it band stops me from flexing my knee after acl surgery

[habarnam]

Hey everyone!

Me, a 35 yo male, finally had acl surgery 12 years after i initially torn it ( the knee didn't cause me pain after i torn it and i was still able to do some sports - but eventually that lead to  meniscus damage which scared me into fixing my knee fast).

Currently I am 2 weeks post op  ACL repair plus work on both of the menisci - the swelling is significant ( stil after my surgeon tried a knee puncture but almost no fluid came out - says it's mostly coagulated blood that will absorb eventually).
My main concern is that the flexion in my knee is still so small - i can only do about 45 degrees - and that is with pain associated. And this because i feel my IT band stiff and rigid, gives me a lot of pain and stops me from flexing further.

My PT worked with me and i got to flex it at about 80 on two occasions (him pushing on my leg), but I was in A LOT of pain at that moment. I can't do it on my own, it feel like it could snap any minute. I also have pain around the Endobutton insertion site.

I am really disheartened by this, I don't feel like the recovery process is doing well at all and I'm starting to get worried.

Is there anybody who can relate to this? There is  no documentation of this post-op symptom anywhere on the internet, and I feel alone in this. My doc and PT couldn't quite put their finger on it either.

Thanks a lot and good health to everyone!

[vickster]

I wouldn’t be too worried. 2 weeks is very soon after a major surgery with a 12+ month rehab (think marathon not sprint)

Have you started to get decent extension back which is more important. At the moment your focus should be on recovering from the op and keeping the swelling down (blood and clots should get reabsorbed in time as you say, again could be many weeks)

I’d be very wary of any physio trying to force a freshly operated knee. Just keep with the ice, plenty of heel slides with towel around ankle, seated bending etc. Once cleared, get into a hydrotherapy pool and work there. More gentle that land physio but as effective

You also need to be very cautious weeks 6-12 when the new feast will be most vulnerable to rupture as it vascularises. What sort of graft? Hamstring or?
Does your physio have lots of experience in ACL rehab?
When you say work on the menisci, stitching together or removing damage (menisectomy)? Which will also affect recovery and rehab time,
Do you also have joint surface cartilage damage/arthritis in the knee?
Lots of patience needed after major knee surgery. There are some really good ACLr diaries in that section of the forum to give you an idea of what to expect
Good luck.

[habarnam]

thanks for the quick response, vickster!

i got a stitched meniscus (fastfix suture) and one which was just cleaned from rough edges, so i guess a meniscectomy . they used a hamstring graft. my cartilage looked perfect.

my full extension is influenced by the amount of swelling in my joint, but i feel pretty confident about it. i also ice my knee a couple of times a day.

i feel bad about being behind on recovery,though,as everyone and everywhere says that the goal at 2 weeks is getting 90 in flexion. and really this all comes down to my IT band which gives me lots of pain as i try to push my knee more. and most importantly, nowhere is this ever stated as a post-op  side-effect or expectation.

i have full confidence in my PT, he deals with high level athletes, but I think I might be the first case for him also with such a problem. again, neither him nor the surgeon could say for sure why I experience this pain, and nobody else at complains about this. on the internet , all i found was an article with two reported cases ( https://www.ncbi.nlm.nih.gov/pubmed/23714387 )

was wondering if anyone here has had an issue with it, or i'm just that lucky and special

i will check out the diaries section, thanks for pointing that out to me!!

all the best!

[vickster]

Are you still non weight bearing due to the meniscus repair? If sontjar needsbto be factored into recovery and rehab of course

One thing to be careful of is to not put a cushion under the knee when it’s uo if elevated as that can inhibit recovery of extension (cause scar tissue), only under foot or calf with knee straight

Has your physio done deep tissue massage or acupuncture to release the ITB?

Ice more regularly, esp after any sort of exercises 

[habarnam]

i got to put weight on it since day 1.  as for the cushion, i did ice it, but not a lot of elevating it, as it hurt the back of my knee.

i just hope tonight went wrong and no damage was done to the IT band in surgery. I don't understand why it's bruised, anyway.

i'll keep icing it , that's for sure!

[JamesMCP]

I agree with Vickster. ACL Recovery is a marathon and not a sprint.

It sounds like you had the Lateral Tenodesis technique in addition to the ACL. This is where you attach a strip of the ITB and attach to the femur to control anterolateral laxity and decrease pivot shift (basically increase support of the knee).

A complication of Lateral Tenodesis is that the knee can become over-constrained. This can lead to further complications in itself in time. You should be aware of this should problems persist.

That said, many knee's react differently to surgery and yours may have experienced significant issues with arthrofibrosis (internal joint scarring) that limits ROM though the build up of internal scar tissue caused by the surgery.

You can either combat this through PT or via surgery.

With PT its important to shift your focus from ROM to a ROM+Volume marker. By tracking the volume of your PT and the ROM achievable you should notice a general trend towards increased ROM. If you're just tracking ROM by itself, you may become disheartened and reduce PT which in turn reduces ROM etc etc.

My top tips:
1. Start tracking ROM & PT Volume. Track the volume of each of your exercises. Before and after each session measure your flexion and extension ROM.
2. Plot everything. Get a bit of graph paper and plot your ROM over time. This visual chart is both beneficial to spot issues, but also to build confidence as you (hopefully) see your situation improving. This is also a great tool to take to your surgeon if problems persist.
3. Set goals. You must be flexible with these, but setting goals can help with motivation. Keep in mind that setbacks can and do happen, but its also great when you reach your goal.
4. Watch your nutrition. If you can, try to fuel your body with antiinflammatory foods to help control inflammation.

The fact you've registered on this forum and are actively seeking info shows a real proactiveness with you recovery. Well done.

Wishing you an optimal recovery!

[sawweee]

i got to put weight on it since day 1.  as for the cushion, i did ice it, but not a lot of elevating it, as it hurt the back of my knee.

i just hope tonight went wrong and no damage was done to the IT band in surgery. I don't understand why it's bruised, anyway.

i'll keep icing it , that's for sure!

Dear habarnam,

How did your story continue? I'm exactly in the same situation like you were: after ACL surgery I should be able to flex my knee at least 90 degrees but I'm unable to reach more than 45 degrees. Doctor and PT keeps saying that "extension is more important than flexion", but they don't comment at all the problem of the flexion itself. Also there is no development at all: I reached 45 degrees two weeks ago, too, and I still cannot do more at all, even though I have been doing my PT 2-3 times per day.

How long did it take for you to get 90 degrees flexion and what is your result now? And what is more important: what helped you to develop your ROM?

Thanks a lot for your answers in advance!