Steves problems after surgery

by Stephen
(North West)

Tibia-

Tibia-"now you see it, now you dont"

I had reconstruction of the ACL via hamstring graft six months ago, following an injury kick boxing february 2008. My recovery has been slow, some what impeded by pain and accomponied with instability.

My physio program had a very slow start being stuck at week 3 up and into my 3rd month of recovery, I have recently started to manage the pain better now, and with perseverance I am pushing my self into achieving better results from physically demanding activitys. I have concerns though about the success of my operation and would love to hear some input from people.
My knee on a whole gives me more trouble now than before the operation. I also have what seems to me like a lot of movement (more than before the operation) between the Femur (thigh bone) and Tibia (shin bone), this movement is most visible when i am satdown working leg muscles with my knee at a 90 degree angle, the Tibia pertrudes in and out with an amount of free movement that looks as much as approximatly 10-20 mm. My surgeon has done an MRI and told me the surgery looks fine and thier seems to be no problems and will see me in 3 months, but i still feel like my knee is worse than before surgery and the movement has not improved yet, at 6 months on from the operation.
I am getting what seems like good continueing support from my physio and in ability have moved on a lot(e.g i can drive manual transmission cars now with very little discomfort and can do 60 minute jogs on tread mill), but im still bearing a lot of discomfort, stiffness, instability, spikes of pain, occcasional clunkiness in movement and a constant dull ache that never ceases. I struggle up and down stairs and going down hills, and simple walks can be riddled with buckling of the knee.
I dont feel wise to what the trouble is and dont seem to be getting the advice i would like, my physio is working more intencely on improving the VMO, my surgeon I will see in april.
I am worried that the large amount of movement between the Femur and Tibia is the root of the problem but my consultant refered it to being a "small amount that could improve", and my physio steers away from discussing it, saying that everybody recovers differently.
I like to think that i can have faith that the professionals are doing what is best for me, some days i just feel like im being fobbed off though.
In my ACL class i seem to be the only one suffering this way, has anyone else experienced similar?.

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Oct 09, 2015
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Steves Problems NEW
by: Merlin

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May 22, 2015
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Education NEW
by: Anonymous

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Mar 05, 2015
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good ending NEW
by: Anonymous

Heya Steve,
a great ending to a somewhat sad story.
Im waiting for the date for my surgery for my meniscus and my ACL. I also did it training for a kickboxing fight back in Sept 2014. Two days before the fight! - loaded up on Voltaren I still fought though. I saw it as a victory , even though I lost on split decision..but being 48 with only ten days to get fight ready, you feel super proud of yourself.
So quick recovery is high priority for me and thats what Im most worried about. It's a little over 5 mnths ago now and Im running up to an hour, mouintain biking and kboxing a couple of times a week - with out feeling too much pain.
SO the thought of me, doing surgery and having 8-12 months of k boxing and I dont know how long off running, doesnt exactly thrill me. And at timed Im questioning whether to do the surgery at all!

Feb 23, 2015
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Steve 2015 update NEW
by: Steve 2015 update

Quite some time on now and a lot has changed.
I went through a second operation where a graft was used from the same leg from the lower centre patella ligament.

The graft was attached from the same origin and insertion points using larger pins. Rehab occurred in much the same manner and the second operation proved once again unsuccessful.

However I took it upon myself to study and research methods of rehabilitation and made a habit of training regularly and finding a passion for exercise, health and fitness methods to improve my physical and mental health, wellbeing and performance.

During this process I did have the misfortune of buckling my knee in such a way that I had to start the process from the beginning again and was under consultation for a 3rd operation of which I refused and chose to rehab myself. The knee buckled and damaged from chasing my small chupwouwai dog! Not as appealing story as when I was kickboxing.

I do not kickboxing anymore and I avoid sports, exercise and training that is dynamic or plyo metric in nature, however I can train frequently and to a very high level in controlled methods and environments. This has been highly beneficial to my health fitness and also aesthetics.

My progress has spurred me on to become a fitness instructor & personal trainer, an occupation I cherish and enjoy everyday. If I had never had my injury the catalyst for me starting my change would not of been there. I have spent incredible amounts of time learning, studying and practicing many methods of exercise to overcome the barriers the injury had created and the end result is a physique and level of performance that is greater than before the injury and of which back then I would never of believed possible to achieve.

I don't kickbox any longer but I've moved on and found a passion that I can help and support others with.
Although my knee is still unstable, with regular controlled exercise it is strong and uncommonly reminds me of the history it holds. It would not surprise me if at a later stage in life I may need to consider surgery, at which time surgery practice I hope will be much further improved.

It sounds strange to say I hold an appreciation for having suffered my injury especially with the early stage lows and frustrations. But the fact is I wouldn't be the person I am today with out it.

I felt at a loss in the beginning with no support to help surrounded by different professionals all contradicting each other. I had relinquished control of myself, my ambitions and self confidence to an injury which at the time had become the centre of my life and excuse holding me back.

I took back that control and worked hard and disciplined going way beyond all expectations.

I deal with clients everyday suffering many different injures, ailments and conditions, regular training has become an mantra for improved health, fitness and lifestyle and one that I swear by.

I hope that this update can serve as an silver lining to your dark cloud.
Wishing the very best.
Steve.

Feb 22, 2015
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reconstruction number 2 NEW
by: Anonymous

Hi Steve

I realize your problems were a good six years ago now and i would be interested to see if you went through with surgery again...

i had my ACL patella reconstruction in 2010 and waited one whole year to return back to anything physical... i was told by my surgeon that everything looked fine and there is nothing wrong with the reconstruction! (this is after I demanded another scan).

I was pissed right off, i knew my knee was not right as it is part of my body! so got a second opinion from separate specialist and he right away said it was placed in wrong, and the ligament had stretched.


I should have got surgery with new surgeon, but wrong timing i guess, i was due to do my oe when i found all this out, and i had a broken spirit by then so left it.

5 years after first surgery, knee is playing up again so got a third specialist in (as previous one i liked had retired - talk about shitty luck!) went back to same private hospital but have just seen a new surgeon there.

Now he has told me everything looks in place on the scan (?!) but it is apparent through the physical testing that the knee is lax. he has given me a million different options, but the two main ones are to get a hamstring graph (as my patella tendon is already gone from previous surgery), or get a patella tendon from someone else who has donated it!

Im feeling unsure, I feel my questions weren't also answered like why it stuffed up in the first place? if he cannot figure this out, I feel it will be hard to fix! I have no idea, I just feel so emotional about the whole thing, and I'm thinking i will go to another surgical team yet again with the recent scans, and see what they say.


What i do want to say is, you know your own body better than any surgeon, and if you feel it is not right best to seek advice elsewhere. sometimes I feel they do try to trick you and word things so you cannot understand, and this is not ok!



i hope everything went well for you, I'm sure we are not alone, and a lot more people have similar problems :'(



Britt

Mar 25, 2010
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latest update from me.
by: Stephen

After getting a second opinion my surgeon has finally conceeded that it is indeed slack, the ACL graft. 18 months later from the original surgery! My consultant/surgeon has identfied that the pin in my thigh bone is bent, causing the graft to be slack. This of course means that the knee will have to be operated on again, although the 2 previous pins are gonna have to be removed and I assume along with the slack graft. I am told then that the resurgery is gonna be done with a different method using different pins and a graft from the patella.
Any ideas what the name of this surgery type is?
Any ideas what could cause the pin to bend?
Should i have any concerns at going through another operation of a different type on the same knee?
Ive been given a date for the reoperation in 2 months, but i am quite worried. Im kind of scared that my knee may end up yet even worse. I still dont have confidence to kick box on my knee but am very athletic in a gym, I would hate to go backwards even more, but would be happy if i could return to the sport I miss and love.

Oct 01, 2009
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Slack ACL
by: Anonymous

I have had the same problems. Kept getting fobbed off with the consultant saying do more exercises.
Had my first acl in 2004, second in 2007, another small operation in 2008. and atill had movement between my knee.
Showed consultant my movement physically and he said the acl graph is slack and is going to do another operation with a different graph to hopefully remove the slack, and leaving the previous acl graph as it is.

May 21, 2009
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Clunkiness and locking
by: Anonymous

This can often be due to further damage in the knee apart from the ACL - meniscus or cartliage. By training with a lax acl especially after surgery the chances the excess movement in the joint may have caused further excess damage. Worth, if you can afford it, getting a private MRI to resolve any of the issues and question you may have abaout the current state of the knee IMO.

May 15, 2009
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update
by: Stephen

Thank you both for the feedback, I appretiate the sound advice and useful information.
I recently have seen my operating consultant and once again I left feeling like I had more questions and less answers. The consultant seems to conceed that there is too much slack in the acl graft, but will not consider doing surgery again until another 6 months has passed.
This has left me quite frustrated again, but I have took the frustration into my training and intencified my programme, although it can be quite painful, I feel that stability has improved a lot, the movement in the Tibia is still the same but the buckling sensation is far less frequent.
Would you agree that my consultant is following good practice in watiing another 6 months? (he thinks it may tighten up yet).
Also, I am a lot happier now im training harder despite discomfort, Ive got new sensations of pain though, should I be concerned?, the new pain im feeling is quite frequent and its like a momentary locking sensation in my knee, I can work my knee past the resistance but there is clunkiness and pain, and im certain I can hear knocking through the knee when it happens, it feels like something is fouling the smooth operation of the joint.
Thank you again for feedback, I will keep you posted on what a second opinion brings.

Steve.

May 13, 2009
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Instability
by: Bart - SII

Everyone does recover differently, but that usually goes towards pain levels, how fast motion and strength come back, and overall recovery time. It doesn't usually go along with the type of instability you are talking about. The movement you are experiencing between the femur and the tibia is slack in the ACL. So, when you are exercising the quads with your knee bent and your quad contracts, it pulls the tibia forward until the ACL becomes tight. This laxity means that the ligament is not providing feedback to the body, (although at 6 months it doesn't provide a ton of feedback anyway) but that results in the buckling feelings you have when you walk.

Hamstring reconstructions have a risk of laxity, and any type of ACL reconstruction is dependent upon proper placement and tensioning of the graft. I would recommend seeking a second opinion from an unrelated doctor - they may be able to give you some options.

Laxity like this can sometimes be overcome with an agressive balance and proprioceptive rehab protocol - teaching the muscles to stabilize the knee and pick up the slack of the ACL.

Good luck!

Bart

May 05, 2009
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independent 2nd opinion
by: Anonymous

You need a 2nd opinion from a surgeon who does ACLs who ISN'T associated in any way with your surgeon or his group. Same for your physical therapist...if you ask, he can't say much. They rely on dr. referrals for business. It seems your gut instinct detects there's trouble, follow up with a competent professional who can make a totally independent evaluation. ACL reconstruction is a good surgery, but not foolproof - nothing is. Your knee looks way too unstable to me.

Apr 10, 2009
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Another 6 Months!!
by: Stephen

After seeing my consultant and having some xrays the other day, My surgeon wants to wait another 6 months to see if the condition of my knee improves. He thinks the muscles in my operated leg are still very weak (which I personally dont believe, but is also talking about possibility of posterior cruciant ligament damage, which may not of been visible when he was replacing the ACL, he tells me that at 6 months the graft is at its slackest and it should be correct by 12 months.
I told him if he has any doubt in the graft improving then i wanted the operation repeating, but he does not want to do it this early because of the possible risks(what are the risks?). he also told me come 12 months I should Evaluate my lifestyle and consider if I do want to go through surgery again!. I hope that my knee improves and he is correct, although I am most sceptical.
I should be rehabilating my self back into kickboxing now, instead it seems I will have to wait another 6 months to find out if the graft is going to improve, and if it does not improve im back on the operation waiting list. I keep getting told that with recovery everybody is different, and I usnderstand that every injury is unique in its own way, Being told that I have slow recovery feels like a cheap fob off, with my body building experience and my martial arts experience I have suffered many injurys and recovery has always come very swiftly to me.
Am I getting the care and advice I should be?
Does this sound credible to you?
I feel like recklessly starting my kickboxing again but fear doing the same injury becuase of the instability, should i just risk it?
Maybe I have misguided myself on what i feel is going on with my knee, what do you think?.

I feel so frustrated and currently wish I never had the operation, I would love to hear some constructive points of view.
thanks for your time.

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