Sports Injury Info

Lateral Knee Pain – 9 Months Post ACL Reconstruction

I play football and one day in late August 2007 at practice my left foot got stuck in the field turf as I was turning and preparing to jump. This completely tore my ACL and partially tore my MCL and lateral meniscus.

I had surgery to reconstruct my ACL and fix my meniscus in early October 2007. The surgeon used one of my hamstring tendons and after the surgery he said everything went really well. After the surgery I did everything I was asked and worked very hard to rehab my knee and since then my MCL has healed completely and my knee has progressed nicely.

When I saw my surgeon back in April (roughly six month checkup) he was very pleased with how the ACL and knee in general was healing and progressing and said he didn't need to see me again until the one year post surgery mark. He did prescribe an ACL brace though which I have now and wear when I run routes (I play receiver) or have the possibility of getting hit.

As I said before everything with my knee had been progressing very well and because of my progress I started practicing at roughly seven months post surgery. I then hit a major setback at roughly eight months. My symptoms were:

- A large amount of swelling (comparably to immediately after surgery)
- A lot of stiffness
- My knee feeling unstable
- Lack of strength in my hamstring
- A large amount of pain and clicking on the lateral side of my knee

I then went and saw my physiotherapist who suggested rest which relieved me of virtually all of my symptoms except for the last one: the pain and clicking on the lateral side of my knee. My PT then treated me for IT Band problems as well as tight hamstrings using acupuncture, ultrasound, etc. I continued seeing my PT five days a week for roughly two and a half weeks. This helped to cure the pain and slowly reduced the clicking but unfortunately my PT went on vacation last Wednesday and the pain on the lateral side on my knee has returned.

The strange thing though is I don’t have the clicking anymore. Just a lot of pain which is making it hard to train for Football. One thing I have noticed is that a tendon (I believe it is a tendon) just below my kneecap to the lateral side is swollen and I believe that this may be the cause of the clicking or popping.

So as of now I am a little confused with what to do with my knee. I can’t take time off because we start training camp in roughly a month but the pain is enough to slow me down considerably right now. So I was wondering if you may possibly know what is causing this pain on the lateral side of my knee and what I can do to get rid of it for good?

Thanks!


Ps – I apologize for writing so much. I hope that it helps in some way.

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Lateral Knee Pain – 9 Months Post ACL Reconstruction

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Jul 03, 2008
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starstarstarstarstar 		Two things concern me...
by: Bart - SII

Sorry to hear about your setbacks - two things from the information you provided concern me...

1) The fact that you had a lot of swelling, similiar to what you had immediately following surgery - this suggests that you had a joint effusion, or swelling inside the joint. That usually means that something inside the joint is damaged or irritated - could be the meniscus, the ACL graft, the joint lining, the articular cartilage, etc.

2) Your knee felt unstable. Feelings of instability are usually not a good sign after an ACL reconstruction. It could be from the swelling and muscle weakness, but it also suggests that there could be something more serious going on. Menicus tears and graft migration / failure can lead to instability.

These two things lead me to wonder if you have something going on inside the joint - if you were my patient, I would probably send you back to the Dr. for an evaluation, perhaps an MRI.

With that said, the clicking and pain could be caused by your IT band where it attaches to the fibula/tibia. This is an area of friction, especially when the IT band is tight.

You could also have some scar tissue buildup left over from the ACL reconstruction that is being irritated. This is very common after ACL reconstructions.

There could also be some mobility issues at your hip and low back that could be causing increased stress on the IT band insertion and the lateral knee.

It is really impossible for me to give you a definite answer without being able to evaluate you. I would recommend talking with your doctor though, if nothing else just to make sure that they aren't concerned about some type of intra-articular pathology.

Hope this helps - comment back if you have other questions.
Jul 03, 2008
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starstarstarstarstar 		What should I do?
by: Anonymous

First of all thank you for responding so quickly and yes, this does help. My first setback (the one with the swelling, instability, pain, etc) cleared up after roughly a week of rest and everything except for the lateral knee pain has not returned. So do you think that something more serious could be going on still? I also had my knee checked by my PT who said everything looked good and after the swelling, instability went away I was able to return to all activities with no hesitation. So now the only thing stopping me from feeling close to 100% is this lateral knee pain which is quite bothersome some days and others it is okay. So if I could get this lateral knee pain to stop I would be off to the races. So with that being said what would you recommend I do? How can I make my IT band not so tight? How can I reduce scar tissue? Should I be stretching my hips and lower back more? Thanks again!

Ps – Could my meniscus on the lateral side be causing this pain since I had it repaired back in October?
Aug 14, 2008
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starstarstarstarstar 		Give it time
by: Anonymous

I had the exact same surgery done in December of 06. I have the very same symptoms that you are experiencing. Post surgery I was freaking out as I am a very active athlete as well. I was sure that I tore my new ACL. After going to the doctor I had an MRI done. Turned out that I had scar tissue that developed on my tendon which was causing some of the irritation. This was diagnosed a year ago. I have not had it removed yet and wont unless it get really bad. After about a month of riding the bike at the gym I was about 100%. I kept wakeboarding throughout the summer(this is how I tore my ACL btw) but I made sure to wear my knee brace(Donjoy) also I did a lot of leg exercises at the gym, making sure to go very light and isolate my left and right legs. If you take care of your knee the lateral pain should go away along with the swelling but make sure you do some more PT and continue wearing your knee brace during the season. If it continues to bother you after a month call your surgeon/doctor and setup an appointment for an MRI. I can say that about 1 1/2 years post my knee is getting closer and closer to 100%. Just give it time.
Aug 14, 2008
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starstarstarstarstar 		LATERAL MENISCUS TEAR
by: Anonymous

I tore my lateral meniscus back in may. I am scheduled to have surgery in september. Since I last saw my surgeon I have been experiencing medial pain now. It is nothing that is real bad, but when i try to run the medial and center of my knee starts pounding and hurting.

I want to know if this medial pain could be caused by more pressure being put on my medial side, from the uneven weight distribution caused by a lateral meniscus tear?
Aug 14, 2008
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starstarstarstarstar 		It could be from additional pressure...
by: Bart - SII

Or it could just be that your knee, because of the lateral meniscus tear, is simply in a constant state of irritation, and the pain is simply presenting on the medial side now.

Referred pain is very common with orthopedic injuries, and often when the pain presents in one spot, it doesn't necessarily mean that the damage is in that exact spot, but perhaps in a surrounding area.

Good luck with your upcoming surgery!

Bart
Oct 01, 2008
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starstarstarstarstar 		pain behind the knee
by: Anonymous

My reconstruction was with a hamstring graph. I also had the meniscus repaired. 7 months after the surgery, i had pain in the back of my leg (behind the knee). i had an arthogram (mri with dye injected into the knee joint) done and it identified additional tears in the meniscus. I had another surgery to repair the meniscus. The pain in the back of knee has not gone away. I've seen three doctors and 6 physcial therapists. No one knows what's wrong. I decided to search online, which is how I ended up here. Any advice would be much appreciated.
Oct 02, 2008
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starstarstarstarstar 		Pain after ACL reconstruction
by: Lourdes

This might be a premature comment but I am so frustrated I just don't know what to do and reading these stories is making me wonder if having the surgery was a good idea. I had 2 acl surgeries. right knee partial tear 2 weeks I was good to go. minor pain here and there no big deal. 2 weeks after this surgery I had a complete ACL reconstruction of my left knee with corps acl. I know it has only been 2 months since my surgery but I still cannot walk correctly (i can extend and bend my knee 100 % with some pain) My problem is when I walk and put my weight on my left leg i cant bend it. it feels like it is about to lock and it hurts. My PT SAIS I should not be going through this by now but I do fell a lot of pain behind my knee and have the clicking as well. If you get an answer to your problem or if anyone has some hopeful words or concerns please let me know. This has been the most frustrating time of my life honestly WORSE than giving birth.
Oct 15, 2008
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starstarstarstarstar 		Knee pain after surgery
by: Anonymous

I had cadaver ACL reconstruction (full tear) in June. 4 months post op and very involved in PT and I'm going in for another MRI Friday. My issue is I'm not progressing and seem to have hit a plateau. I have bad pain when my knee bends slightly, going up or down the steps or walking for an hour or more. I was committed to rehab and the muscles are continuing to strenghten. Sometimes the pain is so sharp it feels like an ice pick is going up or down my knee. The pain is not where the scar is. I'm getting very frustrated because the pain that I had when golfing is gone but this pain is new. My surgeon says it could be scar tissue on the graft or bone that grew too much over the screws. Any thoughts? I am very frustrated and want to get back on the course.
Oct 15, 2008
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starstarstarstarstar 		response to pain after 4 months
by: Anonymous

I am sorry you are going through this but I feel better hearing that I am not the only one. I have an appointment with my doctor tomorrow to check on not being able to walk still I hope I get useful input. You might consider asking for surgical report. It turns out my pt told me to ask for it because the pain that iexperience which is not in my scar area might be a medial meniscal tear that i was unaware of and might have been tampered with during the surgery. Let me know what your MRI sais any bit of info helps. Good luck
Oct 15, 2008
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starstarstarstarstar 		Response to pain after 4 months
by: Anonymous

I was unaware of this. The surgeon said that there was no other damage when he was in there the first time or he would have fixed it then. I go this Fri for MRI. I'll post his results after his appt and if I don't like what he says I'll ask for that report. I'm wondering if my PT pushed me along too fast. I'll post results here. Good luck on your end as well.
Oct 15, 2008
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starstarstarstarstar 		Help
by: Erin

Wow, I am going through something so similar. I had acl reconstruction on my left knee three months ago. Since then, I have had constant pain in one specific spot. The pain has been a constant 3 on a scale from one to ten. The doc says that this is not normal. Then two days ago, I tripped and the now the same exact pain in the same spot is there, but it is a ten out of ten. I am so upset. I am going for an MRI tomorrow but I am terrified of the results. He is either going to say that everything is fine- which is still a problem because I know this much pain cannot be fine. Or he is going to tell me that something is wrong. I just don't know what to do.
Oct 16, 2008
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starstarstarstarstar 		ACL Response
by: Lourdes

For the ( I wonder if my Pt is pushing me to hard)

I have heard and had both easy therapy and very aggressive. The easy is worse for us than the hard. When I went to the more laid back therapy for my ACL Recon. My recovery was going sooo slow. When I started the Aggresive one it went much quicker and got more results. Another thing The weather where I live has been fluctuating (Miami Fl) it has been humid and rainy some days and then nice and breezy others. The humid and rainy days are a killer on me knee I always thought this was in a persons head but I take it back so those with pain still (as I am going through this) consider this. My PT told me that I may have developed tendonitis because I was so scared of stepping correctly on my left knee that I may have injured it a bit. I am know expereincing bruising on the right side and underside of the knee. I may have had blood accumulated in the bone that finally seeped out. There are so many senarios but i have heard that this is a very painful and long recovery. I persisted enough because I was frustrated to see all these other ACL patients doing better than me. but There seems to be hope.
Oct 20, 2008
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starstarstarstarstar 		Ugh
by: Anonymous

I recently fell into some trouble too with my new acl. I hkinda got it stuck in the ground and it fell kind of funny for a split second. Not it has 95 % ROM and some clicking but other than that i have full strength and stability. A little pain on the outer part of the knee. Im praying that its not torn again. Ive been researching for the past couple days now to find anything but i cant find anything specific. I dont think yours is too serious if those were your results after a week or however long. ACL surgeries are hell and i would never wish them upon anybody so hope everything turns out ok.
Oct 21, 2008
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starstarstarstarstar 		Update
by: Lourdes

Well I asked for my surgical report and it seems that all was well except for my ACL (obviously , hence the surgery). My doctor told me that when they perform that surgery that other areas are distressed and can cause pain in other areas around the knee. Some people recover quicker than others. My frustration seems to have a light at the end of the tunnel. My therapist has been taping my knee so to readjust my knee cap. It is working. I can walk better and the click and pain is slowly diminishing. Although it has been over 2 womths i still ice my knee twice a day with my leg totaly extended ( pillow under heel or legs hanging off bed) this too has helped a lot. It seems that because I have overworked myself since my surgery I still have some inflamed areas. Just wanted to add this input hopefully it will help someone. as i have been well informed by this forum.
Nov 15, 2008
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starstarstarstarstar 		8 mos. post-op -- new pain...
by: Nina

Hi -- It's such a relief to find this string -- I have been feeling really alone with my ACL woes -- they seem too "minor" in these times of great anxiety to complain about, but I am worried. I had ACL repair (allograft) mid-March, 2008 -- famous, terrific NYC surgeon; great PT -- am an extremely fit mother of four who never had any trouble recovering from previous (albeit less serious) injuries. Initial recovery was amazing; I am compulsive about exercise and couldn't stand the down-time, but I did as my PT suggested, and after 10 weeks was able to start jogging on a treadmill, gradually building up to running (again, treadmill). I had been working on the stationary bike previously, followed by the Stairmill (the one you climb like an escalator); I also am an avid and advanced student of Pilates, which was incredibly helpful in my recovery. But suddenly, about six weeks ago, I felt my knee swelling, aching and bugging me again. Crouching down was uncomfortable and/or impossible; previously, flexion had been 100% w/o problems. I have continued running for 20 minute spurts on the treadmill, followed by time on the Stairmill. Doing this four times weekly; Pilates twice. As a person who was once very overweight but has managed by exercising regularly over the past 15 years to completely change my body, I am terrified to have to stop working out. Does anyone have any idea why the swelling/pain/inflexibility might have returned? I did not increase my training intensity when it happened. ANY advice would be so helpful. My insurance will possibly cover more PT if I go back to my surgeon and he writes another prescription, but I'm not sure that PT is the key, since it feels like either something else has gone wrong in the knee or I've somehow managed to mess something up. Help!

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