Knee gone again after arthroscopy

[mufc68]

Hi,

I sustained a knee injury playing netball in Oct 2009 in which I ruptured my ACL and I went in for an ACL recon in January 2010.
When I came round I was told that they had only 'cleaned out the stump' and wanted to see how I could get on without the ACL recon.
I was very upset at the time as I had been told and read in many places that people cannot really return to competitive sport without the recon but I was reassured by my physio that if I built the strength up enough it should be ok. When told this I was always told that the ACL could be done in the future if it does give in again and so I was very wary, cautious and nervous about returning to sport.
It is 15 months since my operation and I have worked harder and longer on building up fitness and muscles than they advised me to at the hospital to combat this nervousness. I have not really had any support as to be honest as soon as I could walk ok that was about me done with physio as far as the nhs were concerned!
Anyway I went back to netball training last night for the first time, just light training, I took part in the warm up and a few basic drills, and low and behold less than 20 minutes in I felt the same dislocating pain and my knee gave way completely!!

I am propped up resting it today and have contacted the hospital who have advised that I need to go back to my gp and start the referral process again which could take forever.
I am very frustrated with this and wondered if anyone had any advice in the meantime? Whilst it's painful now should I be trying to move around or should I rest it? Should I take my crutches if I go out or just hobble as best I can?!
I am feeling a bit lost with it and so any advice would be most appreciated!

Apologies for the novel!
Thank you

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[Musculoman]

Just take it easy until you have someone assess the knee and give you further advice, stay away from aggravating activities and open chain loaded movements (leg extensions in the air etc. look up open vs closed chain on google) as you will want to prevent too much anterior translation of your tibia.

If you have completely ruptured the ACL, you should be worried about if further degeneration / injury to the other structures in the knee while it is acutely instable. If you are careful (no running / uneven surfaces) you should be able to mobilise without aids (if you can't though don't force it!). Try not to stand from low seats etc. without being very careful or using the arm rests heavily as well. What are your pain levels and is there large amounts of swelling? or no swelling in the knee? When did it swell? instantly or 24 hours post injury?

No sport goes without saying, no running etc. for a while sorry.

When you rupture your ACL you put increased load on the other intrinsic and extrinsic (inside and outside) structures in the knee, increasing the risk of further injury! Keep that in mind before you start limping around though

[physiobob]

Easy answer. You need a reconstruction. No amount of exercises or muscle building will restore the function of the ACL although truth be told meither will a reconstruction. The main function of the ACL is not to actively or physically prevent instability or giving way. It functions as a receptor to relay tonthe brain what is join on (speed, acceleraton, tension etc) to the brain so that the brain can then fire the muscles to stabilize the knee. Once it's gone you will not have that feedback again. So what to do? Firstly you efforts thus far are not in vein as you needed to do those in anycase. But you also need to do a lot or proprioceptive drills, e.g. side-stepping, lunging (all the movements typical of netball) before you return to netball. This is as the brain needs to learn to use other receptors to take the place of the ACL. That is not automatic so you need to work at it and work at it for months rather than weeks.

Now to add to that you need a recon. That is if you wish to continue netball. If you don't it is my opinion you are at a greater risk of further damage to the meniscus and joint surfaces. An increase in joint laxity and rotatory instability also makes you at anigher risk of patella dislocation.