2x ACL reconstructions within a year, knee still unstable!

by stacey
(germany)

How can my knee be so unstable after 2x ACL reconstructions?


I ruptured my ACL whilst skiing in Jan 07. I had it reconstructed with a hamstring graft in June 07 (germany). After starting an intense rehab course in the Oct things went wrong- but for no obvious reason and knee totally unstable again (could push tibia back and forth to a great degree whilst extended). I had an mri that confirmed a tear in the meniscus, with ACL intact.

In Mar 08 a surgeon in the UK said the graft was too vertical and i needed an ACL Revision op to correct it and hopefully the movement, as well as repairing the meniscus. This was done with an allograft in late May 08. It never corrected the tibial shift, and still pain in medial meniscus.
MRI confirmed in Aug 08 yet again that i have a tear in both medial and lateral sides of the (medial) posterior horn. Is this due to the abnormal movement???

The surgeons' registrar (in July 08) put the movement down to fluid behind the knee. obviously talking rubbish!

I am a keen to stay in the army, but the doctors and physios are completely baffled. This has been going on way too long and i'm going to lose my career if it stays like this.

i know there's quite a bit to take in, but i'd be truly grateful for any advice

thanks, stace

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Oct 27, 2015
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Sep 20, 2015
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knee still unstable! NEW
by: Anonymous

Every game has risk of injury like foot injury, knee injury and elbow etc. These should be treated properly as soon as possible and if pain is severe then x-ray is must.This blog contains information about knee injury in sports. Even after two time reconstruction from editing service of knee but all in vain really disappointment.

Oct 05, 2008
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posterolateral corner
by: Bart - SII

I had wondered about your PLC, but didn't want to speculate or add confusion to the injury. This is not a terribly common thing to see, but it can cause the continued instability you are describing.

I don't know off the top of my head the normal recovery times for a PLC repair, but I would imagine it will be similiar to your ACL reconstructions. I will check and see what I can find and let you know.

Bart

Oct 03, 2008
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good news, ive been given another chance - just hope it works
by: stace

Thank you for your reply. The allograft they used for the 2nd was an achillies tendon, fresh off the street as he described lol.
I've just finished the 2nd wk of my (3rd)rehab course and as much core stability, strength and specific exercises that im doing, there is still no change. However, i had an appointment with 4 specialists on tuesday (head physio, doctor, physical training instructor and another physio) who have now come to the conclusion that its the laxity of my lcl and Posterolateral corner as a whole letting me down. Therefore they are now refering me for an op to tighten the ligaments (extra tight because im hypermobile) hopefully not too long a waiting list. No idea what this entails and how long to recover etc..

cheers again
stace

Sep 30, 2008
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continued laxity
by: Bart - SII

The meniscus tears are likely due to the excess motion between the tibia and the femur. Without a tight ACL, the stress on the mensicus is increased and abnormal.

As to why the surgeries both failed, that is harder to pinpoint. One of the drawbacks to hamstring grafts is that they can become lax over time...usually much longer periods than what you experienced.

It is true that a graft that is placed too vertical can cause problems, so that may have been part of the initial problem. When you had the second surgery, what type of allograft did they use? Another hamstring, or a patellar tendon?

A third surgery may help, but unfortunately even a second surgery has a larger chance for failure because the bones don't give a good fixation for the graft.

I would talk to your doctor about bracing and see if you can find a therapist who specializes in sports medicine and will take an active approach to strengthening your hips and core, as that is the best way to try to stabilize your knee with a lax ACL.

Bart

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