Question - Knee Mobility Post ACL Surgery

by Christine
(Abilene, TX)

I still cannot straighten my knee completely since ACL surgery May 7, 2008. It's at minus 8 degrees at best. Can you advise? To give you some history, I first tore my meniscus in the left knee while jogging and had surgery for that in April 2007. After about 2 months of rehab I still could not straighten my knee completely.

Then I tore my ACL (June 2007) while I was still recovering from the meniscus tear. Went back to the ortho Dr. and he wasn't convinced I tore anything (even though I insisted something was injured in my knee) so I was sent on my way to more rehab. After several more months of rehab, and only able to straighten my knee to minus 5 degrees I went to a different ortho Dr. who diagnosed me with a torn ACL. Did ACL reconstruction the following week (7 May 08) and I've been in rehab again since May 08.

I am still unable to straighten my knee completely. I've been told by a new ortho Dr. (my surgeon has since retired) that I may never straighten my knee again. That it could be scar tissue built up. Now I have hip pain, lower back pain and pain in my right leg because it bears a good portion of my weight most of the time because I cannot stand completely straight unless my weight is on my good leg.

Any advice or information you can give me is appreciated! I am desperate here. I was very active prior to the surgeries. Running, racquetball, softball, volleyball, you name it, I played it.

I am a 45-year-old woman and understand that us older folk don't heal as quickly. But I have a hard time accepting that my knee will never straighten completely again. With the medical technology out there isn't there something that can help me with this problem other than a total knee replacement?

I also have osteoarthritis in my knee which I never really had before the meniscus surgery. My workouts now consist of a recumbent bike, eliptical machines, and walking/exercising in the pool. All are great for staying in shape; however, I can't even do those with the intensity that I want to because of the constant pain in my knee and inability to straighten it completely.

Thanks

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Question - Knee Mobility Post ACL Surgery

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Aug 18, 2008
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How aggressive has your therapist been?
by: Bart - SII

I won't say that it is impossible for you to regain your motion, but it is going to be an uphill battle. The fact that it has been so long since you have been able to straighten it out makes a huge difference in the ability to regain that motion.

You have probably developed scar tissue around the joint, as your physician said, which then limits the sliding of the bones inside the knee joint.

There are treatment options though - aggressive joint mobilizations can sometimes disrupt the scar tissue and adhesions within the joint - however, these are usually fairly painful when performed, and many therapists shy away from them. Also, making sure they are being performed correctly is important to prevent further damage to the knee.

Surgery to go in and clean out the scar tissue and try to restore motion is another option - this can sometimes work, however, it also has the risk of more scar formation because of the new surgery.

Another option is a manipulation under anesthesia - basically you are put under and then your doctor forces your knee straight, breaking up the adhesions and scar tissue - again, there is the risk of developing new scar tissue, so you have to be very diligent to maintain your new motion.

I would discuss all of these options with your therapist and doctor and see which ones are viable. It will likely depend on their philosophies and how they feel about these options with your knee 3 months out from ACL reconstruction.

Bart

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Aug 18, 2008
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Submitted by: Bart - SII

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I won't say that it is impossible for you to regain your motion, but it is going to be an uphill battle. The fact that it has been so long since you have been able to straighten it out makes a huge difference in the ability to regain that motion. You have probably developed scar tissue around the joint, as your physician said, which then limits the sliding of the bones inside the knee joint. There are treatment options though - aggressive joint mobilizations can sometimes disrupt the scar tissue and adhesions within the joint - however, these are usually fairly painful when performed, and many therapists shy away from them. Also, making sure they are being performed correctly is important to prevent further damage to the knee. Surgery to go in and clean out the scar tissue and try to restore motion is another option - this can sometimes work, however, it also has the risk of more scar formation because of the new surgery. Another option is a manipulation under anesthesia - basically you are put under and then your doctor forces your knee straight, breaking up the adhesions and scar tissue - again, there is the risk of developing new scar tissue, so you have to be very diligent to maintain your new motion. I would discuss all of these options with your therapist and doctor and see which ones are viable. It will likely depend on their philosophies and how they feel about these options with your knee 3 months out from ACL reconstruction. Bart

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