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Author Topic: 3 years post ACL reconstruction, AF?  (Read 5090 times)

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Offline Clarkey

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Re: 3 years post ACL reconstruction, AF?
« Reply #15 on: June 05, 2017, 02:35:09 PM »
It is good that you have decided to go for a scope later on this month despite the horror stories you hear on this forum there are thousands out there that have had a success from their surgery. Members on KG like myself have had long term knee problems that are hard to get right again.

I finally have received my follow op consultation report today in the post, took nearly 3 months to know what will happen next. If it was not for the signal changes within the fat pad then my OS would have hesitated to operate for the 2nd time, 1st scope was done by another OS.

Persistent anterior knee pain with recurrent effusion and impingement. is my diagnoses. My prediction all along was correct that I have excessive scar tissue around the patella tendon that was aggravated by the physio that pushed me too hard 3 weeks post-op.

You might find the following paragraphs interesting, similar to your ongoing knee problems.

At his previous arthroscopy he had a very tight plical band which was rubbing on the medial femoral condyle causing bone marrow oedema. This was resected with good effect but unfortunately following aggressive physiotherapy has recurred.

I think the only option left to Nicholas would be a further anterior release and excision of accessory pole of the patella. If it wasn't for the recurrent effusions I would not recommend this but in the presence of such a significant finding it does suggest there is a therapeutic target.


At least I now know when I see my OS again on July 12th he will operate on my right knee that I am happy to risk at this stage as it has been dragging on for too long now. It will reassure my anxiety levels knowing I have tried every option given to me, be silly not to go ahead with it after nearly 3 years post-op without success.

Hope your OS can fix your ongoing anterior knee pain and discomfort, good luck with your surgery hope it a successful. I will not be far behind you maybe September October will be booked in for scope #3. On the NHS may have to wait up to 18 weeks after consultation.

[email protected]
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline hockey_s

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Re: 3 years post ACL reconstruction, AF?
« Reply #16 on: June 05, 2017, 07:08:14 PM »
Yeah, I have to do something to get my life back, even though it might get worse. There are few options available. I have been trying to get my thought straight this evening and come to the conclusion that I have had very very bad luck. Good ROM not indicating AF for most doctors, and then patella baja, which is a very rare complication, if that turns out to be correct, which I believe it will.

Good that you got some more information there Clarkey. It might calm your mind a little to get a diagnosis. How is you patella mobility, and especially the tendon mobility? If you look at the AF rehab tutorial on this site, the second last picture of patella mobilization exercises shows tendon mobilization.

http://www.kneeguru.co.uk/KNEEnotes/courses/arthrofibrosis-rehab-tutorials/patellar-mobilisation 

If you do this, does the tendon feel much more contracted and harder to reach comparing it to the healthy leg? Mine is stiff as bone comparing it to the other and also sits much lower, making it hard to grab, indicating it has scarred down. Hopefully with good rehab and no complications, there might be some relief to the stress, however the elasticity is probably gone.

Thanks for the wishes. However I do feel like this will not nearly be the end of my knee problems, but a satisfactory relief is what I'm hoping for.

18 weeks are not that bad after all. Here in Finland there is a 6 months waiting time, if not extremely urgent. I can get this scope on my private insurance, but after that I will have to get in line with all the others, which might complicate things a little bit in the future. However I am on the waiting list already as a plan B if there are more complications that needs to be addressed, mainly regrowth of scar tissue. I have also already begun planning for a patella tendon lengthening procedure, trying to ask for specialist recommendations. Let's see if there even is an OS in this country that can do it.
Best wishes to you to, Clarkey. Remembe
r that in the end, everything will be alright. Live in the moment but plan for the future. Baby steps, one day at a time.

Offline Clarkey

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Re: 3 years post ACL reconstruction, AF?
« Reply #17 on: June 05, 2017, 10:23:08 PM »
I have noticed a tight knotting feeling around the bottom my patella tendon where it joins into the tibia, if I press my finger in that area up and down it feels like there is a small narrow elastic band around the tibia in comparison to my left knee is fine around the tibia region. If I press my finger against the medial side by my faded incision mark and move my kneecap up and down can hear and feel a crunching sound against my finger that is not as bad on my left knee. 

ROM can still be good even if you have scar tissue build up as I found out with a 2nd AIR surgery looking likely. 18 weeks is the maximum waiting time on the NHS after going to the pre-op clinic for scopes, can be 6 months plus for a TKR patients. More annoyed with my physio incompetence and lack of knowledge towards doing gradual PT exercises! One and a half hour of intense PT that was agony at the time and have a high pain tolerance.

Post-op make sure you don not overdo it with PT sessions finding a PT that has expertise in AF aftercare and protocol.

[email protected]
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline hockey_s

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Re: 3 years post ACL reconstruction, AF?
« Reply #18 on: July 01, 2017, 05:32:22 PM »
So I'm now 10 days post-op, and frankly it's not going very well. OS removed some scar tissue around the patella and also did some trimming of plica (?). "Recovery" has been going good in regard of traditional rehab. 130 rom and full extension, swelling gone down good but the tightness around the patella and incision portals is still there.

First is seemed fine but maybe around day 3 or 4 post-op when swelling went down the tightness emerged again.. Can scar tissue really form this fast? I have been icing like a maniac but despite that I have constant heat around patella tendon area where the incisions are. I have really tried to not do anything that puts stress on the tendon, but even straight leg raises when the leg is fully extended produces the tightness feeling. I am very down at the moment and I do not have any motivation at all to continue with PT to be honest. I'm really hoping that removing the stitches next week could give me some relieve, but I really doubt it.. I think I might have overdone the PT, doing the exercises even though I have felt the stiffness, but really, if I can't even do SLR how am I supposed to make any progress? My OS said this would be like a cakewalk and that I could return to sports after 4 weeks, he even said PT would be unnecessary, but I insisted.

I'll try and speak to my PT when I see him next week if some deep tissue massage could do anything.


Offline Clarkey

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Re: 3 years post ACL reconstruction, AF?
« Reply #19 on: July 02, 2017, 11:12:08 PM »
10 days post-op is still early days after your knee has been through a major trauma, I have never come across a plica being trimmed, it is usually completely removed like mine was excision of the medial plica and fat pad trim during my 1st scope. 

You need to do some friction massage therapy around the portals to break down the scarring around the incision and patella patella mobilisations to help break up the scar tissue on a regular daily basis. The 1st 6 weeks is the time period when you are at the highest risk of getting AF.

https://www.youtube.com/watch?v=FcU7Kc1FtnI

Having the stitches taken out will help the healing process and will feel relief when they are taken out. 4 weeks is too early to return to sports this is not a realistic target. It is always a good idea to see a PT that is specialised in post-op care after scar tissue removal surgery. My PT did deep friction after scope #1 around the portals and the other PT did too much after scope #2. Never overdo too much in one PT session pushing you to your limits is wrong making the knee worse rather than improving it.

Try not to worry about it too much at the early stages post-op as your ROM is improving and swelling is subsiding which is a positive outcome rather than focusing and worrying about all the negatives of what could go wrong, this is putting more strain mentally on yourself all the negative thoughts, that are overruling the more positive thoughts that is a vicious circle to put yourself through.

[email protected]
« Last Edit: July 02, 2017, 11:46:00 PM by Clarkey »
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline hockey_s

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Re: 3 years post ACL reconstruction, AF?
« Reply #20 on: July 11, 2017, 12:30:28 PM »
Yeah I can agree that it's still early, but IMO you get a good reference of the future outlook quite early post OP. Anyway, I'm now like 15 days post OP and the stiffness has improved a little, let's hope it continues to subside. However I still have stiffness when walking, the same feeling as I had before surgery. PS is working on breaking down the scar tissue with massage, ultrasound and patella mobilizations.

I have no swelling anymore, and little heat also. I focus on icing several times a days still.

So I have speculated that my main problem is the old portals which were not addressed during the surgery. OS didn't seem to think they were a problem during surgery. I'm currently considering a cortisone injection if it doesn't improve within 4 weeks.

The good news is it doesn't seem to hurt as much as before when walking, but I have not really put the knee under any heavy stress yet, so it's hard to tell for sure.

Offline Clarkey

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Re: 3 years post ACL reconstruction, AF?
« Reply #21 on: July 13, 2017, 07:04:12 PM »
I would wait a while before you consider having a cortisone injection, it can do more harm than good. Keep doing daily patella moblilisations, friction massage therapy with gentle leg raises will help to reduce any scar tissue buildup. 

Your recovery is going smoothly so far with minimal swelling, this is a good sign that there is no longer any joint effusion. The portals can remain sore for a while, took 18 months post op after I had scope #1 until the portals felt ok again.

I will be joining your club when I have scope #3 sometime in the autumn that I have been prepared for. Was not a shock or surprise when I filled in the pre-op assessment sheets after 3 years of failed attempts to sort out the scarring around the patella tendon in a none invasive approach to the scarring. Another AIR surgery and decompression of the patella tendon is what will be done by my OS that I trust 100%, he would not do surgery unless he thinks it will be beneficial.

[email protected]
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline nsov1

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Re: 3 years post ACL reconstruction, AF?
« Reply #22 on: October 24, 2019, 03:42:17 PM »
Hi, i'm experiencing a lot of your symptoms and also nearly at the 3 year mark of my acl surgery. Really would love to know how everything is going after your latest surgery?