Graft failure following ACL reconstruction

[sabina86]

Hi
Two years ago I fell awkwardly and injured my knee. It was very unstable and painful. I went to hydrotherapy and physiotherapy for 6 months. The knee felt stronger but the pain was getting worse. I was sent for an MRI which showed a complete tear of the ACL. I had surgery in January last year, 9 months after I sustained the injury.The reconstruction went well and I started the long recovery. I did my physio daily and had Hydro once a week. The knee felt more stable and pain was reducing. 6 weeks after surgery I went flying on a wet kitchen floor and twisted the post op knee. It hurt like hell and swelled immediately. I went to A and E who said everything was fine i'd just pulled the muscles.

9 months post op my knee was still unstable and was very painful following exercise. 20 minutes walking was enough to bring pain levels up. The knee became more unstable the more I did. My knee also started clicking and crunching which caused more pain and got worse over time. I was still doing my physio daily and saw my physio weekly. She advised I go back to see my surgeon, he carried out an arthroscopy yesterday (1 year after reconstruction) during which he found a lot of scar tissue which he cleared up, the underside of my knee cap was very rough so he smoothed it off and the ACL graft was also partially torn.

I was surprised to hear the graft was torn but it does at least explain why my knee is still unstable. I am hoping the debridement will help reduce the pain I have been experiencing but now need to decide whether to have the ACL reconstructed again or leave it be. My concerns are that if I opt for no surgery, the knee will continue to deteriorate and the pain will return. I don't know if it was the original surgery, or the acl graft tearing that caused the rough edges in the joint.

I do not see my surgeon for 4 weeks and as i was still in the recovery room when he spoke to me yesterday, was in no state to be processing information and asking questions.

Has anyone else had an ACL graft tear, or a partial ACL tear? Did this cause you any long term problems and have you had it reconstructed?

Would really appreciate any help or advise, Its been two years now since my original injury and I'm desperate to get back to normal life where i am not restricted by my knee.

Many thanks
Sabina

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[neurospast]

Hello, allthough I have had not any surgery as so on my knee I would like to respond and to use the information you provide. Prior to surgery stable knee but pain. After surgery fine until you went flying over the wet floor re injuring the initial ligament.
You reinjured your ACL thus your back to square 1. I must say you have been extremely unlucky on this one! Surgery in principle does repair and damage at the same time. An ACL is after reconstruction up to scratch after about a year; considering the ligament itself and the completion of the rehab. Before that the chance of a re occurance of damage is much higher (on purpose I write a year just to stay in the clear).
You have to understand when you chose not to do the surgery you will have an unstable knee which easily damages more the other structures in the knee and causing early wear and tear and at the other hand surgery and repair which will protect (hopefully) the other structures in the knee and prevent Osteo arthritis (but the surgery will cause in itself early Osteo arthritis. A knee replacement which could follow in let say 20 years can be redone (at this moment in time 2 times) a knee replacement holds if you are slim 15 years.
I think you ought to make a decision on facts not on other people's experiences because everyone knows someone whose aunty had a hip replacement which went wrong (actually hip replacements have a succes rate of +95%).
The 2nd time around for the same surgery will be hard work, you might need a good knee brace to start off with until a proper healing and wining yourself off the brace. using the brace in sport activities. If you choose not to have surgery you ought to a rehab as long as with and you definetily need a brace to avoid further surgery.
To make things worse; a goalkeeper of the Dutch national football team lacked all stabilising structures at the knee, still he was the goalkeeper...
I have worked with patients who needed another ops. they were fine after extended rehab.
For you; I wish you all the best.

[sabina86]

Hey neurospast
Thank you for your reply. It is now 3 days since the arthroscopy, the post op swelling is reducing and with it the stability of my knee. I can feel it slipping when I walk so I am guessing it will be best to have the ACL reconstructed again. Thanks for the advice regarding a knee brace. They didn't give me one after the last reconstruction but I will look into getting one myself if it is going to be beneficial.

Before this injury I worked with horses, riding every day. I have had to change my job and give up the riding and am willing to do whatever it takes to get back in the saddle. Thanks again for taking the time to reply to my post. Much appreciated :-)

[neurospast]

Thank you very much. I hope you will be fine. If you need to know anything I will try to answer at best will. Remember to start rehab in time, you know the drill, don't give up, it's a long road.

[sabina86]

It is now 5 weeks since my arthroscopy. I am in more pain then ever before, with my knee giving way more than before, although I have an improved range of movement. It feels like something is catching or pulling when I bend my leg and walking down the stairs is very painful. These are new symptoms following the debridement.

I spoke to my surgeon today. It was like speaking to a politician, I have come away with more questions than answers. I have established I have grade 3 wear of the cartillage on the knee cap. He has smoothed the surface and removed loose fragments. The ACL graft was intact with only a small tear. It is in a more vertical position than the surgeon would of liked. Whatever that means???

I have now been referred to another consultant, as my surgeon wants a second opinion on whether an ACL revision will be beneficial. Does this mean he thinks it may not be the cause of the problem? I Wish I'd asked him. Could the cartilage damage be causing my symptoms? Wish i'd asked that too. Instead i'm left with more if, buts and maybes. Hoping that whatever the cause, they can fix it.

Any thoughts or opinions regarding my current situation would be greatly appreciated. So frustrated right now :-(

[neurospast]

Sad to hear that you are in more pain and having more problems than before the 2nd ops.
The smoothening of the Patella has the consequence it is a new injury (although it seems to me it must have been there for some time, the roughening of the surface of thejoint). Any Patella problems will give problems going up/down stairs. The feeling of the knee having become more unstable has to do with the pain; your awareness of knee position is impaired due to pain and thus the muscles around the knee become less responsive. when you get less pain, when strength and coordination of the muscles improve with exercise(s) it should become less. Do realise that not only muscles directly related to the knee can have influence; the knee is part of the leg and if you would have other issues e.g. poor coordination of muscles around the hip this will influence as well. I suppose that when you 1st snapped your ACL this must have led to the wear and tear of the Patella. It takes a lot of time to do a good rehab, think of 1/2 year after you start full weight bearing. I suggest you get your 2nd opinion and ask for an exercise protocol. As I said before see to it that your whole leg is taken into account and not just the knee (when something goes wrong at the knee hipflexors, gluts, quads, hamstrings and possible calfs will influence it's functioning. Hope this will help.