Stretched out ACL graft

by Teresa
(Brush, CO USA)

I had ACL reconstruction 20 years ago with a patellar tendon graft. I tore the medial meniscus in this same knee in September 2007, had a meniscectomy in December and during arthroscopy the surgeon could fold the graft over onto itself (stretched out and non-functional).

I'm wondering if this stretching out could have occurred because of a fall during a duathlon (tripped on a rock), landing forcefully on that leg while it was extended.

What do you think?

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Mar 22, 2013
here we go again NEW
by: claire

So my 3rd acl has torn and im due for my 4th acl surgery (5th knee surgery, 7th surgery in 4 years) my surgeon has been amazing and a great support. Im now awaiting a donor patella graft with a Macintosh procedure which I am confident will be better in the long run ... May need to be done as a 2 stage. Can anyone give me more info on what this involves 2 stage and the macintosh procedure. He did explain it but with so much to take in i dont remember much and theres not much online. Any information would be appreciated :)

Mar 21, 2013
Stretched acl again NEW
by: Jo

I ruptured my lefty acl in a car accident in 2009 had hamstring recon and it failed within 12 months when they went in to revise with patella recon the surgeon said the first recon had stretched. Then last year I busted my right acl we decided to have both knees investigated and the left patella recon had stretched and frayed so surgeon stitched it and then did a Lars recon on the right. That was 6 months ago, it appeared the right Lars had failed also, had surgery yesterday fora patella recon on the right surgeon reported the Lars had stretched...I didn't think Lars could stretch, I am desperate to know what in my very slow gentle rehabs I am doing to stretch these acls? I barely get back to a light jog before they have stretched and cause meno end of trouble again, 4th acl rehab underway and am too scared to even stand up, no one has answers not the physio or the surgeons! Help,

Sep 25, 2012
3rd acl revision and feels loose again at 12 weeks NEW
by: claire

12 weeks post 3rd acl revision using patella graft from same knee and my knee feels very loose, gives way and hurts 50% of the time. It felt solid about 4 weeks ago and now feels the way it did before surgery. Suspected soft tissue defect (which makes sense as ive just had surgery on my arm also) cant do anything or even test it properly as its too early but can anyone advise me what would be next step ... 3 failed acls as they become seveGrly loose and useless and im 34. Working hard on rehab as i always do but not overdoing it ... Apart from that not done anything i shouldnt be. Any advice ?

Sep 25, 2012
don't knw wat is happenin NEW
by: Anonymous

Its been a six months to my sugeory and I feel my graft is streched but my doc said its ok wat to do will excersise help me and its pains on my surgical cuts what are the reasOns plss help me

Jul 09, 2012
Stretched out cal NEW
by: Claire

So apparently my graft was stretched out and I've just had an cal revision of a revision reconstruction using my patella graft from my left knee. All going ok 5 days out of surgery and my surgeon has said my joints and muscles, tissue are really flexible and laxed so this could be a factor although we are not sure how it has failed yet again. Thankfully it was done as a one stage rather than a two stage. I trust my surgeon and have no doubt he is one of the best .... On the road to recovery ....Again.

May 28, 2012
My poor body NEW
by: Scotty

Hello everyone! Where to begin?...... I am 35 and am currently up to 23 surgeries: 9 ears (7 tubes, 2 reconstruction left ear), 3 ankles, 5 lumbar spine, 4 left knee, tonsils, etc......here is my problem, I used to be extremely active prior to my spine injury due to a quad accident. Since my knee has been giving me problems again. I have had 2 dislocations and such 2 reconstructions. My last replaced my ACL with a patellar graft , which has lasted well for approx 10yrs. Now when I hike or use my knee a bunch, it becomes very loose and will cause me to fall and much pain under weight bearing. After this activity I can lay my knee in front of me and make my knee move a bunch at will. The dilemma is that during my last "exploratory" surgery, I was under anesthesia and when my doctor performed the knee bending tests did not feel much looseness as such when I visit the doctor office since it is always early in the am when I have appts. My thought is that my graft is stretching during activity causing instability and only becomes loose after that activity. Does anyone have a similar story or a doctor have a thought? I am being scheduled for a two part graft revision, I hope this is it!!!????

Thank you,
Scotty

May 18, 2012
advice please NEW
by: Claire

I had acl recon with hamstring graft on my left knee in 2009 after a dodgy landing at a gymnastics class (im 33) at my yearly check up the PT was concerned about the laxity in my knee and the fact it was giving way. I then got a acl revision bone patella bone graft from my right knee at end of 2010 and this all seemed to heal up nicely. Had an arthoscopy of right knee middle of 2011 for cartlidge damage from the original injury. However, I noticed this year 2012 that same feeling of loosness and knee giving out throughout the day. Combined with pain and swelling I visited my physio whos face said it all and she referred me back to hospital. Surgeons registrars face also told a thousand tales and I am now on the waiting list to have knee op number 4 (third acl) and have been told it may require 2 stages. Obviously i am gutted as I was religious in my physio but didnt overdo it and want to know if anyone has any idea what the 2 stage involves (someone mentioned hip graft) what these stages involve and what "bits" will they use now. I am very flexible and tall but dont know if these are failure factors. I have not been back at gymnastics since the accident and now I jog and take kids dance classes but struggle to this as my knee gives out continuously and follows up with swelling and pain. Any advice please

Jan 24, 2012
HELP. NEW
by: Bailey

Im a girl, 15. I had ACL surgery 10/05/2010. I'm almost 4 months. Up until 3 months I have been EXCEDING physic therapy expectations, with no pain or anything. I went to see my surgeon for a check up. He did the pivot shift and said its shifting too much.? Then asked if my quads are up to strength. I had said I don't think so. I have 3 more weeks before I go back in to decide if I need more surgery... Please help. I'm
So confused. I play basketball and im only a freshman. This was heartbreaking enough the first time. I don't know what I did wrong. I just want back out there on the court. Also a week before I went and saw him I started light jogging.

Feb 20, 2011
Possible stretched ACL (18 year old male)
by: Anonymous

I ruptured my acl last may bmxing. A month later i had a hamstring reconstruction. I've been followng my physios advice the whole way and until last week was in the last stages of my rehabilitation; sport specific work. I was running, pivoting, hopping etc completely fine.

2 days ago i was sledging and put my foot down straight (extended) into a rut. it bent and i got a sharp pain, very similar to the pain i got when i originaly ruptured my acl. the pain died down a lot faster (10 minutes) and i was able to weight bear. I can now walk fine, there is no pain as such anymore, however it is extremely stiff. it is hard to extend it (i had full extension) and it will not fully bend as it did. it generally just feels stiffer.

I am seeing my physio tomorrow so hopefully they can shed some light on it. Maybe its nothing, but i have a horrible feeling that i've stretched the graft. Any advice or similar stories would be greatly appreciated.

Regards

Tom

Dec 15, 2010
DeNovo NT
by: Anonymous

Funny thread. I am going through the exact same thing. I had a patellar autograft in 2000, and just got a patellar allograft two weeks ago. I am also 38 years old. My story is the same as many above - non-functional ACL graft (stretched out) discovered in a meniscus surgery in August (2010). However, the damage was more severe as I am now bone-on-bone. Cartilage gone. So I am rehabbing the ACL revision to prepare for the DeNovo NT juvenile cartilage transplant in the summer of 2011. Fingers crossed - I will have a functional knee again for the first time in 10 years. More importantly I am hoping to avoid an artificial knee when I am 48.

Aug 04, 2010
Stretched ACL graft
by: Kym

I had an ACL reconstruction in Feb. Six months later I started feeling pain. The x-ray showed that the screw moved up the tibia tunnel up to my knee. So I had surgery last week and the doc said he might have put the screw in too far. So he took out the old screw and put in a bigger screw. He also said that my ACL is stretched out for some reason. But he said that a loodr ACL is okay if I strengthen my hamstrings. So the question is "Is a stretched/loose ACL okay for sports?" And is strengthening my hamstrings going to help with the loose ACL?

Jul 27, 2010
ACL graft re-stretched
by: Anonymous

I had an ACL reconstruction in my left knee in November 2004; the OS used the Kenneth Jones technique.

I just found out my reconstructed ACL is badly stretched. When I checked the medical records of my Physical Medicine & Rehabilitation MD, I found out he knew my ACL was stretched since the beginning of 2007, but he never told me. Was it stretched even before 2007? I don't know. Did I injure it somehow or did it stretch over time? I don't know.

I will have my second ACL reconstruction in a week. The OS will use a bone - patellar tendon - bone graft (Kenneth Jones technique again). This time, he will take the graft in my right knee.

Is there a way to prevent ACL re-injuries (for example, by wearing a Donjoy Post-Op brace longer and taking colagen pills from Costco...)?

Thanks.

Jul 19, 2010
MRI
by: Anonymous

an MRI does not show whether or not your ACL graft has stretched. it only shows tears.

Feb 14, 2010
Knee Sublaxation
by: Anonymous

I had acl reconstruction in June 08 and reinjured the same knee in July 09. The doc tells me that I didn't tear anything, but I now have knee sublaxation. I had 2 MRIs that show that nothing is tore. My therapists tells me that my knee is looser than the other one. What do you guys think?

Sep 01, 2009
Football
by: Alii

to the football player, that is most likely just muscle imbalance, or lack of muscle strengthening, when your muscles are weak they tend to give up, which often is what puts all the pressure on your knee strainign the ligemenets, i had an acl surgery last december, 4 months post op i apparently stretched it out by doing exactly what u did, on uneven ground. he said it was streched 4 mm, the maxiumum for a tretched is 3, he stil thinks i can do it, but im considering revision surgery now. or even a second opinion. but back to you, truly its most likely just muscle weakness, it would have to be a big impact for you to strain a ligemtn, good luck bud, keep strengthening.

Aug 04, 2009
ACL questio
by: Anonymous

im 16 and i had my ACL reconsruction last november as well as a meniscus repair. im lookin to play football in september but my surgeon had told me months earlier is had stretched out only a little bit somehow. he told me it was not too late and i just had to get it stronger.

I did that and i was feeling confident in myself. up until about a week ago when i was at the beach and i stepped in a hole and my knee went inward like when u strench out your legs. it wasnt hyperextended just landed in a hole and it went back.

I had no pain when it hapend no pops that i was aware of and i could walk fine. it was maybe a tiny bit swollen but i could walk normal and run
BUT....it now feels kind of unconfortable in the back of my knee kind of liek a burning feeling or a tickling feeling every once and a while.
i really need some advice cuz i might freak if i cant play football...does anyone have any suggestions as to what happened?

Jul 21, 2009
re-ALC graft.
by: Anonymous

Yes i have stability issues with my knee, but mostley when walking in the dirt or off pavement. Thanks for your responce on my question.

Jul 20, 2009
Can't regain strength
by: Lv2ski

My second orthopedic surgeon thinks my graft has stretched in less than a year after surgery. My knee is starting to give out on me. One day it gave out around 50 times. Since then, I have adjusted how I stand up and I pause before I start walking. I have not been able to go up stairs w/o noticing the lack of strenght in the repaired leg.

I feel like I was sold a bill of rotten goods as I was able to go up and down steps and walk 3 months after the injury and before surgery than I can now. I feel like I'm 80 years old.

One odd thing. I don't have pain or discomfort unless I having been kneeling excessively on the bad knee.

My hip is now sore, probably due to all the compensation.

Can I every get my strength back?

Jun 16, 2009
stretched acl graft?
by: Anonymous

Long story short. My 20 yr old athletic son had acl recon surgery in Jan 09 where the doc also repaired 2 meniscus tears. A severe strain of staph infection set in within a week and, well...its been quite a ride. By May we thought we were seeing the light at the end of the tunnel, however my son began having "clicking" in his knee along with pain. The clicking and pain got progressively worse over the past month to the point where PT will not touch him for fear of causing more damage. The original surgeon seemed somewhat unconcerned about the clicking until he put his hand on my son's knee and felt it. Suddenly he was ordering tests. My son saw our family doc for another OS referral. Our family doc has no acl due to an injury and she told my son that his knee is looser than hers is (PT had been telling us it felt way too loose). We have an appointment with a new OS July 27 for a 2nd opinion of what's going on. Due to the rarity of staph infection after acl surgery (i've been seeing .04%) we have not been able to find a whole lot of info regarding what it may cause in long-term complications. You think the infection caused it to stretch? Or the graft was bad to begin with? What about the clicking and pain? More/new meniscus tears? It was a patella graft and I saw that you mentioned they do not usually stretch. He has been 95% inactive since Jan, so there is no way he reinjured it. Any help, anybody?

May 19, 2009
question about knee stability
by: Anonymous

I had my surgery at age 20. I a now 38 and my knee gives out every once in a while. But just 4 days ago my knee went sideways on me. I heard a pop and felt like either my screw or tendon unscrewed and fluid filled my screw hole. My knee swelled up and now my foot is still swollen and always cold. Is what i felt possable or did i just restrech the tendon. I can walk but after a half an hour or so it swells back up and walking is almost inpossable. My knee fell like it wants to give out on me and pain shoots through the inside of my knee.
My doctor told me that i would have to have surgery when i turned 40 or there about. Is this true. I wear my knee brace now and my foot swells up and gets all cold should that happen or not?

May 19, 2009
question about knee stability
by: Anonymous

I had my surgery at age 20. I a now 38 and my knee gives out every once in a while. But just 4 days ago my knee went sideways on me. I heard a pop and felt like either my screw or tendon unscrewed and fluid filled my screw hole. My knee swelled up and now my foot is still swollen and always cold. Is what i felt possable or did i just restrech the tendon. I can walk but after a half an hour or so it swells back up and walking is almost inpossable. My knee fell like it wants to give out on me and pain shoots through the inside of my knee.
My doctor told me that i would have to have surgery when i turned 40 or there about. Is this true. I wear my knee brace now and my foot swells up and gets all cold should that happen or not?

Jan 02, 2008
Interesting...
by: Bart - SII

It is odd that your graft is stretched out, but that your surgeon seemed to think that the stability of the graft was good upon arthroscopic examination.

Patellar tendon grafts are not usually prone to creep (or stretching out) over time. This is usually seen more often in hamstring grafts, or other soft tissue grafts that do not have bone on bone healing.

I don't think that your injury in September caused the graft to stretch out, more that this is something that has occurred over time.

I doubt that the graft has been loose for 20 years, however, your body has probably been able to stabilize the knee through muscle function up until the point where you injured the meniscus. This injury may have led to compensations in your knee, and now the stabilization that you did have through the muscles is no longer working.

There really isn't any way to tighten the graft without going through a revision surgery. However, if you were functionally stable prior to the meniscus injury, you may be able to regain that with therapy focusing on proprioception and balance, as well as hamstring, hip, and core strengthening.

I have treated several patients who have a loose ACL graft but have been able to function in most sports after rehab to improve their functional stability. It takes some time, but with the right exercises, it could help you avoid surgery.

As far as deciding on a revision surgery or not, it really comes down to how much instability you are having, and what kind of activities you are wanting to do. I would talk with your physician and get their recommendations as to your next course of action.

Hope this helps...

Jan 02, 2008
Stretched out ACL graft part 2
by: Teresa

In reply to your question, "Just curious, do you have stability problems with your knee?"

Yes, I do have stability problems, but did not notice until after the initial exam for the meniscus tear when the surgeon told me the ACL was loose. This was about 6 weeks after the injury, and 6 weeks of not running.

During the arthroscopic meniscectomy when the surgeon looked at the graft and checked the technical aspects of the graft and said it was good, he didn't know why it was stretched out, unless the tension wasn't right to start with. I don't think the ACL has been loose for 20 years, so I'm still wondering why it would stretch out and if there is anything I can do besides the ACL revision surgery to tighten the graft up.

Any ideas?

***I moved your submission to the comments section to keep this post together, rather than starting a whole new page :-)***

Dec 30, 2007
Probably not...
by: Bart - SII

Most of the time, when a graft is loose and non-functional, it occurs over time, several years. Because your procedure was 20 years ago, I would lean towards this as the cause for your graft condition. A fall would cause a tearing of the ligament, rather than just stretching it out. And with a fall that injures the ligament, it would cause bleeding, swelling, pain, etc.

I would bet that your ACL laxity is a combination of wear and tear on the ligament over the last 20 years and the type of graft fixation that was used when they reconstructed your ACL.

Just curious, do you have stability problems with your knee?

Hope this helps...

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