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Author Topic: Knee not straightening  (Read 6771 times)

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Offline thediesel

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Knee not straightening
« on: September 05, 2005, 07:19:24 PM »
I had torn my anterior cruciate ligament and also have had a bucket tear in my lateral meniscus on the 5th June, the surgery was scheduled for the 5th July in which the surgeon was going to remove the damaged lateral meniscus and try reconstruct the ACL. But no luck the damaged meniscus was removed and the reconstruction was not done. After my surgeon said that my knee was locked at 15% and he was unable to do the full operation, he said to go away and try and get full extension back in my knee with physio and gym work. So i did and it has been 8 weeks since my last op and my last meeting with my surgeon and still my knee will not straighten, i have had physio sessions 3 times a week and regularly attend the gym. My physio today said that we have worked my knee hard and still no luck with full extension. I had a meeting with the surgeon today to discuss about the next op (ACL reconstruction) and he says that cause the knee will not straighten he will do the op until mid november. My question is: why is my knee not fully extending and will it ever straighten and what happens come my next op and it still has not fully straightened also has anyone any info on how to get full extension back..

 Thank - You

Offline hottubpam

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Re: Knee not straightening
« Reply #1 on: September 05, 2005, 10:26:08 PM »
It sounds like you MAY have scar tissue (arthrofibrosis) that is blocking your extension.  You should read some of the posts under the "Soft Tissue Healing Problems" section of this bulletin board or use the search feature on this bulletin board and type in arthrofibrosis.  You will see many, many posts by people like myself that have arthrofibrosis.

If you do have this condition, your surgeon is RIGHT in not operating until you have full ROM (range of motion).  However, you may need surgery just to remove the scar tissue and restore ROM and then a subsequent surgery to reconstruct the ACL.  Scar tissue removal is frequently referred to as lysis of adhesions (LOA) and should be performed by a physician that has lots of experience in dealing with the scar tissue.


There are other possible causes of loss of extension, maybe somebody else will respond to your post.  You should also discuss the potentional causes with your OS or strongly consider getting a second opinion.

My situation was similar to yours I ruptured my ACL, tore my meniscus and developed massive amounts of scar tissue that prevented ROM.  Unfortunately the first surgeon I saw went ahead and reconstructed the ACL.  Another surgeron  later resected (removed) the ACL and a cyclops lesion (form of scar tissue).  Unfortunately the 2nd surgeon did not know how to deal with scar tissue and it grew back.  I finally found a surgeon with lots of experience in dealing with arthrofibrosis and after 3 more procedures I finally have my extension back.  So it is possible to get your extension back, but again you need to find an OS with experience in dealing with this.

If you do have arthrofibrosis, you have a finite period of time to deal with this condition (somewhere between 6-12 months) or it can leave permanent damage.

So I recommend you doing your research, talking to your dr. and strongly consider getting a 2nd opinion.

Good luck,
Pam
ACLR, Menisectomy 3/04; ACL resection, Cyclops lesion removal, LOA & MUA 10/04; LOA, LR & AIR 12/29/04;#4&5 surgery on 2/9/05 & 3/2/05 debridement, irrigation & lavage, portal closure; #6  LOA, AIR, LR & other releases 12/9/05; #7 surgery 1/18/06 portal closure, lavage, debrid etc #8 skin graft 3/06

Offline Charliemouse

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Re: Knee not straightening
« Reply #2 on: September 05, 2005, 11:05:14 PM »
Sorry to hear your plight ...I have the same injury and was locked at 40-90 degrees for over 2 months. It was assumed that I had a medial buckethandle and no cruciate damage and I went in for a scope last week and came out with 40% less lateral meniscus and no anterior cruciate but I was put in a cpm machine almost immediately which I think helped and then he sent me home in a splint so I couldn't revert to bent (but still not made 0deg yet) ...did your surgeon tell you why you are locked, with that much physio there must surely be something stopping it. Have you gained any rom at all with physio?
18/06/05 Injured trampolining
Fixed Flexion 20-90 deg until...
01/09/05 lateral meniscectomy (40%)
09/06/06 Patella tendon aclr
09/09/06 Back on the tramp (carefully)
10 years on and still going strong
!!Stop twisting when you land or it hurts!!

Offline thediesel

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Re: Knee not straightening
« Reply #3 on: September 05, 2005, 11:44:37 PM »
Hi

Thanks Pam for the posting, I will contact my OS tomorrow to discuss some of these causes and I am in the middle of getting a second opinion. And to Charliemouse with my physio sessions I can extend my leg and almost straighten it, it is about 2 fingers gap from me sitting on a flat floor between my knee and when lying on my stomach I can almost get my heel to touch my bum. My surgeon said that he is still unsure why I have not achieved full ROM and that is why the operation was put back til mid november, as he thinks by that stage the knee will fully straighten, but I have worked very hard with the physio sessions and going to the gym 5 times a week for 2hours, doing bike work and on the step machine. I must say that after gym or physio I have no bother from my knee and there is no swelling what so ever. It simply will not physically straighten.

Thank -You

Offline stgiles16

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Re: Knee not straightening
« Reply #4 on: September 06, 2005, 03:49:51 AM »
I have a question for you. was your knee locked BEFORE the surgery or afterwards? I cant tell by reading your post. IF the knee locked up on the operating table, then the cause could not be scar tissue, if it were locked prior to surgery, why did your OS not discuss this with you before he did the surgery and tell you that he could not fix your ACL?

missy

ps, very smart move getting a second opinion
2 ligament recons right ankle
2 arthroscopic,
5 open knee procedures
2 Plica removals
bone spur removal
2 microfractures
4 debridements
2 open LOAs all on left knee
Arthritis,both knees, ankles, shoulders, elbows, hands,spine
Fibromyalgia
Arthrofibrosis
LOA & PKR 2/15/06
RA
in pain mgmt
TKR JAN 2012

Offline thediesel

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Re: Knee not straightening
« Reply #5 on: September 06, 2005, 01:32:29 PM »
My knee was locked at the time of the injury and my OS told me it was locked at 15% but will only be able to see the full damage when he goes in and looks about. He tried to unlock it by removing the damaged lateral meniscus and any scar tissue but after surgery told me that he was unable to get full ROM that is why he did not proceed with the ACL reconstruction. So answering your question yes the knee was locked before surgery. Baiscally when I seen my OS yesterday he said that he was still unsure why after 8 weeks of removing the damaged LM and swelling has decreased and strength is back in the knee why it still will not straighten and this is why the op is pushed til the end of November to see if that extra time will give the knee a chance to straighten.

Thank - You

Offline SWYZ721

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Re: Knee not straightening
« Reply #6 on: September 06, 2005, 10:56:22 PM »
How do you avoid scar tissue, or more specifically, what causes it? I am 6 days post-injury ACL/MCL tear and who knows what else and I can only get 10-80 ROM and my knee is swollen to hell, BUT i can hobble around with little to no pain (is it ok to walk if I fell I can?), any suggestions? Or predictions as to what will happen to me?



 I REALLY don't want to scar up!!!
Aug. 29, 2005 - ACL/MCL/Meniscusl Rupture
Oct. 27, 2005 - ACL Recon. (Patellar)

Don't play indoor soccer!

Offline thediesel

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Re: Knee not straightening
« Reply #7 on: September 06, 2005, 11:53:03 PM »
Hi SWYZ721

Firstly now that you have done the damage you can't avoid the scar tissue, the reason for the cause is: - White blood cells travel down the bloodstream to the injury site where they begin to tear down and remove damaged tissue, allowing other specialized cells to start developing scar tissue and then scar tissue is formed on the skin or inside the body. The amount of scarring may be proportional to the amount of swelling, inflammation, or bleeding within. In the next few weeks, the damaged area will regain a great deal of strength as scar tissue continues to form. Hopes this answers your question regarding the scar tissue. At the minute try and keep of your feet (if you have cruthes use them), with the injurjed knee elevated when sitting down, also keep applying an ice pack to your knee as that will reduce the swelling. With regards to what will happen next, have you had your MRI scan (with results) and have you made arrangements to consult an Orthopaedic Surgeon with plans for surgery.

Thank - You

Offline SWYZ721

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Re: Knee not straightening
« Reply #8 on: September 07, 2005, 12:35:47 AM »
Hi SWYZ721

Firstly now that you have done the damage you can't avoid the scar tissue, the reason for the cause is: - White blood cells travel down the bloodstream to the injury site where they begin to tear down and remove damaged tissue, allowing other specialized cells to start developing scar tissue and then scar tissue is formed on the skin or inside the body.
Thanks


The amount of scarring may be proportional to the amount of swelling, inflammation, or bleeding within.
I hope not, my knee is incredibly swollen

In the next few weeks, the damaged area will regain a great deal of strength as scar tissue continues to form.
  Wait so scare tissue is good, even though it could potentially harm ROM?

Hopes this answers your question regarding the scar tissue. At the minute try and keep of your feet (if you have cruthes use them), with the injurjed knee elevated when sitting down, also keep applying an ice pack to your knee as that will reduce the swelling.
Ok, I have been icing, not too well though, about 3 times a day for 30 minutes each session, but it doesn't seem to be going down.
As far as walking, obviously I am limping/hobbling, with little or no pain, I'm more worried about my muscles and rehabing them, either way I have my PT tommorow (day 7 post-injury) so we'll see what I can accomplish there..


With regards to what will happen next, have you had your MRI scan (with results) and have you made arrangements to consult an Orthopaedic Surgeon with plans for surgery.
No MRI, and I am should be getting my referral to University of Michigan sportsmed tommorow, but they are hella busy (one of the best) and I wanted to see immediate care prior, additionally two opinions can be beneficial.

I haven't spoken witha surgeon yet, I will have my 2nd visit with my doctor on day 10 post-injury, obviously she explained to me about surgery the first time she saw me (day 2 post-injury) but she said she didn't want to get ahead of herself and signified the importance of returning full ROM and strength pre-op, and told me that after I can perform a full leg lift, I should start weight-bareing somewhat.



Also what are typical intervals for recovery?
After how many days/weeks is it typical to weight bare?
Full walking and quad/muscle strength?
Reconstruction?
Full Recovery?
Aug. 29, 2005 - ACL/MCL/Meniscusl Rupture
Oct. 27, 2005 - ACL Recon. (Patellar)

Don't play indoor soccer!

Offline Charliemouse

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Re: Knee not straightening
« Reply #9 on: September 07, 2005, 01:42:02 AM »
My physio told me to keep it moving (along with ice) and keep trying to increase the rom to help stop a major build up of scar tissue (scar tissue is bad it just makes the fixed flexion worse). If you are locked you may have some meniscus damage too (part of my problem but not really known until scoped). You don't need to weight bear to keep it moving (though as I was told it was an mcl sprain and no more I was walking on it quite quickly even though I was locked) my swellling went down but never away but I can now straighten my leg (post scope)with some effort. What is hindering me is the muscles that have grown accustomed to the knee being bent so any stretches you can manage would be good, calf stretches might have helped me a lot more and that's what I'm working on now along with trying to regain some muscle strength in  my quads and calf which have atrophied quite badly. Your physio should be able to help you find some exercises you can do. Sorry it's not a quick healing process you are probably in for several months minimum.
Good luck
18/06/05 Injured trampolining
Fixed Flexion 20-90 deg until...
01/09/05 lateral meniscectomy (40%)
09/06/06 Patella tendon aclr
09/09/06 Back on the tramp (carefully)
10 years on and still going strong
!!Stop twisting when you land or it hurts!!

Offline thediesel

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Re: Knee not straightening
« Reply #10 on: September 07, 2005, 08:55:21 PM »
Hi are these questions relating to yourself now with the injury or after you have had the operation.

Also what are typical intervals for recovery?
After how many days/weeks is it typical to weight bare?
Full walking and quad/muscle strength?
Reconstruction?
Full Recovery?

Thanx

« Last Edit: September 07, 2005, 09:24:44 PM by thediesel »

Offline SWYZ721

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Re: Knee not straightening
« Reply #11 on: September 07, 2005, 11:17:29 PM »
post-op
Aug. 29, 2005 - ACL/MCL/Meniscusl Rupture
Oct. 27, 2005 - ACL Recon. (Patellar)

Don't play indoor soccer!

Offline thediesel

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Re: Knee not straightening
« Reply #12 on: September 08, 2005, 01:05:18 PM »
Hi

Really what you should be trying to do is to acheive full or near full ROM before the op and also to get your leg strong as that will help the recovery after the operation. With myself I have had the damaged LM removed and still await the ACL reconstruction but in the gym (4 to 5 days a week) I do 30 mins on the bike's and another 30 mins on the stepper machines plus now I have cut it down to 1 physio session a week, I feel that this is just right for myself.  Consult your physio or OS with reagards to yourself being able to do any sort of leg work in the gym and what sort of weight baring you should do. I would not like to say go ahead and start when you are not ready as everyone recoverys different but you will know when you are ready and you will know how far you can push yourself. With regards to your reconstruction that date will be set by yourself and your chosen OS, once again that depends on your OS and how they feel about your situation. I know people that have done their ACL and get the op in a few weeks other people wait months, it all depends on OS, recovery, what exactly the damage is and if it is done private or on any sort of health insurance. - Full recovery - on what I have seen and have read that will depend again how the recovery is coming along and decided by your physio and OS on each stage of your progress. But as my ACL reconstruction is in November if I am in before you I will post/email you everyday to let you know how I am doing and same for you if your OP is before mine. On what I have read it should take anything between 6-10 months for full recovery and to return to full sports.

Thanx

PS - I will be getting my ACL reconstruction done by the Hamstring Tendon Graft  - do you know what type they have chosen for you.

Offline SWYZ721

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Re: Knee not straightening
« Reply #13 on: September 09, 2005, 06:29:57 AM »
Well, I talked to my OS today and he order 4 wks of PT and then another meeting, along with an MRI in 2 weeks. And the way he referenced it, I would be surprised if I have my surgery within a week or so if that meeting. I will most certainly keep in touch on recovery.

As far as what type of graft, I haven't given a thought, I have assumed patellar, what is the basis for choosing a cadaver, patellar, or hammy?

Also what type of PT did you do early on? Right now, I am doing lef lifts, weight free, and the electric muscle stim machine. and ICE ICE ICE.

Also, what do you think about purchasing a cryo cuff or auto chill? If my operated knee is going to be swelling post-full recovery, then I its more than worth it, however it even might be good to purchase pre and post op as I am still very swollen, and I hate dealing with ice packs.
Aug. 29, 2005 - ACL/MCL/Meniscusl Rupture
Oct. 27, 2005 - ACL Recon. (Patellar)

Don't play indoor soccer!