Banner - Hide this banner





Author Topic: ROM after ACL reconstruction  (Read 2082 times)

0 Members and 1 Guest are viewing this topic.

Offline adamn

  • MICROgeek (<20 posts)
  • *
  • Posts: 17
  • Liked: 0
ROM after ACL reconstruction
« on: October 26, 2011, 09:03:04 PM »
Hi, I had an ACL reconstruction 1 week ago using a hamstring graft. How much movement have others got in the knee at this stage of recovery, if I try doing heel slides I have around 20-30 degrees of flexion and around 70 if I'm sat on a chair with the leg hanging. Is this a good range of movement after a week or should I be expecting more?

Thanks

Adam

Offline Kaputt_Knee

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • Posts: 24562
  • Liked: 75
  • [Ed: Sue sadly passed away in 2016]
Re: ROM after ACL reconstruction
« Reply #1 on: October 27, 2011, 07:10:00 AM »
Hi Adam,

Take it easy and do not fixate on the flex in the initial stages. I think we all have done it but it actually not the most important initial measurement. The most important measurement for you is extension. Without full extension you will still limp and therefore the whole bio-mechanical form of your body will be out of kilter.

Currently the amount of flex you can achieve is pretty well controlled by the degree of swelling in and around your knee. As long as there is swelling your flex will be limited. Work on reducing the swelling and at the same time you can work on your extension.

For example when you ice, raise your foot and support the leg under the ankle. Let the knee passively hang, this helps regain the full extension. It feels weird at first, but once you get used to it it is a good way to do two things at once. while you are icing, pump your foot back and forth by pointing your toes down and away from you, then bringing them back as far as you can. n other words deliberately waggling your foot up and down. This helps to pump the fluids in your lower leg and around your knee back into the core of your body where they will be reabsorbed.

Once you have full extension you will be able to walk without a limp and you will find that the knee flexes much more easily.

Sue  ;)
1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee

Offline PiotrS

  • Regular Poster
  • ***
  • Posts: 62
  • Liked: 0
Re: ROM after ACL reconstruction
« Reply #2 on: October 27, 2011, 09:40:59 AM »
Like Sue said, I don't think flex is as big an issue as extension at this stage. I was probably around the same in terms of flexion at your stage, although I was not really checking, and not trying to increase it at all. All the early exercises were about extension and muscle activation, and half the rehab was spent on working on the swelling.

I think I started on flexion after two weeks, by doing a kind of heel slide with my feet on one of these big inflatable rehab balls - it's much easier than doing heel slides on a level surface, and I think it also helped that the leg and knee were elevated throughout the exercise.

I got to about 120 degrees flexion after four weeks and now am making slow but steady improvements almost every day (today is exactly 5 weeks after my op).

Offline adamn

  • MICROgeek (<20 posts)
  • *
  • Posts: 17
  • Liked: 0
Re: ROM after ACL reconstruction
« Reply #3 on: October 28, 2011, 09:37:23 AM »
Thank you for your replies,

Offline Snowy

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • Posts: 2555
  • Liked: 93
Re: ROM after ACL reconstruction
« Reply #4 on: October 29, 2011, 05:50:15 PM »
Sue gives some really great advice on this. I just wanted to echo the comments about not fixating too much on flex, especially in the early stages. I had horrible swelling after my surgery that took forever to go down, and as a result my flex lagged a long way behind other people whose diaries I was reading here. I worried about this at the time, but my physiotherapist kept telling me that I shouldn't be concerned and we'd get there in the end. I was definitely slower to regain flex than the average person, but he was absolutely right - I did get there in the end. On the plus side, my general mobility and strength improvements were quicker than average. Every recovery is individual, and we each have our own strengths and weaknesses as we work through it.

Best of luck with your recovery!
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline Palmfond

  • MICROgeek (<20 posts)
  • *
  • Posts: 1
  • Liked: 0
Re: ROM after ACL reconstruction
« Reply #5 on: May 21, 2014, 02:38:45 AM »
Great posts- good encouragement. I am 34 and 6 weeks post acl and meniscus repair from skiing accident 2 weeks prior to that. I am only at 87 degrees flex and -2 extension. I am obsessively working on the flextion. My doc is talking manipulation if I don't get to 120 in 3 weeks. The last 2 weeks have only offered 2 degrees. Did you have manipulation sue? I am thinking of refusing until 12 weeks. Thoughts?  Like you I am excelling on strength. Personal note: It feels locked and when I try to force beyond that point- I feel knife like pain straight through the knee.  I have tried working it in the pool and it clicks. I am uneasy about the slowness of recovery and the continued swelling despite icing and elevation. Help?

Offline Kaputt_Knee

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • Posts: 24562
  • Liked: 75
  • [Ed: Sue sadly passed away in 2016]
Re: ROM after ACL reconstruction
« Reply #6 on: May 21, 2014, 07:00:40 AM »
Don't obsess on the flex ;D So easily said because we all do it but the less you actively think about it the better it gets, albeit in some cases relatively slowly.

You had a meniscus repair and that actually slows things down quite a bit. When you have just a repair, the rehab protocol is completely different to that of an ACL so currently you have conflicting protocols - ACL requires movement, meniscus repair requires babying!

Work hard on walking as normally as you can and reducing any residual swelling. Continue to push for full extension: a) it does not affect the repair site and b) it enables you to walk without a limp. As soon as you stop limping, you stop thinking about "how" to walk. The flex can be worked on in a variety of ways that do not overload the repair site - cycling, ergometer (rowing machine low resistence settings) but best of all aqua-jogging (that's what helped me the most). The clicking is irrelevant unless it is accompanied by pain, then you go back to your surgeon to get it sorted out.

I did undergo an MUA, but they still had to go in and trim a wee bit more off my meniscus, then I was OK. The MUA itself is nothing, barely 15 minutes under GA. It enables the surgeon to manipulate the knee to see if there is actually anything physically blocking the knee, it is really quite a gentle procedure. The GA is the biggest danger to be honest. Whether we are aware of it or not we mentally block pushing the flex for "fear" of harming the repair. While under GA we are completely relaxed and the surgeons can actually move the knee in all directions to see exactly what is stopping the progress. Very occasionally there is a build up of scar tissue in the knee and the manipulation can break this up.

This should not be confused with a horrible condition called arthrofibrosis though. ALL operations cause scar tissue, some of which breaks up naturally and some of which requires movement to break it up. Sometimes it is pretty determined not to break up, that's when an MUA is useful. With arthrofibrosis the body does not stop producing scar tissue, so an MUA is often just another signal to it to produce more and faster. Despite what you read here, arthrofibrosis affects very few patients. We see and read more about it on this web site because people come here when problems have already slowed their progress down. This is probably the best resource on the web for information about it BUT a slow rehab from an operation does not always mean you are suffering from this horrible condition. sometimes some of us just heal slowly!  ;)
1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee















support