ACL, MCL Reconstruction done..what can I expect?

[Nasty1]

Hi

I was involved in a no fault motorcycle RTA in October 2010 in which I was T-boned on my right side, this left me amongst other injuries with ligament damage to ACL, MCL, PCL and LCL of my right knee...basically it was pretty floppy. To add to the mix I also had a 'bucket handle' tear to the outer Meniscus of the same knee only letting the knee flop so far. All of this sustained whilst wearing full quality motorcycle clothing with proper hard armour and leather knee length motorcycle boots.

The MRI scan revealed most of the above and I was warned that the knee had suffered major trauma and I could/should expect once repaired to experience possible loss in range of movement, possible constant pain of some degree, stiffness (off the knee ) and due to the level of flexibility my work requires, I may not be able to continue with my job.

March 2011 I finally had the reconstruction surgery to the knee in which the Meniscus was repaired and I had a full reconstruction of the ACL and MCL ligaments. The LCL was good to go after healing itself and the PCL is a mother to repair apparently so was left I believe.

I am now sat here 6 months after the accident, the leg is fixed in extension for a month until my next review (by the brace) so I cannot (nor aloud to) bend it and still unable to walk with out a full leg brace (run forest, run) or crutches. Pain is considerable still and hopefully physiotherapy should be starting around mid May.

I have been told that it will probably be 6 months of rehabilitation from surgery before I could possibly return to work on light duties, but could be more or less depending how things progress.

So even after all this my knee specialist consultant will still not advise on my suspected recovery outcome?? Hence my question  'what can I expect'.

I would be interested in other peoples recovery and success rate for getting back to normal after similar surgery.
Oh and for general info I am undertall at 5'7" and over weight at 15 stone prior to the accident and now 16.5 stone after 6 months of being stuck on crutches. I am 46 going on 47 an active physical job in engineering requiring considerable flexibility and I was just getting back into my mountain biking before the accident as part of a weight loss fitness regime.

Cheers

[sanjiv]

I see that it's been a while since you posted this question. I came across it when searching for info about another question.  How is your rehab going now?

I can tell you my experience so far with a similar, but lesser injury.  I had my ACL, PCL, and MCL completely torn in a skiing accident.  I also had a meniscus tear, but it was short of a bucket handle; and I had a sprain to my LCL, but it was maybe one grade 1.  My OS chose to do the PCL and MCL first and hold off on the ACL.  The first first months after the MCL/ACL reconstruction was very difficult.  With a lot of painful PT I finally got my knee bent down to 90 degrees, but hit a wall there.  I think what made it so tough was all the scar tissue the had formed during the first few weeks - like you I had to keep my leg immobilized in extension.  At that point my OS went back in and cleaned out scar tissue and gave me a MUA.  Once all that scar tissue was out he was able to bend my leg to 120 degrees.  I managed to hold onto that flexion, and build back strength in my knee.  A few weeks ago I even went hiking/camping with a light pack.  However, I have less stability than before the injury.  My knee feels loose, like I read so many describe on these boards.  My OS said that being a little loose is the tradeoff for having more flexion.  Last week my OS went in again to reconstruct my ACL.  I'm about a week out from the ACL reconstruction.  I'm again keeping my leg locked in extension for sleeping and walking.  I see my OS for followup in a couple days and will begin rehab again.

[gregoryk]

Hey Nasty1 and sanjiv,
I was on the receiving end of a motorcycling accident (as a pedestrian) and would like to know how your rehab and recovery is going.
more info here: http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=57345.0
Lucky me, being stuck at home with my leg immobile in a 30 degree brace, I had the chance to look up online and thanks to Kneeguru I became aware of adhesions and other related issues so I started mobilizing my patella from the second week (soon as the swelling subsided a bit) so when the hard brace was removed a week ago, I was already able to flex a little. Met with my OS yesterday and he was happy with my progress and mentioned he will use a synthetic ABC Surgilig for my ACL (coming up in a month or so) and said he will do an "over the top" technique which will see me out of surgery without a brace or crutches! ?
What kind of work was done on your ACLs?

[sanjiv]

Hi gregoryk,
My ACL reconstruction was done with a donor (allograft) posterior tibialis tendon.  Not sure what kind of surgical procedure it was (i.e. "over the top" or something else).  As far as incisions, I have two small arthroscopic incisions above my kneecap, and an approximately 4cm incision below my kneecap.  The 4cm incision overlaps the bottom portion of the scar from my MCL repair.  There are no incisions on the back of my knee, so maybe I did get an "over the top".  I am only a week out from the ACL reconstruction, and haven't had my post-op follow-up or started any formal PT yet.  That said, the recovery so far has been a lot easier than this point in my MCL/PCL operation.  Much less pain than before, and by day 5 I stopped using crutches (but am always wearing a brace locked straight). 

Why is your leg locked at 30 degrees and not straight?  Is your OS worried about possible mensicus damage?

[Nasty1]

Hi

And thanks for the replies.

I must confess I did not think I was ever going to get any feedback and forgot about this post. My rehab I would say has not been very successful to date. Here in the UK my knee consultant surgeon has not been so keen on giving me all the technical terms so forgive my poor descriptions.

I have had on 30-03-11 a reconstruction of the ACL and MCL on my right knee and a keyhole repair for a bucket handle tear to the meniscus. The PCL was also left severely damaged but here in the UK they appear not to repair them as if they go bad they go very bad. My ACL was repaired using 2 hamstring tendons stripped from my good (left leg) this has left me with a 3cm scar below and to the inside of the knee cap. The MCL was repaired by taking a section from the rear of my kneecap along with a section of quadricep tendon attached and used as the graft to repair my MCL, it was basically a small piece of bone with tendon already attached.
From the 30-03-11 to the 06-06-11 I was in a full leg brace, for half this time I was locked in extension 0 degrees and then allowed flexion up to 90 degrees. When I was released form the brace the knee was good and tight with approx 90 degree flexion but very weak and painful, I had lost virtually most of my muscle mass in the leg over the 5 months waiting for the operation. My surgeo put me into physio but with strict orders to take it gentle!
Mid July The knee started to loosen up again and it was established that the staples had pull out holding the MCL graft to the bone...now my knee rattles from side to side again. This combined the shifting of the knee forwards/backwards because the PCL is no good has left me almost back to square one. The ACL is still good and there is no talk of further surgery at this time, my surgeon thinks I can still make an acceptable recovery still.

So currently I am still in considerable daily pain, the knee is very weak and still have little muscle mass and struggling to build any back. The knee bends to 90 degrees then does not want to go any further, they suspect the PCL is causing this. Overall I think I am getting no where fast but glad to hear your making progress.
Cheers

Adie

[sanjiv]

Hi Adie,
I deeply sympathize with what your going through.  The pain and struggle of PT is one thing, but the uncertainty of what the outcome will be just adds on top of that. 

I'm a little concerned to hear that your doctor has not talked about further surgery.  Have you specifically asked him for it?  It seems like going in and fixing your MCL again and PCL at the same time would be a good next step.  It may be that your specialist doesn't know how to do a PCL reconstruction.  My understanding is that PCL reconstructions are tricky.  Can you ask your specialist for a referral to get a second opinion?  Here's a link discussing ideas for how to go about that in the NHS.
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=57319.0

[Nasty1]

Thank you for the link. I do not quite understand why further surgery has not been considered, my OS is certainly not one to rush into things and likes to see what the body can achieve on its own before what could be unnecessary surgery.

I suspect at my age (47) and not being sports orientated it is not necessary to go for the perfect fix but what do I know? My OS is apparently highly regarded and I had to wait a considerable time because they wanted me to specifically see him, he has special interests in sports related injuries and partial knee replacements so should know his way around a ligament or two.

At my next appointment with him I am going to ask if anything more can be done as I feel it is the pain through movement in the knee that is stopping me from progressing.

Cheers

Adie

[gregoryk]

Hi adie, I had a little trouble asking questions to my OS... He is supposed to be one of the best (ain't they all?) so far so good. But after a couple weekly visits I figured I'd keep notes if what I want to ask and then I hit him with the entire list. Your OS should be happy to explain your options. I am new to this stuff so I am learning as I go but take some pointers from around the board and if you show your surgeon you are expecting something then he will have no choice but to sit down with you and explain what goes where and when (so to speak)

Hi sanjiv, knee was locked at 30 degrees because as the surgeon explained, after the MCL was reattached (it was a clean cut) the resting position for the ligament is with the knee flexed between 0-90 degrees and 30 is a happy medium. Anything close to the extremes (0-90) and the ligament will be stressed. 
I guess mine is not the run of the mill ligament sprain. I got a picture from my OS and the MCL looks like it was laser cut (I guess the bike that hit me was going a wee bit faster than the limit)

[ese230167]

Hi Nasty1 (sounds odd!)
Can I ask what technique your surgeon used for ACL and MCL recon? I'm having both done in a few weeks and mine is proposing LARS (synthetic) for the MCL and an Allograft for the ACL

I had the ACL done in June (after seriously injuring the knee skiing) with an allograft but due to the continued instability of the MCL (because they chose not repair it) I have now got a fully ruptured MCL and have re-ruptured the ACL!! So back to square one (and worse).

I'm just not comfortable with the LARS thing and would rather have allograft or autograft. But they're reluctant to take my own tissue because my other knee has had significant surgery already (I am a crazy skier and runner!) and the currently injured knee is quite a mess!

Any advice on how you're getting on, rehab, and what techniques you had used would be greatly received.
Many thanks. Bunny

[Nasty1]

Hi Nasty1 (sounds odd!)
Can I ask what technique your surgeon used for ACL and MCL recon? I'm having both done in a few weeks and mine is proposing LARS (synthetic) for the MCL and an Allograft for the ACL

I had the ACL done in June (after seriously injuring the knee skiing) with an allograft but due to the continued instability of the MCL (because they chose not repair it) I have now got a fully ruptured MCL and have re-ruptured the ACL!! So back to square one (and worse).

I'm just not comfortable with the LARS thing and would rather have allograft or autograft. But they're reluctant to take my own tissue because my other knee has had significant surgery already (I am a crazy skier and runner!) and the currently injured knee is quite a mess!

Any advice on how you're getting on, rehab, and what techniques you had used would be greatly received.
Many thanks. Bunny

Hi Bunny

'Nasty 1' is an old gamer tag I used when online gaming many moons ago...its sort of stuck and I use it for most forums...not really a reflection on me!

Anyway I am afraid I do not know what the medical terms were for my two types of repair although I have detailed them in the posts above. What I do know is that it was all my own tissue, the ACL being done with Hamstring tendons  taken from my good leg and the MCL being done with a bone plug and tendon taken from the top of knee cap on the bad leg, the picture attached further up shows the scars after surgery if that helps any more.

Again my progress has been briefly described in posts above detailing the failure of the MCL etc. Sorry but not more has developed or improved.

Personally I feel that I will end up living with an element of constant pain and doubt that I will flex the knee beyond 90-100 degrees again, I should find out inthe next couple of weeks wether the accident has caused the loss of my job.

Good luck with your surgery though. One last thing, I have not researched it myself but believe grafts from a Cadaver can be used but like I said I do not know anything about it but may be worth researching on the risk of rejection/infection.

Cheers

Adie

[ese230167]

Sorry Adie, I don't know why I didn't see the previous detail - you have indeed outlined the surgery very well! I think I'm going to push for more of my own tissue to be used. I guess I'm not that trusting of the allograft (cadaver) route following the previous ACL failure.

Your MCL reconstruction  sounds interesting and my surgeon hasn't mentioned that technique so will ask him about it. I'm 45 but very physically active so I'm very keen to have a good strong knee and the synthetic/cadaver route just doesn't feel right!
Good luck with your rehab
Bunny

[Johnnyp060]

Hi, I too am in the same boat. To make a long story short, I was in a dirt bike crash March, 2012 which tore my ACL, PCL and MCL. I had my surgery May, 2012, replaced all ligaments with cadaver tendons. Had a sucky year after surgery going to grueling PT 3 times a day for 3 hours at a shot. I'm getting stronger every month, walking better, have good ROM and able to ride my bike again. Then about a month ago I started having issues with my kneecap not tracking right. I called my Doc to go in for a visit and just found out a couple days ago that the ACL and PCL healed up really well but the MCL, where the worst of the worst of the damage was, never healed correctly. I have to go in for another surgery now to have the MCL redone. I'm hoping beings my leg is pretty strong now, there's a lot less trauma to my leg that my body will be able to focus more on healing the MCL this time around. I'm hoping and praying.