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Author Topic: 2nd ACL reconstruction. Hamstring vs patella tendon recovery  (Read 4159 times)

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Offline Zimframe

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2nd ACL reconstruction. Hamstring vs patella tendon recovery
« on: November 08, 2016, 11:56:41 AM »
Hi guys
I'm new to the forum and very glad to have found this site!
I am now 4 days post op for a patella tendon ACL revision with lateral tenodesis.
My original reconstruction was in Aug 2015 with a hamstring graft which failed approx 7 months after surgery due to me being too eager to return to full martial arts training 😖.
I thought it may be useful to share my experience of the recovery process and how it has differed for the two procedures.
I'll start with a quick overview of my progress after the 1st recon (hamstring graft).
The surgery went well, I managed to avoid having the meniscus repaired and instead got away with a small amount being trimmed off. I was astonished by how quickly my initial stages of recovery went, I was able to fully weight bear and walk with minimal limp after 2 days and had not lost much control of my quad at all. Full ROM had returned between 1/2 weeks and I was off all pain medication within 3 days. I took physio very seriously and despite a small hamstring tear made good progress. By 5 months my leg was stronger than it had ever been and I was focussing on impact and change of direction exercises.
I then learnt the hard way that there is no way to accelerate the maturing of the graft, regardless of how strong the leg has become. To me, my knee felt fantastic and I threw myself back into karate and rock climbing. It held out for a couple of months before I had that dreaded feeling of my knee "giving out" during a sparring sessions. MRI scan confirmed a full rupture of the graft. Gutted but only myself to blame😑
So anyway, by the time I had seen a surgeon and with waiting time I had my revision surgery on 4th Nov 2016. After A long discussion with the doctor, he told me the best option was to this time use a patella tendon graft and also add a lateral tenodesis procedure to add rotational stability which was a slightly bigger operation but there didn't seem to be much choice.
So here I am, 4 days post op, very early stages but so far I can tell you in feels like a whole different ball game. Pain is far worse, a lot of swelling is really restricting movement and my quad is well and truly shut down haha.
I've been trying to push my range of motion, I can straighten my leg but not near full extension yet and can almost get 90 degrees flexion albeit very very slowly. My main focus is on icing and elevating right now and trying to ease the pain up a bit.
I'll try to keep documenting progress and i hope this is of use to someone.
Any advice would be greatly appreciated as well!

Offline Zimframe

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Re: 2nd ACL reconstruction. Hamstring vs patella tendon recovery
« Reply #1 on: November 10, 2016, 08:59:59 PM »
So, a couple of days on (6 days post op) and things are looking slightly better already.
Pain has reduced enough that I decided to stop taking dihydrocodeine today and just stick on the paracetamols as the DHC makes me feel like crap.
My flexion has increased slightly but it is returning the leg to straight after this that causes the most pain so I have been hesitant to push it any further.
To my delight, I managed to achieve a straight leg lift using a huge amount of will power which shows that the quad is starting to wake up. (It wouldn't move a mm of the floor before this) Again, pain only allowed a few at a time due to the lateral tenodesis wound still being quite tender.
I will be seeing the onsite doctor at my physio tomorrow to review the wounds with him and draw up a PT plan. Hopefully will be starting PT sessions early next week. Really looking forward to doing some exercises with the EMS machines as I found this an absolute game changer last time in terms of getting the quad firing again.
My biggest problem however is sleeping. I've tried almost every position, leg elevated, not elevated, side with a pillow etc but just can't get comfortable. The sleeping on side works well for the first few hours and then once I have woken up it is impossible to get comfortable again and that's it for a good nights sleep  :(
Does anyone have any recommendations on best sleeping position or how long this bad nights lasted for?

Offline BarefootPilgrim

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Re: 2nd ACL reconstruction. Hamstring vs patella tendon recovery
« Reply #2 on: November 10, 2016, 10:05:40 PM »
I remember having some difficulties sleeping, but eventually settled on the bent knees, pillow between the knees, sideways position, which worked for me.

Hope you can get some decent sleep son!

Offline icarus

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Re: 2nd ACL reconstruction. Hamstring vs patella tendon recovery
« Reply #3 on: November 12, 2016, 12:39:29 AM »
Hope your recovery goes as well as your first one! I also hope you'll be more careful this time.

It is interesting though. It seems you didn't go through the normal signal of a full rupture. Normally there's alot of pain even when you tear it a second time. All you felt was the knee giving out? Does that mean when you were trying to walk normally, your knee would become unstable?

Offline Zimframe

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Re: 2nd ACL reconstruction. Hamstring vs patella tendon recovery
« Reply #4 on: November 12, 2016, 02:47:38 PM »
Thanks and yes I will certainly be taking it slower this time!

Regarding the second rupture, there was definitely pain but nothing like the original injury. There was no audible "pop" like the first time but there was a sudden moment of it giving way and the knee collapsing. I did some research after this and like you said, many people say that a second rupture is often as painful as the first which even made me doubt that the graft had failed.
However after this, I had plenty of instability in my knee just like the first time and the knee would give out under some twisting movements (although this did start happening much less after a few weeks).

The thing that made me realise something had changed structurally was that my knee would grind and click on full extension. This disappeared completely after a month or two and my doctor later told me this was likely the remains of the graft getting caught in the joint which then managed to free itself.
« Last Edit: November 12, 2016, 06:12:00 PM by Zimframe »

Offline Zimframe

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Re: 2nd ACL reconstruction. Hamstring vs patella tendon recovery
« Reply #5 on: November 23, 2016, 03:36:22 PM »
I'm now just over 2 and a half weeks post op and things have definitely improved despite some persistent swelling and stiffness. After my 2 week check up I was given the go ahead to stop using the brace and I am now completely off crutches. I can walk normally for about 10/15 minutes before it begins to stiffen up and causes me to limp a bit but not much pain to go with it.
I also had all the dressings removed and the wounds are healing very well so I am able to shower normally again, which is a relief!
My leg straightens completely although I seem to have lost the hyper extension I had before and have on the other knee. I'm not sure if this is a good or bad thing as I have been told that hypermobility can increase the chance of ACL injuries  :-\

My flexion is increasing day by day, already well past the max 110 degrees that the brace had allowed. My physio has told me not to try and push too hard on this so that the patella tendon can heal properly.
I do have a strange sensation of something obstructing my knee as I bend it from straight. I imagine this is due to scar tissue building up around the patella tendon.  I will start to massage this to try and break it down and hopefully reduce this feeling.

I started PT sessions last week including a hydro therapy session, all mainly focussed on increasing ROM and reactivating my quad with straight leg lifts and isometric contractions. I have another session tomorrow where I can hopefully progress on to more exercises such as mini squats, lunges etc

Best of all, is that last night I finally managed to sleep through the entire night which is such a relief after weeks of disrupted sleeps. A relief also for my girlfriend who had pretty much had it with my constant moving and fidgeting.

I'm glad that the worst of it is over now and look forward to getting back to 100%















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