Advertisement - Hide this advert





Author Topic: Post ACL reconstruction issues  (Read 3338 times)

0 Members and 1 Guest are viewing this topic.

Offline Rhisling

  • MICROgeek (<20 posts)
  • *
  • Posts: 7
  • Liked: 0
Post ACL reconstruction issues
« on: February 03, 2012, 11:37:45 AM »
Hi,

Great to find a place on the internet where people share their stories and can get advice.

My problem: I had an Anterior Cruciate Ligament reconstruction 4 months ago, with hamstring tissue. The knee feels very stable and I'm doing regular physio to recover the strength in the quadricep. I have full extension with no pain and 144 degrees flexion, but I'm working on increasing it.

Since week 2 after the surgery, I have a problem in one of the fat pads, the outer knee one. If I have the knee stretched and start bending it slowly, I start feeling increasing pain in the fat pad area. In a certain moment, let's say at around 30 degrees flexion, the pain/pressure gets to a point where something "pops" out. I can see something being pushed against the skin. It's as if the fat pad is near the patella tendon when the knee is stretched, and as I bend it the pressure increases in that area and it ends up with the fat pad being pushed out and away from the tendon, towards the outside of the knee. I'm not sure this is what happens, just looks like it...

I'm being followed by a physiotherapist team who never saw this issue before and my orthopedic surgeon says it's probably scar tissue in the fad pad causing the "pop".

Did someone ever see this and have an actual explanation for my problem? I googled some much, the only thing I found was hoffa's syndrome, but that should only happen if I had issues stretching the knee, which I haven't.

Any ideas would be great. Thank you in advance!!

Offline PiotrS

  • Regular Poster
  • ***
  • Posts: 62
  • Liked: 0
Re: Post ACL reconstruction issues
« Reply #1 on: February 03, 2012, 12:02:23 PM »
Hi Rhisling,

If you read my previous posts, you will see that I had exactly the same issue with the fat pad on the lower lateral side of the patella. My Physio also said it's the first time he has seen it - but clearly it seems it is not such a rare occurrence!

I am also 4 months on from my operation, and I have almost completely "fixed" the problem. For me it was a case of weak muscles (particularly VMO) causing patella maltracking and irritation of the fat pad. One of the portals for the arthroscopy was actually made around the fat pad area, so maybe there is some scar tissue issue there as well.

I had exactly the same mechanism for bringing on the pain as well, bending the weighted knee from an extended position.

The main tips I can give you, and what worked for me, was firstly kinesiotaping of the patella to help it track more medially. I had the taping for about 4 weeks in total (changed every three days by my physio). Secondly, avoid doing any exercise that aggravates the fat pad - give it some time to calm down. Thirdly, serious exercising of the quad of the operated leg to stregthen the VMOs in particular and correct the tracking. Before starting any physio session, I would do 100 weighted step ups on my operated leg. That seemed to get the VMO firing, and helped to keep the patella tracking correctly for the rest of the session, and even allowed me to do some potentially aggravating exercises without consequence for the fat pad syndrome.

I still do feel the fat pad occassionally, but now I really have to twist my leg into an awkard position for it to misbehave. There is still some swelling there as well, but I can do almost all exercises now, even involving slow bending of the knee from full extension under weight.

Let me know how you get on with that, or if you have any other questions. Like I said in the beginning, I don't think it is such a rare issue!

Piotr





Offline Rhisling

  • MICROgeek (<20 posts)
  • *
  • Posts: 7
  • Liked: 0
Re: Post ACL reconstruction issues
« Reply #2 on: February 03, 2012, 12:19:58 PM »
Thank you for the reply!

I'm leaving home now to get a second opinion from another surgeon, but tell me something: did you also feel the fat pad moving? Like a "pop" when the pressure built up in the fat pad while bending...

I'll come back with more info in a couple of hours.

Regards

Offline PiotrS

  • Regular Poster
  • ***
  • Posts: 62
  • Liked: 0
Re: Post ACL reconstruction issues
« Reply #3 on: February 03, 2012, 12:33:54 PM »
Yes, exactly the same. There was an increase in pressure and pain while bending, and then there would be a "release", I felt something, like a lump, slide past the patella (?) and then I could continue the bend. There wasn't an audible pop, but I did see a little bum appear in the fat pad area.

Offline Rhisling

  • MICROgeek (<20 posts)
  • *
  • Posts: 7
  • Liked: 0
Re: Post ACL reconstruction issues
« Reply #4 on: February 03, 2012, 02:23:37 PM »
Mate, that's exactly what I feel. I also don't have an audible pop, it's just that sensation of something sliding and being pushed against the skin.

Both surgeons recommended waiting more time, with very intense physio.
I've been doing that so I just have to continue.

I'm going to read everything you wrote now :)

Thank you so much, this has been driving me insane for 4 months now....

Offline PiotrS

  • Regular Poster
  • ***
  • Posts: 62
  • Liked: 0
Re: Post ACL reconstruction issues
« Reply #5 on: February 03, 2012, 02:55:25 PM »
No worries, I am sure you can get it sorted with the right rehab plan. Ask also about the taping - it really worked for me. Lots of step ups to work those quads, but avoiding step downs which irritate the fat pad.


Offline Rhisling

  • MICROgeek (<20 posts)
  • *
  • Posts: 7
  • Liked: 0
Re: Post ACL reconstruction issues
« Reply #6 on: February 03, 2012, 03:01:24 PM »
I had it taped for 3 or 4 weeks and it definitely helped. As soon as I stepped down from the "bed" with the knee taped the fat pad problem was magically solved.

Your timings are very similar to mine. I injured the knee in December 2010, had it operated in the 15th of September 2011.

I didn't fall or twist the knee like you did, my issue in the fat pad is here since the 2nd week post surgery.
I only have two strength training sessions a week, which include a bit of balance exercises. I'm going to return to the gym to work more on the strength and balance and I'll also start cycling intensively more often.

Again, thank you for replying, gave me hope that I can also overcome my problem.

Let's keep in touch, I want to know how you progress.

Cheers!

Offline PiotrS

  • Regular Poster
  • ***
  • Posts: 62
  • Liked: 0
Re: Post ACL reconstruction issues
« Reply #7 on: February 03, 2012, 03:47:48 PM »
To be honest, I cannot be certain that the fat pad issue started after my fall, or whether it was at that time that I started doing more forceful exercises that possibly aggravated the fat pad.

I currently do two physio sessions per week, and 2 weights sessions as well. Actually yesterday I noticed that my good leg is getting most of the benefit of the exercise, while my operated leg is still weak, so the physio told me to do exercises just with my op leg wherever I can - so I will be doing that on the leg press and on the bike tonight (it's possible just to pedal with the one foot).

Other than the fat pad I also have a bit pain on the lower medial side around the area of another portal - hoping it's just scar tissue rather than anything else.

Good luck on the rehab, and let's compare noted as we progress!

Offline Rhisling

  • MICROgeek (<20 posts)
  • *
  • Posts: 7
  • Liked: 0
Re: Post ACL reconstruction issues
« Reply #8 on: February 05, 2012, 09:36:48 PM »
Do you feel that the pops and pain increase when you spend a lot of time sitting with your knee bent?
I feel better after a training session but if I spend some time sitting the knee gets stiff and the pop/lock increases...

Cheers!

Offline PiotrS

  • Regular Poster
  • ***
  • Posts: 62
  • Liked: 0
Re: Post ACL reconstruction issues
« Reply #9 on: February 09, 2012, 12:19:28 PM »
I think generally the problem is worse when the muscles are "cold" since the tracking will be worse with the muscles not fired up and working to keep the patella in place. Straight after exercise my knee generally feels stronger, probably for that reason.

Apparently there is something called "movie theatre syndrome" that happens when the knee is bent for a long time - although I am not sure if it is related to our particular issue!

Mine seems to have got a bit better again after a few days out in the mountains. Did a few sessions of cross country skiing, which probably helped to strengthen those muscles a bit and improve the tracking.

Offline Rhisling

  • MICROgeek (<20 posts)
  • *
  • Posts: 7
  • Liked: 0
Re: Post ACL reconstruction issues
« Reply #10 on: March 13, 2012, 04:41:27 PM »
How's your recovery going PiotrS?

My popping is becoming less noticeable. Just did some tests and the difference between quads is around 30%, on the limit to start some light running. In 1 month I should be able to run  ;D

Offline PiotrS

  • Regular Poster
  • ***
  • Posts: 62
  • Liked: 0
Re: Post ACL reconstruction issues
« Reply #11 on: March 13, 2012, 05:27:52 PM »
Hi!

Things are going pretty well! I still get the occassional tweak in the fat pad, particularly if I deliberately bend the knee in a way to aggravate it. But it certainly doesn't affect exercise or movement in any way.

The muscle strength has really increased the last few weeks, and now in fact my left, operated leg, is stronger than my right leg on almost all exercises. I was really surprised that the hamstring strength in my left leg is so much better than in the right, seeing as I am missing a few tendons in there!

I have started jogging around the rehab room, but not been allowed to run outside yet - appartently that will come in two weeks. Have started biking, and doing around 30km on the mountain bike at the weekend. That has really helped with the quad strength I feel. Overall the knee feels pretty good now, almost without any signs of having gone through an operation. I will hit the 6 month mark in two weeks.

Offline Rhisling

  • MICROgeek (<20 posts)
  • *
  • Posts: 7
  • Liked: 0
Re: Post ACL reconstruction issues
« Reply #12 on: March 14, 2012, 02:10:54 PM »
You're recovering faster than I am then. That's great for you!
Having the pop since week 2 slowed down recovery, only now I'm getting it back on track.

Good luck with the recovery and talk to you soon!

Offline ap14

  • MICROgeek (<20 posts)
  • *
  • Posts: 1
  • Liked: 0
Re: Post ACL reconstruction issues
« Reply #13 on: April 27, 2018, 03:06:56 PM »
Hey Rhisling,

I know this is a long shot that you will even see this considering it has been 8 years, but was doing some research as I have been having issues with my knee post ACL surgery (3 years ago), for which no surgeon/PT has been able to solve yet. I came across your original post here and my pain is IDENTICAL.

Just wanted to see how you are doing, if the problem has gone now and if so, how you went about getting it sorted?

Really appreciate the help!















support