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Author Topic: advice needed for 3 year post-op ACLr - I want to hike the PCT!  (Read 212 times)

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Offline vbud

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Hi all, I discovered this forum recently and thought I'd run my situation by you all. It's been a long journey.

I have been dealing with PFPS since my ACLr surgery (patellar autograft) in March 2019 after a skiing accident. The PF pain is generally worse when walking down hills. I also had a cyclops lesion removed in December of 2019, which allowed me to get back most (but not all) of my knee extension.

My primary goal with rehab is to get back to where I was backpacking 15+ miles per day. I planned to hike the Pacific Crest Trail in 2019, but the injury has caused me to delay my plans every year since. I plan to do it this year (I have a permit even), but I keep having setbacks. PF pain and lots of punishing downhill are definitely not a great match, but I persist nonetheless :).

I have reintroduced running and hiking at various points, but never been able to stay with anything for more than a couple months before I get some kind of bad, sharp pain in my knee (in addition to the "normal" 2/10 - 3/10 PFPS pain I've become accustomed to).

In November 2021, I started having very sharp pain just below my kneecap when walking/running down hills and stairs. This made some degree of sense to me, because the pain was more or less a sudden worsening of existing PFPS symptoms. I rested for a few weeks, then in December I tried a new physical therapist who is having me do a lot more work in the gym and with weights. We reintroduced hiking about 1 month ago. This program had gone well for me up til a few days ago - my legs are stronger than they have ever been. But once I hit 30 miles per week of hiking last week, my knee started to feel a bit off, then suddenly I felt a new sharp pinching pain, but this time at terminal knee extension. Clearly something is wrong in the knee, because it's a little more swollen and feels stiffer than usual. It kind of reminds me of the sharp pain I had before my cyclops lesion was removed.

According to an MRI I had done last November, I have chondromalacia patellae, though my other knee has asymptomatic crepitis, so I'm not sure how much stock to put into this (I know many people have asymptomatic chondromalacia patellae). Though I do know that my patellar cartilage has gotten more damaged since my second surgery, as the MRI shows more damage and new fissures.

I didn't think PFPS or chondromalacia patellae could be symptomatic at terminal knee extension, is anyone aware of such a thing?

For a bit more context on my symptoms, my knee has always felt "tight" post-surgery. I have lots of clicking and knocking as my knee kicks outward to terminal knee extension. Something that has always looked strange to me is that my kneecap on my operated leg does not protrude outward as much as on my non-operated leg, and the top of my tibia appears slightly shifted forward. I've wondered before if the ACL graft is too short, or was placed in a way that has pulled the tibia forward. Or maybe this is normal due to thickening of the patellar tendon.

Anyway, I could write pages and pages about this, but thought I'd just cover the main points at a high level to see if anyone has any useful thoughts or advice for me based on their knowledge or experience.

I'm determined to rehab this knee successfully, whatever it takes!