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Author Topic: Can anyone comment on a "frayed" ACL... instability and athrophy?  (Read 8571 times)

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Offline SofaGeorge

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I was in a car accident about a year and a half ago.  Essentially I had my feet straining against the floorboards as I slid into the crash.  Afterwards, I knew something wasn't right with my knee.  My initial diagnosis/surgery was for a torn meniscus.

I am a boxer, kickboxer, and lifelong weightlifter.  After surgery I went through Physical Therapy (PT) to start recovering use of my leg.  Both I and the doctor observed that by the time I had surgery I already had significant atrophy of the muscles in my injured leg.    (I had surgery about 9 months after my accident.  I kept putting things off under the false hope it would heal itself.)

I am now about 8 months post surgery... and I find myself still having difficulties with movement and exercise.  I am back to boxing, kickboxing, and weightlifting... but I have a VERY difficult time moving my injured leg with good control while boxing, my kicks with the leg are very slow and have no power or control, and in weight lifting... I'm just plain working a weak leg.

What I notice is that as I walk I still feel slightly unstable.  I only feel comfortable using a cane.  My leg is also still atrophied.  I discussed this with my OS and he raised the issue of the possibility of needing a second surgery.  He said that when he did my meniscus repair he saw that my ACL was "frayed" but still attached.  He tested my legs and saw that my injured leg moved and wobbled where as my healthy leg was firm at the knee.

His suggestion was that I work hard at recovering the leg muscle over the next three months - and then revisit the issue.

My question - has anyone here experienced anything similar to this... and were you able to build up the muscle?  I'm a bit dubious.  Something just doesn't feel right... and I'm questioning a bit the possibility of successfully returning to sports and restoring my leg while it feels unstable.

Can anyone offer advice or insight here?

Offline fitnesskitty

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Re: Can anyone comment on a "frayed" ACL... instability and athrophy?
« Reply #1 on: January 16, 2008, 07:56:56 PM »
Hello,

I am so sorry to hear of your car accident!  I cannot speak to the frayed ACL, but I know about muscle atrophy, as my right leg atrophied a lot over a few months.  I dislocated my patella last August when I fell coming down my stairs.  I had a surgery six days later to repair a partially torn tendon, remove bone fragments and realign the patella.  I was in an immobilizer for several weeks.  Then I went to PT and got stuck around 50 degrees flexion.  All this time my muscles were atrophying.  In late October, my first surgeon referred me to his partner.  I had a second surgery with him on November 1 to remove scar tissue (LOA), to have a lateral release and to have a manipulation under anesthesia.  I had only 20 degrees of flexion that day, and he got 120 on the table.  I am now up to 134, only 4 degrees shy of my other leg.  Needless to say, my muscles atrophied a lot.  I started PT the day after the second surgery and was at 90 degrees within a few days, but my muscles were so weak, and still are somewhat, as I do have extension lag of about 15-20 degrees I would guess, maybe a bit more.  My point is, it takes a long, long time to build muscle back up.  My PT says a minimum of 6 months to a year to get them back to matching the other leg.  You just have to be patient with that aspect, but if you feel something is not right, then you should definitely seek out a second and even a third and fourth opinion if need be, till you find a doctor that can help you.  Maybe your current OS is hoping the ACL will heal but I could not imagine it being fully functional again without surgical intervention if it is frayed.  I am not a doctor or even remotely close to an expert, but that is what I would think.

I wish you the best of luck in finding the resolution to your knee issues and the best of luck also for a speedy recovery.

Take care,

Sarah
Aug 17 07 Injured
Aug 23 07 Open surgeryOct 18 07 No progress made at PT for awhile - stuck 52/53 degrees
Oct 23 07 Saw OS, wants second opinion from partner-ROM stuck 30-35
Nov 1, LR, LOA, MUA
PT 2X/week now, was 3X
Jan 8: ROM 134
Rest In Peace, Lucky!  I love and miss you so much!!!!!!!!

Offline SofaGeorge

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Re: Can anyone comment on a "frayed" ACL... instability and athrophy?
« Reply #2 on: January 16, 2008, 09:29:48 PM »
Hi Sarah,

Thanks so much for your very thought out answer!

It's encouraging to hear how long normal recovery might be.  I've been up around and semi active for a few months... but I haven't been hammering leg exercise perhaps as hard as I should.  I've actually been trying to take it "easy" a little... and perhaps that is the root of the problem.

Can a damaged ACL actually heal on its own?  Or partially heal?

My concern had been that there was some nerve or blood flow impediment that was causing the atrophy.

Offline fitnesskitty

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Re: Can anyone comment on a "frayed" ACL... instability and athrophy?
« Reply #3 on: January 17, 2008, 12:07:00 AM »
Hello,

You are very welcome.  I have heard of people not getting surgery with a partially torn ligament.  From what I have read, they rest for a few weeks, then start a rehabilitation program with a PT.  I have also read, however, sometimes if the ACL is not surgically repaired, the patient will likely have to give up high-risk sports such as football, skiing and basketball.  If there is no instability in the knee, most people can live witha partially torn ACL, as long as they do not participate in the above-mentioned sports.  I do not know a lot about ACL injuries though.  I will post a link below where I found some information.  You might also try a search on the main KneeGURU site.  I am sure you would find some great information there as well.

http://orthoinfo.aaos.org/topic.cfm?topic=A00297

I would also say, be vigilant about what your PT wants you doing at home.  Your participation is vital to a successful recovery from your knee injury.  If you wish to be more active and play sports, you might want to consider surgical intervention. If you do any sharp, cutting moves in your kickboxing and boxing, you might need a surgery as it could completely rupture if there is high impact in any of your activities.  Do your home PT and you will see good results, but if you feel that something is not right with your knee, definitely push your OS for further information and get another opinion if necessary, and keep going till you have found someone that is willing to help you get your knee back to its old self so you can resume the best quality of life possible.  My other question is, is your PT doing electric muscle stimulation at your sessions?  I have a home unit my PT loaned out to me for free that I use twice a day.  It helps to re-educate you muscles.  It helps you regain control of your muscles and reminds them, especially the VMO, of what they are supposed to be doing.  It also helps the neurological side...helping your brain and musles exchange messages so the muscle does its job.  This might be where some of your lack of control is coming from.  Or it could be the ACL, but like I said, I don't know enough about ACL injuries to say one way or the other.  Just be sure you don't settle; get that knee fixed up so you can do your kickboxing, weightlifting and boxing.  The OS's job is to get you feeling as good as possible.  Do not let them dismiss you.  That is why they make the big bucks!  They are experts and should do everything possible to help.

Best of luck and keep us posted on how you are doing, what you decide, etc.

Take care,

Sarah
Aug 17 07 Injured
Aug 23 07 Open surgeryOct 18 07 No progress made at PT for awhile - stuck 52/53 degrees
Oct 23 07 Saw OS, wants second opinion from partner-ROM stuck 30-35
Nov 1, LR, LOA, MUA
PT 2X/week now, was 3X
Jan 8: ROM 134
Rest In Peace, Lucky!  I love and miss you so much!!!!!!!!

Offline Army John

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Re: Can anyone comment on a "frayed" ACL... instability and athrophy?
« Reply #4 on: January 17, 2008, 05:53:48 PM »
My question - has anyone here experienced anything similar to this... and were you able to build up the muscle?  I'm a bit dubious.  Something just doesn't feel right... and I'm questioning a bit the possibility of successfully returning to sports and restoring my leg while it feels unstable.

Can anyone offer advice or insight here?

I have had a similar experience.  I didn't know my ACL had been torn and had scarred over, providing me enough stability to not overly concern me.  The pain in my knee got so bad that I went to the OS and they scoped me- finding the issue with my ACL.  I used to play lacrosse and I have also strained ligaments- leading to instability and muscle atrophy.

I suppose it's safe to say that there is something going on since you are continuing to experience atrophy.  You might have completely ruptured your ACL, or you may have strained it due to some of your hobbies- particulalrly weightlifting and kick boxing.  I have had EMS for my quad. I believe, based off of my experience, that as long as you continue to fight atrophy problems for an extended period of time, you probably still have an issue going on and EMS probably won't be the solution.

I don't know your age, but I had my ACL surgery when I was 25.  It was a long recovery-- there's no getting around that.  I won't say you couldn't continue to do kickboxing and lower body lifting (assuming you needed an ACL reconstruction), but I would recommend that you altered that activity afterwards.  What I didn't account for very well was that I would get older and that when I recovered and went back to my activities, full throttle, it would hurt me later in life.  I'm about to turn 37 and I continued to pound my knee over the last 12 years.  I just had another surgery done this past Friday and I am going back in for another reconstructive surgery, but not on my ACL.

I won't turn into a couch potato, but I need to seriously consider alternative, non-impact cardio activities.   Funny, I did consider turning to some form of martial arts but not so much for the physical aspects, but more for the flexibility and conditioning.  It's an activity I always wanted to do and it's something I'd like to do with my son when he gets older.

Best of luck-- John
L knee meniscal repair- 6/89
L knee scope- 11/95
L knee ACL reconstruction- 2/96
L knee scope (included a lateral release, cartilage biopsy, and the ever fun bone shaving)- 1/08
L knee ACI/TTO- 4/08
L knee scope/manipulation- 7/08

Offline SofaGeorge

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Re: Can anyone comment on a "frayed" ACL... instability and athrophy?
« Reply #5 on: January 18, 2008, 09:44:50 PM »
Army and Fitnesskitty,

Thanks for the info.

I've considered getting eStim for home, but truthfully I'm hitting exercise so hard now as I try to recover this - eStim would be over kill.

Army, your comment that there may still be an underlying issue causing atrophy is my biggest concern.  My leg atrphied LONG before my surgery... and it has not been coming back with exercise.  I am going to train HARD for the next three months and work on building the leg up as best I can.  I'll be meassuring the leg size each week as well.  (As of today's meassurments the left thigh is about 1 inch smaller than the right.)

Offline DougF

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Re: Can anyone comment on a "frayed" ACL... instability and athrophy?
« Reply #6 on: March 21, 2021, 07:44:10 PM »
I too had knee surgery for a torn meniscus.  The surgeon removed about 70% of the medial meniscus.  My surgeon said that although the ACL was frayed the knee was stable enough that I do not need surgery to reconstruct the ACL.  And he does lots of ACL reconstructions and says he can readily tell which knees need it.  I lost some strength in the knee but it has recovered.  I used to do leg extensions on a weight machine and that was useful to see the difference in strength but now with Covid the gyms have been closed since November so I can't do that.  I had the initial injury in November 2019 and my surgery was delayed because of Covid until July 2020.  I was able to return to cycling and playing beach and indoor volleyball in September and cross-country, alpine and Telemark skiing and skating this winter.  I've been using a hinged metal knee brace that was prescribed before the surgery.  I use it for the skiing and will use it for beach volleyball when that returns.  It is not because the knee feels weak or unstable but to protect against possible future injury.  I am now 68 years old.  I have some osteoarthritis in the affected knee (as I did before the injury) but it doesn't bother me that much; I am still able to do a full day of skiing with just minor pain.  Because of the arthritis, I don't run that much or do other things that are high impact but I am pleased with what I can do.  It seems that the cycling and the Telemark turns are building my quads and I hope that strong quads and flexibility and use of the brace will help me avoid further injuries.

SofaGeorge, how is you knee doing?  It has been 13 years now since your original post.  Is your knee doing better these days?
« Last Edit: March 21, 2021, 08:03:42 PM by DougF »















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