Post -ACL Surgery Band of Tightness Below Kneecap

I injured my knee August 2009 while playing soccer. I am 54 years old but was very active and fit. I had ACL surgery using an autologous hamstring graft with the Biomet system about 12 weeks ago. Also had a lateral and medial partial meniscectomy and chondroplasty of the patella.

I have been doing PT 3X a week. My problem is that ever since I stopped using the surgical brace I have felt a constant band of tightness below my kneecap that wraps around to the sides. I don't feel it at rest, only with movement. When I walk it feels like an elastic band is pulling back on my knee and I feel it more acutely going up and down stairs.

I have good knee flexion (137 degrees) but have a problem achieving terminal knee extension on my own. I have discussed this with both my OS and PT. Up until my last visit at the end of Oct., my surgeon said it's normal to have sensations like this after ACL surgery. When I asked for a more specific explanation at my last visit he said I have some scar tissue which usually resolves in 90% of patients by 4-5 months although he is not certain this is the cause of this sensation.

I agree I have scar tissue--I have a lump on the medial side of my hamstring incision. My PT seems to think the sensation is related to patellar tendonitis which I've had for a while post-surgery. She has been doing knee mobilization techniques and I also try doing these at home.

The interesting aspect is that I discovered accidently that if I wear a knee strap above my knee it reduces the feeling of tightness significantly. When I mentioned this to my OS he said it probably helps with proprioception. My PT believes it helps the tendonitis and would prefer that I wear the strap below my knee. However, having tried that I find the most relief comes from wearing it above my knee.

I'm thinking about getting a second opinion or requesting a MRI. I'd like to know what your thoughts are regarding the tightness.

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Post -ACL Surgery Band of Tightness Below Kneecap

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Dec 22, 2009
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Tightness
by: Bart - SII

Tightness like you describe below the patella is common after an ACL reconstruction - more common with a patellar tendon graft, but also with a hamstring tendon graft. It can be caused by a multitude of things - scar tissue formation, poor patellar mobility, tendonitis, etc.

In patients I have treated, this type of "tightness" is usually due to patellar mobility and a loss of normal arthrokinematic motions in the knee. Is your patella as mobile as the uninjured side? Does it freely move side to side and up and down as easily? If not, this can contribute to the tightness sensation. Patella mobilizations can help with this, and may be what you are referring to with "knee mobilizations" done in PT and at home.

Arthrokinematic motions can be improved with focused tibial and femoral glides done by your therapist. Anterior posterior glides are usually done, but a rotational glide at end range extension can also help restore the normal "screw home mechanism" of the knee. Talk to your PT about this.

The knee strap above the patella providing the most relief is interesting. The strap in this position does a couple of things - it increases proprioception for the quadriceps, allowing, possibly for a better contraction by increasing the resting tension of the muscle. It may also reduce tissue stress across the quad insertion. Which may indicated that this isn't so much a patellar tendonitis issue, but rather a quad muscle function problem.

If the band is improving proprioception and contraction, the tightness may be contributing to an altered length-tension relationship for the quads, limiting your terminal knee extension. Just thinking out loud here...

I would explore with your PT mobilization of the patella and tibia, as well as looking at proprioceptive activities that would improve your quad function and hip control.

Bart

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