5 years post acl reconstruction issues

[katiea]

In 2006 I tore my ACL, MCL and meniscus playing in a college basketball game. I had it repaired using a allograft and some of the meniscus was taken out. Almost 10 months later, I still had horrible range of motion DESPITE the 2-3 hours I spent in rehab every single day. I had my knee scoped to clear out some scar tissue and the ROM got better. However, since then I have been having problems for 4 years and the only thing suggested to me is to start a strength program which I have been doing and have not seen any improvement. My three major issues are:

1. going down stairs. I hate it, I avoid it at all costs because it's so uncomfortable and painful. It's been getting worse and worse and no one seems to know why. In the mornings when I go down stairs it will have a HUGE pop associated with a lot of pain. It used to just be in the am, but now I am getting this throughout the day. It's to the point that I will walk way out of my way if I know I can avoid going down stairs.

2. Sitting for long periods of time. If I sit with my knee at a 90 degree angle for more than an hour it get unbearably achy. The whole joint starts hurting and the only thing I can do to help is to get up and walk around. Unfortunately on plane rides and during class or speaker sessions (i'm a grad student) I don't have that option.

3. Any type of top loading activity, ie, squatting. Ever since my first surgery I have never been able to squat down. I can almost flex my affected knee as much as the other (maybe 15-20 degrees difference) but I can not put any weight on it whatsoever in that position. Absolute shooting pain. I can't even squat down to pick something up off the ground. However, I can do motions such as a leg press where the weight is on my feet and not coming from above my knee without any problem.

Does anyone have any suggestions at ALL as to what is happening? Its so frustrating to go from a college athlete to not even being able to walk down stairs correctly. The only theory that I have been able to come up with (a very layman theory) is that maybe the graft is too tight? I have had multiple MRI's since my second surgery and the docs say structurally it looks ok but whenever anyone does the ACL test, the first thing they comment on is the tightness of the graft. Any help would be very greatly appreciated!!!

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[simonmcwey]

Hi Katiea,

Has anyone assessed the ROM in your hamstrings? Maybe releasing them at origin with releasing of glute med/piriformis could help, id also look at your SIJ and Lumbar spine performance to assess any mechanical defects that may be contributing to your problem.
The popliteus muscle can also be an issue with poor ROM in the knee.
Has bone bruising been ruled out from previous investigations?

[katiea]

Hi,
I have had my ROM in my hamstrings evaluated and they are fine (and much better than what they were pre-surgeries). My left quad (the affected leg) has been a little bit tighter since the surgeries because I can't seem to stretch it well with the lack of ROM in my knee and the pain it causes. I have also previously had issues with my SIJ and went to physical therapy for a while to get it under control. The physical therapist I have worked with always checks that out before we do anything with my knee and he always says it's doing well. Most of my pain is on the lateral side of my knee going down stairs and when I run but is more medially when I'm sitting for a long time and trying to so any squatting motion. Maybe it is the popliteus muscle? That has never been mentioned to me in any of my appointments. As far as the bone bruise, I know when I injured it they said I had a bone bruise but it hasn't come up again. I can't think of what I would've done to cause that because unfortunately since the injury I haven't been terribly active. I wouldn't think a bone bruise would last 5 years would it? I really appreciate any and all of your help because I am so frustrated with this. I have done everything I have ever been told to do and it just keeps getting worse. Then when I go and see doctors they just say, continue the strength program and make sure you are stretching everyday. Thanks again.

[physiobob]

Unfortunately I think this one is going to need a hands on physical assessment to add any real insight into what may or may not be happening. After 4yrs with no relief of discomfort you might consider a revision of the graft. But again one would need to assess the pain as you get the pain. i.e. provoke it during a physio session and then assess what movement or otherwise might be done to reduce it on the stop as a means to isolating the causative factors. The ACL should not normally be an issue going down hill or downstairs as it is not under much tension. It is more of an issue going upstairs or running up hills. BUT if the graft is overtight then perhaps it could be playing a roll. Would be nice to work out where the pop is coming from. Could be joint line, patellofemoral joint, foreign body in the knee etc. My advice would be to go to a good knee/ortho/sports PT and get them to work with you to provoke all symptoms and try to evaluate the cause a little more.