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Author Topic: Limited ROM 3 Mos after ACL Surgery - Graft Tightness?  (Read 317 times)

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Offline mestope

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Limited ROM 3 Mos after ACL Surgery - Graft Tightness?
« on: April 16, 2018, 06:57:57 PM »
Hi there,

I’m new to this forum although have been reading up since I tore my ACL back in Jan of this year skiing and had surgery first week of feb. I am a 25 y/o F, no previous injuries. I’ve been having extension and flexion problems ever since. I’d like to say I’m pretty diligent on my PT exercises, working passively at work on my extension (ankle up for gravity, sometimes weighted extensions) for up to 8 hrs a day and actively for probably 2-3 (including muscle strengthening exercises).

I’ve been stuck since week 2 at 4-5ish degrees lacking in extension (to 0) and 100 in flexion. I went in for an arthroscopic debridement/manipulation to break up scar tissue beginning of this month. This helped my flexion tremendously, I gained about 25 degrees right then and there, and the doc cleaned up some scar tissue around my knee that he said was creating problems in extension.

My concern is: I am still at 4 degrees extension and after my 2 week post op appointment, OS told me my knee “went straight” (not sure about hyper extension) while under for surgery #2 with pressure, but that it popped right back up to 4 when he took his hand off.

Doc is going to put me on a dynasplint in 2 weeks if I don't progress, but I am wondering if there’s something potentially wrong with my graft. I’m not worried about placement, as post-op xrays showed good tunnel placement, but doc seems to slip in how “tight” my knee is every time I have any concerns, as if being tight is a good thing. I dont think he understands my concern is that it could be TOO tight. I realize I am just at 3 months out and have time to gain still, just have not seen any improvement since week 2. He also made a comment about how I could live with ~2 degrees lacking (which is NOT an option to me). This kind of makes me feel like he knows there's a deeper problem if he's assuring me I can live with a bent leg.

Does anyone know if an ACL graft (w/ patellar tendon) could stretch over time? I have read more about hamstring grafts stretching (not in a good way) because they are muscle and not a tendon. I’m starting to feel defeated and anxious :/

Other things to note: I don't remember having full extension prior to surgery, although I didn't know that was something to make sure of and therefore didn't pay attention to whether it was there or not. I definitely didn't limp like I do now, but I don't *think* my leg was completely straight. I can't figure out if this limits or just hinders extension post-op.

Also to note, pain feels like a pinching sensation coming from inside of my knee during extension (and extension with body weight), not the stretching sensation on the back of my knee my PT describes I should be feeling.

Any help or advice is incredibly appreciated! Thanks
« Last Edit: April 19, 2018, 01:22:42 PM by mestope »

Offline mestope

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Re: Limited ROM 3 Mos after ACL Surgery - Graft Tightness?
« Reply #1 on: May 17, 2018, 07:47:56 PM »
Hi all,

I figured I would post an update, as I hope this forum would be helpful to someone in a similar situation in the future. I went to another doctor, as my original OS was not very happy to answer questions, and it seems as though I am going to need a re-do on my original ACL surgery.

Graft is too tight, limiting my ROM; my surgical bad knee is at a -1 on the Lachman's scale, and a +1 on my good knee (meaning I guess my anatomical ACL is slightly loose in my good leg, which doc said is fine). My bad knee does not have any give whatsoever. Just got a new MRI and will be updating once I can look over the results with my doc.

Doc had talked about using a Patellar Tendon Allograft from a cadaver but I am worried about that since I'm young. I know there are more risks of my body rejecting it or it weakening over time, but this sounds like a better option than my hamstring which is weak (I can't flex or contract my leg so I can still see some visible atrophy in my muscles).

Do people use the other knee's Patellar Tendon for a revision ACL surgery?

Hoping for the best...