heather M.

  • SuperKNEEgeek
  • *****
  • Posts: 4007
  • Liked: 10
    • Check out my photography!
Re: ACL Revision-How Soon to Full Extension??
« Reply #1 on: May 19, 2005, 06:20:53 AM »
I'm sorry to say, but usually the doctors want you to get extension back as soon as possible. I'm assuming from your comments that your extension is +3, meaning three degrees short of straight--right?

Lack of extension (aka extension deficit) can be a couple of things:  arthrofibrosis (excess scar tissue in the joint, esp. under the kneecap and patellar tendon--been there, done that), tight graft, impingement, patella baja, severe muscle contracture due to trauma, etc.  Look up extension using the web site's search engine, focusing on the 'soft tissue healing problems' and 'struggling with rehab' sections, as these have the mosts posts dealing with extension problems.  Also, check the 'cruciates' section further down the main bulletin board page.

You will find some exercises for extension loss peppered throughout the posts in the above sections.  My main one is to sit with a rolled up towel under my heel and the leg straight in front of me.  So-called 'prone hangs' can also work--do a search on the term and you may even find photos in Google.  The thing is, your PT should be coming up with these ideas...if he/she doesn't have any suggestions, then you need to get a new one--pronto!  Find a PT who specializes in knees and uses things like McConnell taping, biofeedback, Russian Stim, patellar mobilizations, and myo-fascial release in order to work on an extension deficit.  If you want to post the general area where you live, someone might be able to recommend a good therapist....

Here is an article dealing with arthrofibrosis, one of the most common causes of extension loss following ACL recon.  There are a lot of medical terms, but be persistent and see if the descriptions fit you.  In the meantime, work smarter in PT...try to avoid excessive pain and irritation and swelling of the knee, as these can actually make your extension problems worse.  Just monitor redness and swelling in your knee and see how things go  day to day.  Read through the posts esp. in the soft tissue healing problems section, and you will find lots of support.

Let us know how things go, and if you need help locating extension exercises using the search engine.

Heather

http://www.physsportsmed.com/issues/2001/03_01/eakin.htm
« Last Edit: May 19, 2005, 07:52:08 AM by Heather M. »
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline Alla

  • SuperKNEEgeek
  • *****
  • Posts: 819
  • Liked: 0
Re: ACL Revision-How Soon to Full Extension??
« Reply #2 on: May 19, 2005, 07:45:25 AM »
HI there

I am 15 days post op and just had a revision visit with my OS today.  With my physio I can get the extension quite easily, but after being cramped in a car for the 2 hour drive to the OS I got out all stiff and couldnt get the full extension straight up for him.  He blasted me over it (nicely,... it wsant too bad) and said that I had to get the extension and improve my quads within the next two weeks or else.  I've been doing the exercises they gave me religiously... so I guess I have to do more!! 

I'm told the sooner you get extension, the better, and the less risk there is of them having to go in and remove scar tissue.

Alla
Torn ACL December 04
ACL Reco May 05
Cleared to return to sport May 06

Offline dtoneill

  • MICROgeek (<20 posts)
  • *
  • Posts: 3
  • Liked: 0
Re: ACL Revision-How Soon to Full Extension??
« Reply #3 on: May 20, 2005, 12:28:42 AM »
heather and aliia,

thank you both immensely for taking the time to reply and thanks in particular to heather for the link and search suggestions.

until yesterday when i posted, my doc and pt didnt seem alarmed by my not easily being able to get full extension on my own. she said that because i could get to full extension "passively" (when she maniupulates it to go straight) that i was fine. she said i'd get those last three degrees once the swelling went down. my 6th sense told me it was taking too long and that my pt is not aggressive enough. it looks like your replies confirm my fears.

the good news is, i found a different pt clinic today and went in and told them my issues. right away, a much more on-the-ball seeming pt told me i'm behind in my extension and that i should've gotten it in four weeks. the old pt had never given me any guidelines or goals like that. i just went in three times per week and did what they said. bottom line: i start at the new clinic monday and am kicking myself for not questioning the first pt more aggressively.

thank you again.
age 39
4 rt knee ops since '84: acl recon patellar tendon '90, acl revision allograft '05, other ops were meniscus repairs.

Offline Alla

  • SuperKNEEgeek
  • *****
  • Posts: 819
  • Liked: 0
Re: ACL Revision-How Soon to Full Extension??
« Reply #4 on: May 20, 2005, 05:52:38 AM »
Hi there

I know this is a passive exercise, but have you tried some leg hangs??  You lie on your tummy on a bed with your kneecaps off the edge of the bed and a rolled up towel under your knee (between the lower thigh/upper knee and the bed surface)  to support it and leg your legs hang in a straight postion over the edge of the bed.  You are supposed to relax and stay in that posisiton for a few minutes.   I have that excercise in my list of exercises to do especially if Im having trouble with extension.    I'm a bit like you... I can get to the straight position if I manipulate manually, but I struggle to get there with muscle action alone because I have badly wasted quads... it is getting better though.

Alla
Torn ACL December 04
ACL Reco May 05
Cleared to return to sport May 06

Offline dtoneill

  • MICROgeek (<20 posts)
  • *
  • Posts: 3
  • Liked: 0
Re: ACL Revision-How Soon to Full Extension??
« Reply #5 on: May 21, 2005, 05:18:26 PM »
hey allah,

i was doing those hangs you mention, on my belly with my leg hanging over the edge, but the pt (the new one i start with monday) says that exercise isnt all that effective bec the hamstring ends up fighting it. she said better to have the leg up on pillows with weights placed just above the knee cap and let it just hang there. she said the hamstring is relaxed in this position and that gravity will do the work. i've been doing that as much as i can since she told me this two days ago and in fact, am doing it right now!

if definitely helps and right after i do it i can walk nomrally for about five mine but then my leg will still go gradually back to +3 extension on its own and a-gimping i go. hopefully i will just keep at it till it stays that way.

how many weeks post op are you? and what did you have done?
age 39
4 rt knee ops since '84: acl recon patellar tendon '90, acl revision allograft '05, other ops were meniscus repairs.















support