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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Jan 08, 2009
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similar problem
by: donna

I fell down some stairs at work and hit my lt knee on the metal lip of the step. It was bruised and swollen and very painful. I too have arthriris in both knees but it never limited my activities before the accident.My ortho doc did arthroscopic surgery on oct 9 2008.He said I damaged the cartilage to the bone and he drilled 2 holes in my knee with hopes of growing new cartilage.I have been through pt for about 2 months and I can't completely straighten my leg out plus I am still having a great deal of edema at my knee after short periods of weight bearing.I too am having a great deal of pain in my low back and hip from my gait being altered. My doc said that the mobility I have may be as good as it gets but I am not willing to accept it.I too am 45 years old, a nurse and very active. someone has to have a different outlook .

Mar 25, 2009
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Post ACL problems
by: Anonymous

I have had a acl reconstruction using my patella graft, its been nine months and i am still having pain and tendorness in my knee and i cant completely straighten my knee, This is causing me to put all my wight on my good leg the right one and this is casusing hip and back pain, could someone please tell me why this is so and how can i fic it, the graft is fine. i am only 24 so i want to fix it before i get to old.
Thank you

Jun 08, 2009
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Cannot straighten knee and am worried
by: Jadycat

I too have had a patella ACl reconstruction, this was beginning of February 2009
(4 months ago)
My knee has full bend without pain, but I cannot straighten it.
It does not hurt trying to straighten it, just it will not straighten.
my physio has said it might be because my leg alignments are not straight, my hip, thigh and knee might be out and facing one direction, while my lower leg is out and facing the other direction. I hope that by manipulation I can straighten the leg so that everything fits back to normal (yet it hasn't so far after 6 weeks physio) but I too am worried this is actually due to arthritis or scar tissue build up, I am scared I may have to have another operation.

Jun 15, 2009
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UNABL E TO STRAIGHTEN KNEE
by: dwight

I have swelling in both legs caused by edema. I am scheduled to see a vascular surgeon for the swelling, howver the other problem I have is same as other posts / unable to straighten right knee. Ortho dr wants to do surgery thinks there is ligament damage interferring with full joint movement. I have concern about surgery re scar tissue and making problem worse. I have pain walking from inability to fully extend leg. Stiffness and pain go away while moving but pain occurs after sitting for any time, then getting up and down.

Jun 22, 2009
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Same here
by: Dee

I had Medial Meniscus surgery and orthoscopic surgery done in 2004 on my right knee. During ortho surgery he ruled out my ACL due to it was not stretched too much so he left it alone. I had a total tear and my meniscus was re-sewed and my ortho doc told me that I needed to be very careful when playing soccer ( how I injured it in the first place) and that perhaps tennis & skiing was out of the question. My knee recovered fine at that time but I gave up playing sports - I stuck to running and working out at the gym on the ileptical and walked/ran. No more ice skating, tennis, soccer or other twisting type sports. In July of 2008 I was cleaning the pool outdoors when my right knee gave out and slipped out of joint. The same ortho doc confirmed I had a re tearing of my right medial meniscus and my ACL was also torn. I opted for surgery because I could not stand my knee popping out of place all the time including swelling and pain. I had surgery October 7, 2008 with a medial meniscus repair on the right leg and a right hamstring graft to repair the ACL as well. Surgery was successful and he sent me home with the usual ice, immobility and pain med etc. I was walking with a limp a week later, no crutches and when I went into the doc for follow up he sent me home telling me to try walking normal and straighten my leg when I do walk. He did not even give me a script for PT at that time. My 2nd follow up visit 4 weeks later I still had a swollen knee and limping, again he told me to try and walk and straighten it out without a limp. Of course it was early still and so I tried, no way could I do that though. he also insructed me that I had a bone fragment he saw on my x-ray and also a screw was not properly fit into the knee, perhaps the screw was too far into the bone he said. He said he was hoping it would resolve on its own. He issued me a script for PT 2 times a week for 4 weeks then back in his office. I lost my medical insurance and could not afford PT, I was undergoing a divorce and my ex cut my insurance off. I had no job and limited money in savings. I then went to the gym at the community center 3-4 times a week and walked and did light weights, I also used the bike and this seem to help allot. I just couldn't afford PT, sorry. I did my best but now I am unable to straighten my knee all the way like the other knee/leg. It is causing me some back and hip pain and I even tried yoga and this helped somewhat but the knee just won't budge. It is locked. I wrote my doc a letter explaining that perhaps he could help me due to not having insurance and take a look. perhaps the knee fragment he left in my knee or the screw was impeding the straightening of my knee. It is now 8 months later and I'm still waiting for him to call me. It has been a week since I mailed it and no call so far.
continued below

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Jun 22, 2009
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Submitted by: Dee

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I had Medial Meniscus surgery and orthoscopic surgery done in 2004 on my right knee. During ortho surgery he ruled out my ACL due to it was not stretched too much so he left it alone. I had a total tear and my meniscus was re-sewed and my ortho doc told me that I needed to be very careful when playing soccer ( how I injured it in the first place) and that perhaps tennis & skiing was out of the question. My knee recovered fine at that time but I gave up playing sports - I stuck to running and working out at the gym on the ileptical and walked/ran. No more ice skating, tennis, soccer or other twisting type sports. In July of 2008 I was cleaning the pool outdoors when my right knee gave out and slipped out of joint. The same ortho doc confirmed I had a re tearing of my right medial meniscus and my ACL was also torn. I opted for surgery because I could not stand my knee popping out of place all the time including swelling and pain. I had surgery October 7, 2008 with a medial meniscus repair on the right leg and a right hamstring graft to repair the ACL as well. Surgery was successful and he sent me home with the usual ice, immobility and pain med etc. I was walking with a limp a week later, no crutches and when I went into the doc for follow up he sent me home telling me to try walking normal and straighten my leg when I do walk. He did not even give me a script for PT at that time. My 2nd follow up visit 4 weeks later I still had a swollen knee and limping, again he told me to try and walk and straighten it out without a limp. Of course it was early still and so I tried, no way could I do that though. he also insructed me that I had a bone fragment he saw on my x-ray and also a screw was not properly fit into the knee, perhaps the screw was too far into the bone he said. He said he was hoping it would resolve on its own. He issued me a script for PT 2 times a week for 4 weeks then back in his office. I lost my medical insurance and could not afford PT, I was undergoing a divorce and my ex cut my insurance off. I had no job and limited money in savings. I then went to the gym at the community center 3-4 times a week and walked and did light weights, I also used the bike and this seem to help allot. I just couldn't afford PT, sorry. I did my best but now I am unable to straighten my knee all the way like the other knee/leg. It is causing me some back and hip pain and I even tried yoga and this helped somewhat but the knee just won't budge. It is locked. I wrote my doc a letter explaining that perhaps he could help me due to not having insurance and take a look. perhaps the knee fragment he left in my knee or the screw was impeding the straightening of my knee. It is now 8 months later and I'm still waiting for him to call me. It has been a week since I mailed it and no call so far. continued below

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Jun 22, 2009
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continued
by: Dee

I am an athletic, 49 year old woman who previously was in excellent shape. I realize that perhaps I was not aggressive enough in my own PT but honestly, it hurts like crazy to try to straighten it and there feels like something is in the way to keep me from straightening it. I can bend my knee fine but the knee itself has a bump on the inner knee where my patella looks off kilter and not adjacent to where it should lie. Compared to my left leg and knee, it looks uneven. My right upper leg is smaller then my left, losing muscle tone and I have a hard time bearing weight. I am a nurse waiting to take my nursing refresher course so I can go back to work and I and cannot even be on my feet for longer hours now or stand for long periods of time. I cannot walk without a slight limp either. I am depressed about it and don't know which way to turn now. I wonder if this doesn't pan out if I should seek an attorneys advice? Some of your point of views would be nice. Thanks!

Sep 19, 2009
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Meniscus Surgery, locked knee can't straigten it
by: Shelly

Hi there,

In July 2009 I got up off the couch to go out shopping and felt an incredible pain in my knee that took my breath away. I couldn't bare any weight on my right leg and my knee was in a locked position. I stayed off my leg and got into the Ortho Surgeon and had immediate surgery...this was eleven days after it locking. I'm now on week nine and still can't straighten the knee, it varies between -10 to -15 degrees. I've had in house physio and now I'm going out to physio...just having to get someone to drive for it's my right leg and I still can't do the gas to brake thing.

My doctor has requested that I get some imobilizing brace which goes on three times a day for 30 minutes each time. There are tension rods which force my knee straight...I can't bear weight during this process...and it is really expensive 800 dollars a month, possibly four months of use, as well as physio.

Has anyone heard of this contraption and/or used it with any success. Please let me know.

Thanks

Sep 19, 2009
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can't straighten after a total knee
by: donna

I had a total knee in may 09 and now am unable to straighten my knee. I do PT 2 times a week and my therapist doesn't understand why the joint is so tight and my ortho doc just says it's perfect. I am still in a great deal of pain after standing or sitiing for periods over 20 minutes. I have been using a device they call an extensionator but my degree of straightening is no better now thsn it was when i first stated PT in June. My therapist literally pulls my leg by the ankle while her assistant pushes my leg to the mat( extremely painful and brings tears to my eyes). they put their full body weight on my leg and still I have had no improvement. I have 125 degree flexion I just can' straighten it.

Dec 03, 2009
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post-op acl recovery
by: Anonymous

dear 45 yr. old woman ,
Going through rehab now due to acl replacement.
My ortho told me he didnt like how the range of motion only allowed me to extend my leg forward 90deg. ( no further) this was concerning him.
1 month after surgery he then issued me a leg extensioner , he told me ( after 4 wks of more
therapy and using the extensioner) if my leg wasnt fully extended by then, he would probably be considering surgery again to remove all scar tissue that had formed preventing me to straighten or bending my knee backward to its fullest. IM just wandering if you have to much scar tissue build-up in your knee and maybe getting another opinion on the possibility of removing scar tissue? I do know what your going thru , i hope this advise was helpful at all. good luck in the future hope the best for you and god bless !

Dec 04, 2009
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post total knee replacement
by: Anonymous

Thank you for your suggestions. I have been going thru intense pt and have increased the strength in my leg however I am still having alot of pain and unable to straighten it. I am also having a numbing sensation down the outer aspect of my leg down to my ankle.I am waiting for appt for second oppinion. keep me in your prayers please.

Jan 09, 2010
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can't straighten my knee after surgery
by: Anonymous

I had orthoscopic surgery in October 2009 to repair a torn miniscus and also repair a cartlidge in the back of me knee that was hanging down and he also took care of arthritis while he was in there. I have been receiving physical therapy twice a week land and water. I am know only doing land and the therapist gets on stool and pushes down on my knee trying to straighten it, This is so painful, I cry. The doctor was me to be put under now so he can manipulate the knee but I will still have to have therapy. I have done all the exercise reaquested at home as well, please email me if this has happened to you. I could use the support. wvuscout@aol.com

Mar 17, 2010
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Unable to straighten knee or walk
by: Gayle Lakeland, FL

I shattered my patella in 2004. The ortho removed the bottom half because he said the pieces were too small to put back together. After that ordeal, I was able to walk (with a cane) but my knee did not entirely straighten. Since that time, I had a arthro meniscus r epair, total knee replacement, and pt many many times for the last five 1/2 years. Now my leg is so bent I can only walk with a walker around the house and use a wheelchair everywhere else. A new ortho says I need a knee revision and it has only been 9 months. I am only 57 now and was 52 when I shattered my knee. I have been through **** and still can't walk right. If anyone has any suggestions, please e-mail me at GR8Gayle@tampabay.rr.com.