Reconstructive ACL surgery

[saravanaphysi]

hi
A 30 year old athlete, with a history of fixed knee deformity for almost a year after reconstuctive ACL surgery. Not responding to physio treatment. could you advice what sort of rehab could be done for this patient? This advice is for my friend who is treating the patient in some middle east country with limited facilities. Plz guide what could be done. Thanx

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[1234nale]

Hi
From your question I couldn’t see what sort of reconstruction was patient undergo or what sort is his problem with a knee. Because there are numerous surgical techniques, using different grafts (from patellar tendon, iliotibial band, semitendinosus, gracilis tendon or even synthetics ligaments) and using different grafts is taking different postoperative problems. For example, patient who have hamstrings graft are prone to hamstring injury. Average time for rehabilitation after ACL reconstruction to return to sport was 12 months and now even shorter up to 6-9 months. So it is very important what kind of rehab program was he undergo until now? If you can ask it would be easier to track problem. There are few more problem who could be associated with ACL reconstruction like patelofemoral pain (on the injured or uninjured side), inferior displacement of the patella, patellar tendinopathy, soft tissue stiffness (arthrofibrosis) or soft tissue laxity.
I could give you full rehab program after ACL reconstruction but it wouldn’t help because that athlete should be back in sport by now. So try to find out what went wrong and treat that problem.
Best luck

[Physiobase]

It could be that the surgery missed something and there is a phycial block to movement or it could be that the patient is subconsciously blocking the movement. That said surgery is often the problem in later stages where normal range is not achieved. The first thing to do is find out this answer.

Closed chain exercises are useful but if the deformity is flexion, then active concentric knee extension exercises might assist with the relaxation into eccentric flexion. You can do the same for eccentric hamstrings work (prone with assistance into flexion) where the eccentric work may let them go into more flexion. Numbing up the area with ice prior and during might assist even more if this is a brain lead restriction rather than a physical one.

[neurospast]

As Nale and physiobase already mentioned, at least how I interpretate it: you must give some more information before anyone can give a sensible answer. Fixed in what position, any details like MRI, X-rays name it. Is there any movement at all? What is the history behind the injury? and so on and so on.
Cheers

[saravanaphysi]

hi friends
Thanx for all of ur suggestions. I have forwarded ur queries to my friend and hope that my friend will also be joining in the topic shortly.
Thank u very much