ACL Surgery...stiff knee..OS told I have Early Arthofibrosis...

[Kearns]

Blew my knee while skiing.  5 days later had a scope and found out I had damage to mcl and acl.  1 week later another scope for a new acl allograft...I am the walking dead.  5 more days and back in hospital with a blood clot.

I am now 5 weeks out and have bad rom 0' extension but only 75 flexion.  Saw a new OS and he called it early arthofibrosis.

He has me on a CPM at night (wish I had this earlier...like right after the surgery)

Going to PT twice a week and trying home exercises,  but knee feels locked up!!!

Anyone had a similar experience... I am getting pretty freaked and not sure what else to throw into the rehab mix!

TIPS??

[Kearns]

Should add...I had limited ROM before the surgery.

Didn't know the risk of early operation and pushed to "get it fixed".  OS didn't seem too worried so I went for it.

Not so sure now.

[EdD]

Sorry you are going through this!! What are your other symptoms? Is your knee red, hot and swollen? What makes it better or worse? Are you icing? Where are you located?

[Snowy]

Yes, unfortunately that's one of the reasons they often don't recommend early surgery. It's very hard to get full range of motion back afterwards if you go into surgery with it limited.

Is the surgeon sure it's arthrofibrosis? If so, I'd strongly recommend heading over to the arthrofibrosis section of the board and doing some reading up. The right treatment for AF is key. There are a lot of horror stories about people whose surgeons didn't take the right approach and triggered further inflammation through well-meaning attempts to force ROM, which led to more scar tissue.

It's a rough complication for sure, but at least if it is AF you've caught it early. And there are some great resources on this board to tap into. I'd suggest reposting this over on the AF section to get some first-hand opinions and recommendations on what to do next.

Good luck! I also sacrificed an ACL to the snow, so I sympathise - and I'm sorry you're dealing with complications. Sounds like the new OS is on the ball, which is a good thing. Will keep my fingers crossed for you.

[Kearns]

Thanks for the reply.  I am in Canada.

It does still get swollen after physio exercises and I love ICE!!!
No heat or redness.

I am also stiff after a good physiotherapy session.


Hey Snowy....so I shouldn't. Be pushing ROM too hard???
This new OS suggested I should be reefing on it to break adhesion....but sounds like this may backfire.

Ugh....

[Kaputt_Knee]

Don't worry about having had an "early" fix - a) it's done now and you cannot undo it and b) it does not always lead to complications. I've had both - even same day surgery and was back skiing within a year each time. Ultimately it comes down to 2 things - the skill of your surgeon and your will to push through with the rehab properly.

It may well be early onset of arthrofibrosis, but I would also not fixate on that just yet. Some people simply heal more slowly than others - now that is a fact and it has little to do with whether you go into the procedure super fit or not. Yes, it is better to start the surgery with as little reduction in the ROM as possible, but it is not a critical factor by any means. If it were, the surgeon would not have operated. The fact that you surgeon is even aware of arthrofibrosis is good news just in case as many seem to have a major blind spot on that particular subject. Next time you see the surgeon ask what is the next step if it does turn out to be arthro. Their answer will tell you whether they really know about the condition AND its treatment (especially in the early stages when it can be treated successfully without surgery). In the interim read up as much as you can so you are knowledgeable about the condition, symptoms and treatment options. Luckily in the Information Hub here is probably the best collection on the web of articles and information about this condition.

Try to give yourself a break is my best advice, the flex may start to improve now you are spending time in the CPM. You have almost full extension which is a big positive and OK 75° is not as good as many after 5 weeks, but you have undergone two surgeries and also treatment for a blood clot, so cut yourself some slack. 

Sue 

[Kearns]

Thanks. Sue!!

Patience and faith.   I appreciate your advice....forward looking and positive.

CPM is nice....wish I had one immediately post op...but this is good as well.

Cheers

[Kearns]

Still working....

I am at 100 flexion and now 8 weeks post acl reconstruction.

Dr is talking scope debridement and manipulation. 

Will range of motion come back without a scope.

Anyone have a theme ought for a guy with a stiff knee

[Kaputt_Knee]

Sorry, I've been really busy with work and just spotted this! 

Has any decision been made about the scope and debridement? If it has, disregard the rest of the post!

OK instead of thinking "WOW 8 weeks and not too good, think WOW 2 months it's coming along slowly but surely!"

Some people heal fairly slowly, others heal really quickly - we are all individuals and cannot, particularly in the case of rehabbing, be fitted into one neat catch-all box.

If your surgeon is so keen to get in there, ask why? Ask for a justification of the plan of action. Evidence and experience at diagnosing and treating these things would help improve your confidence in the surgeon's advice.

I know you are in Canada and the wheels of the system sometimes grind slowly, but you always have the right to ask for a second/alternative opinion. That should really come from a doctor who specializes in this procedure and is independent of the other doctor. Sadly colleagues in the same hospital are not always truly independent, so you may have to go elsewhere for a true evaluation.

My advice would be to avoid any kind of surgery until it has been proved that the benefits far outweigh the risks and that there is "gold-plated evidence" (if such a thing ever exists) that surgery is the only route to go down because all the others have been tried and failed.

A compromise may be to go for the MUA, but make sure you exclude any kind of surgical procedure while you are unconscious. The block on the flex may well be a sub-conscious one. By putting you under they can play with your knee to their hearts content and truly see if there is a physical block to the the flex. The fact that you are improving your ROM, albeit slowly does not really indicate that there is arthrofibrosis in there. But perhaps some big clump of scar tissue which an MUA can break up. They have been successful for me at doing that on a couple of occasions.

Anyone have a theme ought for a guy with a stiff knee

- working on an i-Pad or-Phone by any chance? 

It can take time to recover flex, for some a very long time but it does return to a functioning level if everything else is right. I still don't have full flex in either knee but I can ski and do all I want to so I really do not give a tinker's cuss if my heels cannot be bought up to my butt! I'm doing my best to help - like letting my butt sag towards the heel these days!  I am skiing on a regular basis, over 50 days again this season (but I was wiped out in December/January with bronchitis/pneumonia so too knackered to ski much then). The one time I had real problems I could not get full extension and the flex was also off. Turned out the surgeon had placed the graft incorrectly as well as inserting a graft that was way too wide. Perhaps asking the surgeon if the problems he thinks you are having are not so much to do with you as to do with his handiwork might get him to rethink his ideas!  Whether that is a good idea or not in reality is up to you to decide as you know your surgeon and have an idea about the ego aspect!

Keep us posted as to how things develop. I hope you are a tortoise in terms of rehab - slow but steady and you will get there in the end. From what I've heard you did not miss much in terms of the end of your season. All my Rocky Mountain based friends have been complaining about the snow, or lack of it compared to other years! 

Sue 

[Kearns]

Thanks again Kaputt.   Aka Sue

I have two OSs saying I don't need debridement or manipulation....so that is good news.

I am now at 11 weeks and ROM is at 100 degrees.  The knee is improving...I am just not believing that the range is ever coming back.

Can ROM still come back this late???  Things I read are that what I have now is sort of what I will be left with...any flexion experts out there?

I really appreciate the input.

[Kaputt_Knee]

Patience, patience patience! 

You are still only at 11 weeks - the first stage of vasculization is barely finished so give yourself a break for goodness sake!   

You really do need to read up some more on the general principles of rehab to get an idea of what is involved BUT remember that every single one of us reacts/rehabs at different rates. There is no "Norm" that you have to be measured against as it is impossible to set one. The Information Hub on this site is a really good place to start as it has masses of information about general knee anatomy as well as specific information about ACL related topics.

How is the swelling around the knee? Quite often there is more than you think and this can inhibit both flex and extension.

Whether or not you get back the full range of movement your non-operated knee has depends on so many factors as well as time. I did actually get my right heel to my butt once after a Pilates session about 15 years after the last reconstruction. I was quite shocked and have since been unable to repeat this "momentous event" - do I care - nope! Does it stop me from taking part in the sports I enjoy - nope! I think my age has slowed me down more than anything, but according to most of my friends I still do way more than most people with my shade of grey hair! 

Concentrate on what you can do and then push the envelope a wee bit more. Setting yourself huge goals at this stage of things is going to result in disappointment. Look back over this thread for example: you were worrying about only 75° of flex a few weeks back - now you have 100° and climbing! Celebrate your achievements, it is way more constructive in the long run!

Recovery from an ACL reconstruction should be seen as being like running a marathon - start out sprinting and you end up in trouble before half the course is through. Pace yourself sensibly (for you not others) and you will be back participating in your sports before you realise it. The recovery is a marathon, not a 100m dash so relax and cut yourself some more slack. Even in Canada, winter has finally come to an end, get out and enjoy the Spring and summer, you will be amazed at how much things start to improve once you are out and about.

Sue 

[Kearns]

Thanks again....I know...I know

Funny that I listen to your opinion pretty much the same as my doctors.

Confidence in a recovery is hard...but I am realizing super important.

[aef1000]

Hi
Have you had an MRI to see what's limiting your ROM?  I had a major postlateral corner injury with blown ACL, LCL, PCL strained, paraneal nerve attenuated, etc. Had 2 surgeries to repair the damage spaced a few months apart.  Had limited ROM before both surgeries.  Ended up with about 120 deg ROM. Not acceptae to me.  Finally got a new OS to MRI the knee and said to forget the PT the knee was solid full of scar tissue.  He went in arthroscopically and cut it all out. Immediately resumed PT and in a few months had full ROM.  Today my knee is as good as new.  You may need a more experienced OS that knows what to do with scar tissue
Anne

[Kearns]

I am going for an MRI in three weeks so this will hopefully give some insight.

Kaputt aka Sue is very positive, but I can't help feeling something is wrong.  When I say I am getting 100 degrees that is in physio after getting worked on while I am on drugs...my day to day ROM doesn't give much functionality.

Any stories about late bloomers in terms of getting ROM back? 

[Kaputt_Knee]

Sorry Kearns but if I have learnt one thing here, it is that if you think hard enough and long enough about something being wrong, then there will be something "wrong". 

Some people do take a long time to regain their ROM. With my very first ACL reconstruction (which was a general knee reconstruction by the way via open knee surgery), it took me about 4 months to get any worthwhile active flex. I was still limping when I made it back on to my skis a year later because my extension was crap. Some people would have screamed arthrofibrosis and looked at having more surgery and more surgery, etc. I had an incredibly patient and inventive physiotherapist who just kept plugging away until I was able to actively bend my knee beyond 90°. I did get full extension back eventually and the rest of my ROM came along slowly behind. I had a functional knee, but not a fully functioning one - which is probably why I blew the carbon fibre ACL a few months later slipping on spilt food in the school canteen.

There is a vicious circle in action here - the less activity you can do, the more the muscles atrophy, which means you can do less for yourself. Sadly under current tick box regimes, everyone has to conform to specific deadlines and if you have not achieved this degre by this specific date you are either lazy (they can't say that though) or you have scar tissue blocking the range of movement. I'm glad I'm no longer under such a regime and good physio as many times a week as you need to progress is provided without a second thought.

I really do hope the MRI shows that you are not among the very, very small proportion of the population who genuinely do suffer from Arthrofibrosis. It is a horrible condition and more surgery from an inexperienced surgeon will only cause more to develop. Poor outcomes from an ACL reconstruction are all too often due to poor initial placement or graft error by the surgeon, but sadly the vast majority of them are not able to admit to this. Perhaps getting a copy of your MRI pictures and taking them to an independent second opinion (i.e. not at the same hospital) will get you a better evaluation.

Good luck

Sue