Allison's arthrofibrosis problem post ACL surgery

by Allison Fontana
(Plantation, FL)

This is my third post. I need help. I'm a 44 year old firefighter/athlete that wants my life back. I tore my ACL on March 28th, 2009, had reconsruction on April 14th using my patellar tendon, then had surgery to manipulate and remove scar tissue on July 7th. I am still having pain and tightness in my knee and range of motion problems. Lack of full extension is bothering me the most. Also when I stand from a seated position I have to move my knee all around to get it to snap into a comfortable position. Before the snap (that comes from different places in the knee) my knee is painful and feels out of place. The snap itself is not painful at all. I recently had another MRI that showed more scar tissue. I have a great therapist who has done everything under the sun to help me and I do not shy away from hard work.
Since I've been an athlete my whole life, I know my body and I know something is wrong with my knee. My doctor wants to try a wait and see approach over the next few months as he believes the scar tissue will soften over time. Is this possible? It's been almost 8 months since my first surgery and 4 months since my 2nd. I don't know if I trust him anymore because although I told him something is wrong with my knee, he kept saying that I was progressing. It was obvious that I was at a stand-still so I insisted on an MRI both times. Both showed excessive scar tissue.
I've since done a lot of research and I don't believe that my case was handled as well as it could have been. First of all, I had no therapy between the injury and the ACL surgery. Secondly, I think the doctor waited too long to take my complaints seriously and order the MRI (I had to be on Vicadin until my 2nd surgery just to get through the day and I'm not a pill person). Lastly, I wasn't given a real plan to discourage more scar tissue growth after the 2nd surgery... just prednisone and 3 days per week therapy. I think I should have been given a CPM machine and daily therapy sessions.
Right now my knee feels very stable and my quads and hamstrings continue to get stronger. The pain, although pretty low in scale, is getting to me because it's keeping me from jogging or even walking for long periods of time. I can ride my bike for hours with no problems. Having to consciously align my knee to walk or to get comfortable is also getting old.
Have you ever heard of scar tissue relaxing over time? Do you have any suggestions? I would like to get a second opinion but I want to go to someone with a lot experience in handling arthrofibritic patients. How can I locate such doctors? I live in southeast Florida but I'm willing to travel to see an experienced doctor. Please help...
Thank you,
Allison

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Allison's arthrofibrosis problem post ACL surgery

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Nov 09, 2009
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my experiences with arthrofibrosis in ACL patients
by: Bart - SII

I feel your pain and understand the frustration. I have had a few patients with this type of problem, in both the knee and the shoulder. The biggest concern, as you already know, is that surgical intervention for the scar tissue leads to more trauma and more scar formation. Unfortunately, stopping the body from producing more scar tissue is difficult, if not impossible.

With my patients who have had this problem, we took a neuromuscular approach to their therapy. We stopped any type of range of motion therapy altogether - no more joint mobilizations, no more stretching, nothing that even hinted at trying to improve motion. This does two things.

First, it takes the focus off of the frustration. If you are constantly focusing on getting range of motion back, for 1-2 hours at a time, 3 days a week, and are not making any progress, it becomes so hard to feel any type of achievement. That turns into a psychological block, and adds to the stress and frustration of the entire process.

Second, it often allows the therapist and patient to re-establish a new view of the injury and treatment. If you are not working on range of motion, the focus shifts to other things. Improving the communication of the muscles and joints, and how the lower extremity functions as a whole.

A neuromuscular approach to the knee involves restoring normal function and communication of the joints and muscles. I did a lot of functional exercises, specifically working on control of the hips and core. It sounds crazy, but if you can improve the function of the hips, and restore more normal movement patterns of the entire lower extremity, the knee often falls into place, and you see gains in motion and function secondarily.

I know this doesn't help you specifically, but it may be something to discuss with your therapist - if you can change the focus of your rehab, it may be able to alter your outcomes enough to get you back to where you want to be.

Bart

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Nov 09, 2009
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Submitted by: Bart - SII

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I feel your pain and understand the frustration. I have had a few patients with this type of problem, in both the knee and the shoulder. The biggest concern, as you already know, is that surgical intervention for the scar tissue leads to more trauma and more scar formation. Unfortunately, stopping the body from producing more scar tissue is difficult, if not impossible. With my patients who have had this problem, we took a neuromuscular approach to their therapy. We stopped any type of range of motion therapy altogether - no more joint mobilizations, no more stretching, nothing that even hinted at trying to improve motion. This does two things. First, it takes the focus off of the frustration. If you are constantly focusing on getting range of motion back, for 1-2 hours at a time, 3 days a week, and are not making any progress, it becomes so hard to feel any type of achievement. That turns into a psychological block, and adds to the stress and frustration of the entire process. Second, it often allows the therapist and patient to re-establish a new view of the injury and treatment. If you are not working on range of motion, the focus shifts to other things. Improving the communication of the muscles and joints, and how the lower extremity functions as a whole. A neuromuscular approach to the knee involves restoring normal function and communication of the joints and muscles. I did a lot of functional exercises, specifically working on control of the hips and core. It sounds crazy, but if you can improve the function of the hips, and restore more normal movement patterns of the entire lower extremity, the knee often falls into place, and you see gains in motion and function secondarily. I know this doesn't help you specifically, but it may be something to discuss with your therapist - if you can change the focus of your rehab, it may be able to alter your outcomes enough to get you back to where you want to be. Bart

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Nov 09, 2009
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Were in the same boatt
by: Anonymous

hey allison. im in the same boat as you.
I had my first acl reconstruction in June. with also lcl and menicus work(can't spell it)
and after the surgery i could not get full extention i was lacking 30 degrees due to scar tissue. So sempt i went in for another surgery/scope on my knee to remove scar tissue.
After my surgery I was doing pretty good. Could not get full extention. Now more scar tissue built up in my knee and also in my fibula head. im in pain everyday even if i don't do anything im still in pain. Right now at physio were just trying to get the scar tissue down our slefs but its not working. So i go back to see the surgon in a week to book an app for another opp. I just want my knee to heall! like it sucks i was supposed to go to the states this year on a full ride schoalarship for soccer. So i had to dealy it. I just hope everything is fine by summer so i can go back playing soccer

Dec 21, 2009
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Doctor in Southeast Florida
by: Anonymous

My daughter had ACL reconstruction in February 2009 and also had a bone graft done on her femur, she was 17 at the time. She is totally pain free and has been for quite awhile. Her physical therapist has been amazed from the beginning at how well she has done with no pain at all, he said its all in the surgeon. We went to Dr. Kevin Shrock at Fort Lauderdale Orthopaedic Surgery & sports Medicine. He is the greatest!!

Jan 04, 2010
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austeopath
by: Anonymous

full range of motion = austeopath
one day after acl reconstruction surgery I went to an austeopath (spelling) and regained full range of motion and great blood flow..My leg became pink again. I had physio ... chiroprator and have progressed to a point. Its been 2 years and my leg is noticeably weaker and smallr . My hamstrings (two had to be taken) well its still very weak. Really the whole left side of my body is weaker!.

My rite noticeably stronger.
I am not balanced.