Anxious about knee problems 7 years after ACL-R

General questions about exercises, stretching, gaining range of motion, handling pain and swelling.Also braces, mobility aids, sleeping aids, shoes.
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Fhhm
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Anxious about knee problems 7 years after ACL-R

Post by Fhhm »

Anxious 7 years out (w/ relatively recent MRI)

I’ll try to be as concise as possible but my anxiety is spiraling because my function currently is awful.

Had ACL surgery on left knee with slight medial meniscus shaving in 2017. Never fully got back to sports but was able to shoot the bball around and could do some running before my knee would get sore. Was also getting back into tennis. I had some serious graft site morbidity (patellar graft) which I was still working through. Summer 22 I had an Achilles strain that caused me to walk funny and ultimately and over time slowly caused what felt like impingement in my lateral left knee next to my kneecap. Had XR then MRI. impressions are attached. Symptoms were serious impingement feeling in lateral knee that stopped me from walking more than a block. A year and a half later I’ve been in PT (albeit I’m not super motivated right now because of life circumstances) and go to the gym semi regularly. I’m still not really walking distances or with heavy bags. Symptoms remain relatively the same as that summer.

Symptoms:

Knee feels stiff and pressure builds in patella region. Some days it feels weak and like I can’t really step through it. Pain and pressure occur localized to that lateral region of the knee between the epicondyle and kneecap. When walking I feel like I’ll need to rub my knee to go a few more steps. Not tender at rest but becomes so after stress of hard bike ride. Sometimes working out hamstrings and glutes helps but depends on the day. I’m able to squat okay and do leg machines with light weight fine. This has also been complicated by some sciatica. There may be some weakness due to that which I incurred from deadlifting last winter (but may have had some preexisting issues with it that got worse when I started rehabbing exercises).

Please any advice, similar stories, reassurance, whatever pearls you have would be incredibly appreciated. I’m most worried I need some life altering surgery again which I’ve been traumatized from before.Image
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Re: Anxious about knee problems 7 years after ACL-R

Post by Fhhm »

INDICATION: ACL reconstruction and BTB autograft on his left knee in 2017. He has history of right knee pain in the past. Patient is resting a lot and taking Mobic once daily.

COMPARISON: Left knee radiographs 8/15/2022

TECHNIQUE: Multiplanar and multisequence MR imaging of the left knee was performed without the administration of intravenous gadolinium.

FINDINGS:
Menisci:
The medial meniscus is unremarkable. The lateral meniscus is unremarkable.

Cruciate Ligaments:
Status post anterior cruciate ligament reconstruction. The ACL reconstruction is intact and normal in signal but slightly more vertical than Blumensaat line. A 10 mm rounded structure that is intermediate on PD hypointense on T2 (series 5001, image 19) anterolateral to the graft near the entrance to the tibial tunnel, which could represent scar tissue. The posterior cruciate ligament is intact and unremarkable.

Collateral Ligaments:
The medial collateral ligament is intact and unremarkable. The lateral collateral ligament complex is also intact and unremarkable.

Extensor Mechanism:
Status post bone tendon bone harvest with expected bony remodeling of the lower pole of the patella and tibial tubercle and mild thickening of the patellar tendon. The quadriceps tendon is intact. There is mild edema within the suprapatellar fat pad.

Joint:
There is no joint effusion. There is no significant fluid in Baker's cyst.

Articular Cartilage:
The articular cartilage of the patellofemoral and medial and lateral tibiofemoral compartment is intact.

Muscle/Marrow:
There is a small area of focal edema of the anterior aspect of the lateral femoral condyle without evidence of fracture. This appears to be at the far periphery or just beyond the articular margin of the lateral femoral sulcus. The musculature appears unremarkable.

IMPRESSION:
1. Nonspecific edema of the anterior lateral femoral condyle at the periphery or just beyond the articular surface of the lateral femoral sulcus. Possible etiologies include a direct contusion, degenerative subchondral signal change, or an abnormality related to patellar tracking. Mild edema in the suprapatellar fat pad also noted.
2. Intact ACL graft. Small, intermediate signal tissue anterolateral to the distal ACL graft, probably representing scar tissue
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vickster
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Re: Anxious about knee problems 7 years after ACL-R

Post by vickster »

You say you do hard bike rides? Have you had a bike fit, especially if you ride clipless you might need your set up assessed.
Also, have you had your gait assessed to see if orthotics might be beneficial and check your footwear generally?

It doesn’t read like there’s too much structurally wrong with your knee, no arthritis to speak of which you might expect after past ACL and meniscus injury and surgery. Have you discussed the results with a specialist?

In terms of treatment it might be worth discussing hyaluronic acid or PRP injections with a specialist to see if you can get any inflammation to settle (avoid cortisone though as your articular cartilage is intact).

Good luck :)
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Re: Anxious about knee problems 7 years after ACL-R

Post by The_KNEEguru »

Hi
Have a read, also, about 'cyclops' lesion - https://www.kneeguru.co.uk/KNEEnotes/kn ... ops-lesion
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Re: Anxious about knee problems 7 years after ACL-R

Post by Fhhm »

vickster wrote: Fri Feb 09, 2024 9:53 pm You say you do hard bike rides? Have you had a bike fit, especially if you ride clipless you might need your set up assessed.
Also, have you had your gait assessed to see if orthotics might be beneficial and check your footwear generally?

It doesn’t read like there’s too much structurally wrong with your knee, no arthritis to speak of which you might expect after past ACL and meniscus injury and surgery. Have you discussed the results with a specialist?

In terms of treatment it might be worth discussing hyaluronic acid or PRP injections with a specialist to see if you can get any inflammation to settle (avoid cortisone though as your articular cartilage is intact).

Good luck :)
Yes I discussed these results last summer. He wanted to put me on mobic or give me a steroid injection which I passed on. I’m wondering if it’s a chronically inflamed fat pad or bursa or something too. Maybe once the inflammation occurs my muscles shut down and I feel the weakness through that knee.

I’m not as concerned about a cyclops because I had 5 years with this graft before this problem occurred. And extension was the first thing I achieved. But maybe it could happen later? Not sure. I know I still get patellar pain too but it feels like a side note now compared to the knee cap etc. have full flexión and extension.
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Re: Anxious about knee problems 7 years after ACL-R

Post by The_KNEEguru »

I’m not as concerned about a cyclops because I had 5 years with this graft before this problem occurred.
This is a valid point. In this paper https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6374043/ - "Cyclops lesions detected by MRI are frequent findings after ACL surgical reconstruction but do not impact clinical outcome over 2 years" the authors note that cyclops lesions were found in 25% (28/113), 27% (20/75) and 33% (11/33) of patients after 6-months, 1- and 2-years, respectively.
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