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Author Topic: Extension after ACL reconstruction + Posterior Knee Pain  (Read 3487 times)

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Offline willdo

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Extension after ACL reconstruction + Posterior Knee Pain
« on: August 14, 2014, 05:40:28 AM »
Hi all!

I tore my ACL along with my meniscus in April of this year. At the beginning of July I had ACL reconstruction with a peroneus longs allograft along with a meniscal rasping in order to promote healing to my meniscal tear. It will be around the 6 week mark this week. I should mention that before my reconstruction, I had pretty much full range of motion and was doing physical therapy.

I started physical therapy about one and a half weeks after my ACL reconstruction. At that point, I had significant quad atrophy and could not do a straight leg raise for about 2 to 3 weeks. For about three to four weeks after the surgery I had extremely limited range of motion.

However, my knee recovery has picked up and I am making gains. Most recently my knee has been able to reach -1 degrees of extension and 115 degrees of flexion. And I am able to fire my quad now. However, we are still not happy with my extension. Ideally, I would be at 0 if not over 0 like my other leg.

I have been doing prone hangs, quad sets with my foot under a towel and everything I can do to increase my extension but I feel as if I have hit a barrier.  My doctor attributes it to a hamstring in spasm, as it is much tighter on my operated leg. Thus my PT has been working on massaging and stretching it. Should I be worried about my extension or lack thereof at this point?

I also have another issue. When I go from periods of flexion to extension, I feel a pinching in the back of my knee that is slightly painful. If I sit upright in a chair with my knees flexed and go to extension often it will pinch as I am extending and almost reflexively push me back into flexion. I have to slowly ease back to extension to dull the pinch. And over a period of time passively or actively at my max extension, the pinching slowly goes away. Does anyone have any insight on this pinching pain? What it is? How to fix it? It is extremely frustrating. Many thanks in advance!

« Last Edit: August 14, 2014, 09:20:59 AM by willdo, Reason: Details. »

Offline Scubagrl4

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Re: Extension after ACL reconstruction + Posterior Knee Pain
« Reply #1 on: August 15, 2014, 07:50:59 PM »
Hello will do,
I have had similar problems following ACL surgery and a MCL tear. My bigger issue has been with flexion, but for the same reason. I have been "solving" my problems by having one person push down and in on my hamstring while another bends my knee to prevent my hamstring from spasming. I have also been getting 1 hour massage with myofascial release right before PT, using the foam roller 2x a day, and taking a fairly slow approach to strengthening to avoid irritation.  It is taking a long time to calm down my hamstring, but is gradually working. I seem to be about 3 weeks behind schedule, but still making gains. Maybe you should try some of these things, and also be patient. I just broke up a ton of scar tissue this week and my muscles are starting to behave.
I completely feel your frustration. I'm sorry you are having a tough time :(
4/14/14 L ACL rupture, grade 2+ MCL tear
6/6/14 ACLr allograft
9/4/14 MUA
10/6/14 LOA/AIR, synovectomy, lateral/medial retinacular release, partial lateral menisectomy, chondroplasty, deep tissue
biopsies.
11/20/14 insufflation, MUA
10/19/15: LOA/air, PLM, chondro, synovectomy, med/lat releases

Offline willdo

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Re: Extension after ACL reconstruction + Posterior Knee Pain
« Reply #2 on: August 15, 2014, 10:36:27 PM »
Scubagrl,

It's so comforting to know that I'm not the only one with terrible hamstring tightness. Out of curiosity did you have any hamstring problems before your ACLr? Did you use a hamstring graft? My OS actually showed me that exercise the other day, so I'll have my PT replicate it. Surprisingly my PT has told me to avoid foam rolling for now until I gain better quad strength so my foam roller has been neglected.

I'm about 2 weeks behind schedule as well. Keep going! I was stuck at a point of 75 for flexion for a while, then miraculously my knee started making crazy ROM gains in that direction! Hope all goes well!

Offline Scubagrl4

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Re: Extension after ACL reconstruction + Posterior Knee Pain
« Reply #3 on: August 16, 2014, 04:03:19 AM »
Willdo,
Thanks for the encouragement...hearing it always helps :)
I had hamstring pain and cramping since the day of my injury. Because of all of my other issues, the hamstring was never really evaluated, but I'm pretty sure I strained it. It has been bruised since I injured it over 4 months ago. Like you, I had an allograft. There was too much concern with the amount of atrophy and scar tissue after being immobilized after the initial injury for three weeks...the doc was concerned with causing even more trauma. I was willing to use the other leg, but that knee looked arthritic following three previous patellar subluxations. My hamstring also cramped getting onto the operating table. So, it has been a pretty long journey so far.
Luckily, my PT and doc think I am out of the woods. With help, I can get to 137 of flexion. I just can't get myself there yet b/c of the hamstring. I think I can get to about 105 after some stretching. I just wish it could maintain so I can walk normally. 4 months with a limp is no fun :( this has definitely been a huge lesson in patience.
How long ago was your surgery? Are you walking fairly easily at this point? Oh, and have you tried terminal knee extensions? They might help. You have someone hold a theraband, put it around your leg just below the back of your knee, then straighten against  resistance while contracting your quad. Just a thought...
4/14/14 L ACL rupture, grade 2+ MCL tear
6/6/14 ACLr allograft
9/4/14 MUA
10/6/14 LOA/AIR, synovectomy, lateral/medial retinacular release, partial lateral menisectomy, chondroplasty, deep tissue
biopsies.
11/20/14 insufflation, MUA
10/19/15: LOA/air, PLM, chondro, synovectomy, med/lat releases

Offline willdo

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Re: Extension after ACL reconstruction + Posterior Knee Pain
« Reply #4 on: August 17, 2014, 06:02:36 PM »
I too injured my hamstring a few months before ACL surgery! By the time I went under though, it had pretty much healed and was not bothering me. I'm sorry that recovery isn't as going well as you hoped. 4 months is a long time and extremely frustrating.

I can't reach 137 degrees of flexion yet, but getting my flexion back was interesting. I was stuck at 75 and it seemed I would never get anymore, then suddenly it just started coming back! Hopefully it picks up for you! To get my flexion back I spent around 20 minutes a day on an exercise bike, another ten minutes laying on my back with my legs against a wall and my back a small distance from the wall and sliding my feet down to maximum flexion, doing heel slides and finally sitting it a chair facing the wall with toes up against the wall moving my butt forward as each position got more comfortable.

I'm around 6 weeks out of surgery. And I am walking fairly well and around 80% of the time without a limp. I have tried terminal knee extensions! They are parts of my very long physical therapy routine I do each day.















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