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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Stretched out ACL graft

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Dec 30, 2007
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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...

Jan 02, 2008
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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 :-)***

Jan 02, 2008
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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...

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Jan 02, 2008
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Submitted by: Bart - SII

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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 <a href="http://www.sports-injury-info.com/proprioception.html">proprioception and balance</a>, as well as <a href="http://www.sports-injury-info.com/sports-injury-rehab.html">hamstring, hip, and core strengthening</a>. 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...

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May 19, 2009
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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
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Jun 16, 2009
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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?

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Jun 16, 2009
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Submitted by: Anonymous

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Comment
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?

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Jul 20, 2009
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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?

Jul 21, 2009
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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.

Aug 04, 2009
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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?

Sep 01, 2009
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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.

Feb 14, 2010
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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?