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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Steves problems after surgery

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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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Apr 10, 2009
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Submitted by: Stephen

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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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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.

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 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.

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May 15, 2009
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Submitted by: Stephen

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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.

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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.

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.