ACL Reconstruction Hamstring Graft

[ACL Jack]

I have recently had an ACL Reconstruction of the knee.
After a hyperextension of the knee on the way home in the back of a car i heard a large snap or twang that felt like it came from my hamstring. The hamstring today is red and tender and looks like it may be a hamstring pull/strain or tear.
My question is is this normal after a ACL Hamstring graft and will it have damaged my ACL reconstruction?
Thanks

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[Physioindeed]

HI
I have had two patients after ACL reconstruction who have suffered from hamstring tears. This is not surprising if part of the hamstring has been harvested to make the ACL graft. Means the remaining fibres are under more stress. Also to consider: Hamstrings are having the same function as the ACL: to stop the tibia sliding forwards under the femor (anterior drawer test). So ACL injuries will have increased hamstring tension anyhow because they are trying to compensate.
The hamstring also has the function to decelerate the swing of the tibia into extension:meaning it has to activate whilst being lengthened. This will proof a difficulty if a) it is to short/ thight and b) if it is to week.
Very telling is the snap you heard, the localized tenderness over the hamstring. If you still need more proof: it will be sore if brought on length (single leg raise with extended knee), it will be sore if activated against resistance (lying on your front, bring heel to bum). Likely there will be bruising in a few days time.
Of course initially after injury and depending on where you are in your rehab this might not even be possible. I would youse RICE (rest, ice, compression, ice) for 24-48 hours, NSAID if not contraindicated and then start very gradually with some bending and straightening without resistance (in lying, then in front lying) and some very gentle stretching for the hamstrings.
About wether you have damaged your ACL : most likely not, but let it be tested with the anterior drawer test. Also your knee would be quite unstable.
I defenetly would get a physio to help recovery along: making sure to treat the hamstring injury first. THis incident will set back your recovery time a little but hopefully not more than 2-3 weeks depending on the extend.
Just as a word of causion. Done over the net, without seeing you, all the above are assumptions from my part and have to be varified by a trained physio or consultant.
best of luck!

[ACL Jack]

I have localised swelling in the back of the knee. I have been using RICE technique. The swelling is up to the inside of my leg by the groin also.

I can straighten my leg with little pain but bending it past 120 degrees hurts. I am on day 3 of my rehab after the op. I pulled my hamstring literally 4 hours after the op.

I believe the reason for this is i have been operating fully without a ACL for 2 years so i presume my hamstring has adapted to make up for this. Once a new ACL was fitted it will have stretched my Hamstring back and then obviously it has been too much for it. If that makes sense? Also hyperextension.

I panicked a but today and made an emergency visit to the physio. He confirmed that it looks like a hamstring tear/sprain.

I asked about the acl damage and he said because of the swelling it was difficult to tell but he said that the graft should be ok.

Thanks for you very detailed and impressive response. You got it completely right and that was without a visual.

You are obviously very good at your job.

My only concern is the liklyhood that it will have streched the ACL graft or damadged it but you said this is unlikly? Can you explain further?

[Physioindeed]

Hi Jack
just some statistics: Likelyhood of graft faliure is 3-6% in most studies (Bruckner and Kahn, CLinical Sports Medicine) within first 12 month. You will have put stress on the graft by overextending (normally allowed is extension to 0 degrees in the first two weeks) to some degree but it didn't sound as if there was a lot force behind it. I think those things made me think that most likely and hopefully you will not have damaged the graft. I think the best thing is to just get on with your rehab program and in due course to improve the hamstring strength and length on both sides (there are studies, that show that actually the other side underlies the same risk as the injured side!) together with the other aims of rehab (range of movement, strenght, proprioception, core strength and alignement)
Good luck with it

[ACL Jack]

So after dosing some more research on the internet! (Let’s face it I have the time!) I have roughly worked out what injury I think I have sustained.

I am on day 9 now. Pain and bruising are coming to light from the bottom of my buttock to the middle of my calf right down to my heal. Purple, Blue, Black and Yellow. For the past three days the pain has been out of 1-10 around 16!! I am guessing this will be because I was on strong pain medication for the knee reconstruction so did not give my semimembranosus any time to heal. Hence day 7,8,9 have been so bad.

I now realised the movement I preformed to hear the snap in the car was a Valgus Stress movement. As my leg was to one side. This explains why I can lie in bed with my leg straight comfortably only in that position.

My questions are:

What will it mean If I have avulsion (completely torn) my semimembranosus and are there any tell tale signs of this? I do have a lump of tissue at the bottom of my thigh towards the knee. Will this require more surgey? I am able to sleep comfortably in the position I snapped the ligament which would lead me to think it has completely ruptured.

What are the difference between a grade 1 and grade 2 tear of these muscles?

I have been told to exercise my leg doing the normal ACL Reconstruction exercises every hour by my physio but my leg is in complete agony if I do them even twice a day.

Should I just rest the leg or try to move it. I am still on crutches. As soon as I stand though it is as though someone has poured a scalding kettle onto my leg as the blood rushes back in.

Can you shed any light on the subject?? Feel free to ask any questions.

[Yarok]

hi

have You done ultrasound scan?

Yaro

[ACL Jack]

Hi

As of yet no. I have visited my local Physio who didn't seem to think this was needed. I was more concerned about the ACL Reconstruction to be honest at first. Surly my Physio would have checked for a rupture??

Thanks

[ACL Jack]

Hey

So my hamstring is now complete agony. I am in serious pain mainly from my ankle achilies tendon and in my calf. All sorts oftightness swelling pain. The pain goes right up to my buttock along the semimembranosus tendon. The movement i perfomed was an over extension in a Valgus Stress movement position. How would i know if i had completly ruptured my semimembranosus tendon? What are the signs and symptoms?