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Author Topic: Flexion issues 11 weeks ACL Post OP  (Read 451 times)

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Offline msra7hm2

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Flexion issues 11 weeks ACL Post OP
« on: September 27, 2018, 07:49:50 AM »
Dear All,

I hope you are fine.

I had an ACL surgery 11 weeks ago with a hamstring autograft. There is still considerable swelling above and below the kneecap, which does not seem to go even with medicines and regular icing.

Also, I am struggling to achieve full flexion. Without warm up, I am only able to flex about 120 degrees and with a lot of warm up and cycling, I am able to reach about 130 degrees only. I am really worried about achieving full flexion because I have been told that no progress is possible after 16 weeks.

Moreover, although I am able to fully extend my leg, it is still a few degrees less than the non-operated leg, which has a hyperextension of about -10 degrees. While walking, I tend to slightly bend the knee and walk and it is difficult to keep the knee extended.

Please advise, based on your personal experience and study:

1. How to get rid of the swelling above and below the knee cap?

2. How to achieve full flexion?

3. How to achieve hyperextension equal to the other leg?

4. Which medicines, if any, could help?

5. Is it better to relieve the swelling and push the ROM slowly or go aggressive despite the swelling?

Thank you for all the help.

Best Regards,
« Last Edit: September 27, 2018, 12:23:33 PM by msra7hm2 »

Offline The KNEEguru

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Re: Flexion issues 11 weeks ACL Post OP
« Reply #1 on: September 27, 2018, 11:42:49 AM »
I trust some of the ACL people will soon jump into your thread. You are right to be concerned. Here are some things that will help you understand where you are with this problem -

ebook on how to perform patellar mobilisations -

course on the anatomy of knee flexibility -

course on arthrofibrosis rehab -

If you know all that, then it may be time to check out Dr Noyes' 12 part course on arthrofibrosis -

Offline BornToRun

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Re: Flexion issues 11 weeks ACL Post OP
« Reply #2 on: October 23, 2018, 11:27:29 AM »
Hi OP, as the post is a few weeks old, I hope some if not all of this has got better over the last few weeks. Just in case it still helps, here are a few thoughts from my experience so far. I have to stress that I am not a specialist, so all I have to offer is from the past six months rehabbing from hamstring ACLr and lateral meniscus repair.

First are you seeing a physio? A good one, preferably a knee specialist, is an absolutely invaluable resource for the rehab. He or she should be in the best position to tell you why the swelling is persisting. It could be something as simple as doing too much too soo, or pressure on the joint due to weak muscles or muscle imbalance.

A word on icing as well, which I know not everyone agrees with. Both my surgeon and physio are of the view that icing helps the first 6-8 weeks or so, as it stops/slows bleeding in the joint and acts as pain relief through numbing. But, later than that, too much icing can exacerbate swelling because it slows down blood circulation and stops it taking the "gunk" away from the knee. I stopped icing altogether at about 8 weeks, maybe 10 at most. From there on, the physio put me in a heat and compression machine at the beginning of each session. I also used microwaveable heating packs at home for a bit and, even now, I always try to go to the sauna for at least a few minutes after a heavier exercise session. My knee also absolutely hates the cold outside and seizes up and grumbles like crazy. To deal with the swelling, the physio  also encouraged me to go to the pool and do gentle exercises (not swimming), which really helps with swelling. Gentle cycling helps too, as does moving in small increments, but frequently. Say every hour for 5 minutes or so. Like I said, not everyone agrees with this, so worth checking with your physio.
Extension: obviously very important to reach and maintain full extension as soon as possible. Hyper extension on the other hand, the jury is still out on. My understanding is that ACL grafts are usually "set at zero extension" so to speak. Hyperextension is thought by some to lead to a less stable joint. So worth checking with your surgeon if they think you should push for hyper extension or no. Only he or she knows what they saw and did inside the joint, and can advise you accordingly.

Flexion: Unlike extension, it is my understanding that there isn't such a big rush to reach full flexion. 130 or so warmed up was roughly where I was around 11 weeks. At that point the physio told me to stop pushing it so as to not stress my graft. He said we would resume work on it once things have settled, at around 6 months, which is where I am now. I might add that I don't have full flexion yet, and from what I've read of other people's experience, many don't for quite a while.

There are a number of reasons why you might be struggling with flexion. One is swelling - as that goes down flexion will literally improve in leaps and bounds. I found swelling above my knee laterally was a big inhibitor and it improved hugely once that went down. The hamstring is another inhibitor, and a pretty common one with the hamstring graft, as it plays a big role in flexing. This is the inhibitor for me for instance - the graft site is still sensitive and hates being compressed in deep flexion.

The reason why you'd be concerned about flexion is if it was inhibited by scar tissue build up. Obviously that should be checked out with your surgeon, physio or both, especially if it comes in conjunction with loss of extension. Have you done that already, and what is their view?

Fingers crossed and hoping it all gets better from here for you!
6 Mar 2018 - skiing fall, ACL rupture, MCL and LCL sprain, lateral meniscus tear and bone bruising
13 Apr 2018 - ACL reconstruction with hamstring autograft, small meniscus repair