Problems following ACL Reconstruction Surgery
I suffered an ACL injury 9 years ago which persisitently caused problems with knee instabillity and my ability to funtion and participate in sport. Finally 2 years ago, after numereous arthroscopies, I had reconstructive surgery – this came about after a complete rupture of the ligament.
Following an X-ray a few days after surgery the surgeon expressed concern that the screw in the femur was protruding and suggested further surgery. This was to replace the screw with a smaller one or remove it completely. The procedure was carried out however the surgeon was unable to repace or remove the screw as it would result in disturbing the graft. He said he was satisfied that the screw would not cause problems as he had checked the range of movement in the joint.
I underwent prolonged physiotherapy – 12 months – however was unable to achieve a return to my usual range of motion. I could only flex the knee to 115 degrees with a lot of effort and some applied force and could not get full extension. I was informed that this sometimes happens and it should not be a problem as the range of flexion and extension gave me good function. I have continued to disagree with this, firstly as the limitation prevents me from squatting, lunging, kneeling and effectivelyt stretching my quads, and secondly I was not aware that this was a risk of having the surgery.
Since the reconstruction I have had further surgery, again to attempt to remove the screw which they finaly did after a second attempt but not arthroscopically. Surgery has also been used to manipulate the joint and discover what is causing the limited movement. I have also been offered mosaic plastico to repair the damaged areas of bone and meniscus. I declined this as even though I still suffer pain I did not see how this would improve the range of movement – pain is not the barrier to the range of movement a physical blocking is more the issues. The last surgery was week ago, even though it is only a short-time since I still feel unable to gain full or near full movement passively. Even with applied force the movement stops and there is no flex beyond this. I am no surgeon or specialist in this field, however it is my knee and I do not feel satisfied with the result – it is quite debilitatting in terms of being able to perform sport as well as a number of normal day to day activities.
I am keen to find out a number of things to help me resolve my problem.
Is a limited range of movement common and acceptable following this type of operation.
What are the possible causes of the symptoms
What can be done to rectify the problem
Have I any rights to request that problem is corrected.
Any advice or comments from anyone experiencing similar problems would be much appreciated.
8 comments
Anonymous
Check out this link. It is the complete story of how to tear your ACL and live to tell about it. I had an ACL replacement last October. I tore my ACL while wakeboarding just like the guy in this story. His story matches mine. I would highly recommend getting the replacement. My knee is back to normal now and works excellent. Feel free to send me an email if you have any questions.
Here is the link:
http://www.wakeworld.com/articles/2002/ACL1.asp
Brad
I had surgery on June 20. My Acl was completely torn. Surgeon opted to use hamstring tendon, with 2 bio – absorbable pins in the femur, and screws and washers in the lower leg. Operation took around 2 hrs.Pain was not as bad as i thought, but Dr gave me a shot called a femoral block, which basically deadened the leg for around 16hrs, which was great. Was walking without crutches in one week, although very carefully. Seems to be progressing quite nice. Will have to see over time.
Anonymous
I have recently also torn my cruciate ligament and am contemplating surgery, a reconstruction of my ligament from my hamstring. I’m very keen to find out as much info as possible before I have this done. I want to know what the chances are of full recovery if I do have the operation, from the above replies, it does not sound too positive. How has your movement and flexibility been since the operation? How aware are you of your knee? Can you do everything you want with it? In particular, if you have NOT had the operation, are you as mobile as you were before you tore the ligament?
vmbri
I am not sure i fully understand your problem but let mme try to help.
with the limitation of movement do you get pain when at 115 degrees? have u had rhabilitation stretches to extend the muscles around the knee (quads,hamstrings & gastrocnemius)this will allow full range of movement.you may not be able to do this now with it being so long after the injury/operation.
I have just finished a sports injuries course and we had to learn about making sure full range of movement by heating up muscle stretching and then cooling to extend muscle (help full range)this would continue until full range was achieved and the you would go onto excercises to strengthen the muscle was this ever carried out on you?
if I can help any maore email me.Bri
Brad
The surgeon that i have been dealing with, uses self disolving screws in the femur. I have heard they can be used in the lower section as well, but he doesnt. It does sound better than screws.
Nik1963
Advice from a laymen – surgeons can be pretty good and then there are those who are poor, to say the least.
Find out from the surgeon how many reconstructions he has performed, what type of surgery he is going to use – there are a number of ways of doing it. What rehabilitation will involve. Expect anything from 3 to 6 months at a minimum of twice a week for a couple of hours a time. Ask him about complications – not the standard, anethesia, infection stuff, but the specific issue relating to the op. What do they mean by successfull. Does that mean full return of mobility to the joint, or could there be limited mobility. This is an issue i am trying to find out about for my own purpose as my range of movement is limited to 110 deg – means i can get to sitting position but no further, so i cant squat or kneel. My other legs range is 140+ where i can pull my heel back up to my haunches. In my mind thats full recovery. If you get any info here i’d appreciate it. The issue of pain and discomfort is relative to the individual. You’re going to expreince some form of pain or discomfort whether you have the op or not most likely in yhe long run. Regular and gradual increases in intensity and duration, rather than over-training helps with managing it. Guess its like keeping the mechanisms oiled and tuned or if you haven’t done anything for a while its going to cause aches and pains!
Also, if you know of a good surgeon see if your GP will refer you to him/her. There is a guy called Weeber in Northallerton, North East UK, who i understand is top.
If you get a good job then things should be fine. No intention of slagging off the medical profession but i’ve spoken with a number of people who have had quite poor reconstructions. The surgeon who performs this type of operation should be doing them on a regular basis and not just the odd one. The injury is fairly common these days.
The thing that probably could cause most problems is the positioning of the femoral screw. Too far forward and it – i think – tends to limit the range of movemnent and cause stiffness in the joint. This is what i suspect i have, though no one will confirm it. I just keep having to go back for ops to try and sort it out. Also the if the graft is to thick this can cause an impingment in the joint, again restricting movement.
My brother had his reconstruction done in NZ. The guy who did it is part of a practice who treat the All Blacks rugby team. His is excellent and the follow up physio was prompt – whithin 2 days of surgery. It pushed him relatively hard. Physios in the UK seem to have their hands tied by the recommendations of the surgeon and are not treated with the full professional respect they deserve – guess the health service is more worried about litigation than effective good practice. Elsewhere physios tend to work independently of the surgeon – taking their advice but using thier own proffessional judgement to deliver treatment.
Anyway, I have probably more negatives on this issue due to my experience and recommend you get views on the other side, from those who have had success.
I you do get any info. about expectations on whether there are potential permanent/longterm movement limitations i’d be grateful if you could let me know.
All the best!
Brad
If you had to do it all again, would you opt for the surgery? I have a completely torn ACL, and have to make up my mind. All in all, for karate and judo, its not bad. I have strengthened the hamstrings, and legs, so the support is pretty good. Surgeon says it should still be done, but thats the surgeons point of view, and as much as i respect it, i would like different opinions.
He says i will be worse down the road……
Clebe
I also had the surgery and my screw sticks out. Somedays it sticks our more than other days. It only hurts when it gets bumped. It does however bruise, and make for an ugly knee. But I have chosen not to get it taken out.
Good luck-