ACL reco. hamstring graft results is hamstring tendonitis?

[wozzie]

I was just wondering how everything was going now and if anyone could help me?

I had my ACL and a tear to my medial meniscus repaired last October now - I am now 6 months down the line and have been having significant hamstring problems since Christmas.

Basically Oct - Christmas was spent on a limited physio programme due to the meniscus repair - no squats, no pressure on a bent knee beyond 30 degrees etc.... Then after Christmas I reached my 3 month point and we began to introduce the squats and single leg work.

However since that point I have had problems with my hamstring. To start with I thought that I had just overdone the exercises a little too soon - as I had such tightness post exercise and cramping on anything like hamstring curls that after a session in the ACL class at physio I struggled to do anything the next day at all and even struggled to walk without a limp at times.

Diagnosis 1 - muscle imbalance between quads and hamstrings. Suggested that we adjusted the exercises.

However this did not improved things - in fact what I hadn't realised was that after exercise I was getting bruising appear in a vertical line up the centre of my hamstring from my knee (same place as I had bruising post surgery but this had cleared up before Christmas) and a large lump had formed.

Diagnosis 2 - scar tissue that needed breaking down. So on top of my twice weekly acl physio classes I now began having massages to break down the scar tissue.

However whilst the scar tissue and lump significantly improved after massage, exercise irritated it and caused it to build again. So we removed the exercises that irritated the most - single leg squats, lunges, dip steps, running etc... However it couldn't stay like this forever so we tried to gradually reintroduce exercises. By this point we were at 4-5 months. I got to see the surgeon during this time and he was at a loss as to why and what - he tested my hampstring strength but the whole lot went straight into spasm. He referred me to have an ultra sound but I am still waiting for this.

In the meantime - Diagnosis 3 - nerve tightness and resulting neuro stretches - but still the hamstring is a problem.

I am now 6 months in, and over the last couple of weeks have tried to just push myself forward through accepting the pain and discomfort and trying to do the exercises - but to no avail. I work in sport and have always played sport - so the lack of recovery has really started to get me down. Now the physio is now back to the muscle imbalance diagnosis - lower back perhaps this time so a new lot of exercises.

In terms of ongoing symptoms - hamstring cramps very easily doing curl type exercises, numbness where scar tissue lump continues to build on lower hamstring, recurring bruising (although significantly lighter that in the past), general throbbing of the hamstring whilst at rest, nagging right up to my bottom, lack of strength depsite daily exercise (the squats are not getting any easier) and the same exercise still continue to aggrivate it - single leg squats, dip steps, and running for more than 1 minute.

Does anyone have any suggestions? Will the ultra sound find out what is wrong? Will it just get better over time?

Any help gratefully received.

[arniar]

Hello

This sounds similar to my problem. 17 months after the ACL reconstruction with hamstring graft, I am still having the same problems and 1 year ago. Extremely tight hamstring and muscle spasm even when exercising lightly. Swelling and loss of sensation in the foot. This ACL reconstruction has destroyed my life.

MRI has shown degenerated Semitendinosus muscle. I have a bulge in the hamstring when I tense the muscle. Either caused by failed regeneration of the Semitendinosus tendon or nerve problem. Probably the tendon is damaged. Whatever the problem is, I want this fixed. I have met a number of orthopedists and no one has seen this before. Next week I will be meeting some of the best orthopedist in Denmark. If you like to know how it goes, just ask me to post it here.

Arni Richard
[email protected]

[wozzie]

Sorry to hear that you are no further forward and so long after surgery too. I would be grateful to hear how your appointment goes next week. I'm just finding that the physiotherapists are just unsure of what is going on as they haven't seen this before - they are trying and giving a lot of time, but we are still not any nearer.

At the moment I am at the physio department 3-5 times per week and I am exercising (cycling and swimming mostly) in a bid to get better. I have done everything as instructed pre and post op, so it's just frustrating. And I don't think I have been asking enough questions or demanding enough answers.

Thanks for sharing your experiences.

[arniar]

Is your harvested muscle tight at all times? Is there any visible bulge when you tense the muscle or flex the knee? Can you sense that the harvested muscle (presumable Semitendinosus) is smaller than in the other leg?

The lump you mentioned could result from muscle adhesion.

I suspect my condition to be a bad case of that described in this paper:

Failed regrowth of the harvested semitendinosus tendon: a rare complication of tendon harvest after anterior cruciate ligament reconstruction.

My advice to you is to find an excellent orthopaedist and get MRI on the thigh as soon as possible.

I had an ultrasould sonography which did not reveal anything. Just waste of time for me.

For the last months I have been focusing on stability exercises, because the knee will be unstable with so weak hamstring. The stability has got a little better, but not good enough.

[arniar]

Complete rupture of a hamstring muscle.

reconstructed acl was incorrectly inserted (as revealed in a surgery last Wednesday)

Going to file a lawsuit.

[wozzie]

Really sorry to hear that things are not good with your hamstring - but some answers at long last it seems!

I have now had my ultrasound and it shows a mass of musle which shouldn't be there in this particular place, but no damage to it and no apparent reason why it is still going into spasm.

Now waiting for consultants appointment.

In the meantime - physios have tried and now ruled out an inbalance in my back and this morning suggested it could be scar tissue that is causing it all when I saw a different physio.

So still playing a waiting game.

[arniar]

In my case, the muscle tore from the upside, not from the downside. This had confused many who tried to diagnose the problem.

I am being told that it is too late to attach the muscle. But I wont give up and will meet another doctor on Wednesday who has actually performed a later repair of a completely ruptured hamstring.

I think the reason for the torn muscle is that my physiotherapist made me do an exercise immediately after the operation which I should not have done. The exercise is seated leg curl, and should not be done for the first two months after operation in the case of hamstring graft.

My doctor says I should be able to run with a torn muscle, by strengthening the adjoining muscles. I really hope he is right.

Your case sounds like a rupture. If that is the case, it must be repaired as soon as possible.

[wozzie]

I have had an ultrasound - do you think I should be pushing for an MRI too? (Although I'm not liking my chances)

Was it only surgery that finally solved the unknown in your case?

I am just desperate to know what is going on and then work to get it fixed, but the system is just not getting me anywhere fast.

[arniar]

I gave up on the public health care and went for a private hospital to find the best known orthopedist surgeon in Denmark. In just few minutes he found out that the muscle was ruptured from the upside, without looking at the MRI at all.

I did not have a surgery to find this out. However, a knee surgery revealed that the acl was wrongly inserted.

In your case, you should really demand MRI.

If there is a tendon rupture, the muscle is loose at the other end.

If you can consult a respected orthopedist who works mostly with sports people, you should definitely do that even though it will cost you some money, that is if you can afford it.

Best of luck

[arniar]

I have got yet another diagnosis and now it is confirmed. My semitendinosus tendon did not grow back. I blame it on hamstring exercises that my physio made me do only one week postoperatively and onwards. It involved hamstring curls with weights.

This came as a shock to me even though the doctors tell me that I will be able to run without this muscle. I really want the muscle fixed. I wonder if prolotherapy can help. Otherwise I may consider tendon reconstruction with an allograft.

I need to work on the hamstring now since it is very weak. I experience spasms in the semitendinosus in hamstring curls even when only using minimum possible weight.

All advices and information about my considerations are well appreciated. Also some tips on hamstring exercises. I dont know whether I should work more on the weak hamstring than the healthy one, or keep it balance. Should I do training everyday, or more intensive training 3-4 times a week?

[utahacl]

It's incredible to read that others have gone through exactly what I have! Thank you for your post arniar. I thought I was the only one that has had this rare complication. I have the exact same problem with my hamstring and I've been dealing with it for 14 years! I had an ACL reconstruction in 1996 where the surgeon harvested the gracilis and semitendinosus muscles, and a month after the surgery I had extremely painful cramping in the back of my leg. There was and still is a bulge closer to the knee, and the doctors could never figure out why the bulge wasn't up near my pelvis. They figured if the problem was that the tendon of the hamstring never regenerated, then when the hamstring contracts it should pull upwards and form a bulge there, not down by the knee.

I went through 3 different MRI's to figure out what was going on, and it was obvious that my injured leg was very different from my normal leg, but none of the doctors had a clear idea why. They proposed various ideas, and suggested different treatments including just cutting open the back of my leg and having a look. One of the surgeons said he thought it would make a great paper in a journal because he was certain nobody else had gone through what I have.

In the end, I tried lots of physical therapy and while the pain is not as bad as it was, it's never gone away and my leg has never been the same. If I do dead lifts or squats, the hamstring in the back of my right leg immediately cramps up. I decided not to do another surgery because none of the orthopedic surgeons had a clear idea of what was best to do. One doctor thought the problem was due to the release of the fascia covering the hamstrings during the operation, and another thought I actually ruptured my semimembranosus training after the surgery. The doctors said they didn't think it could be the semitendinosus muscle causing the problem because how could it rupture near the pelvis when the lower tendon was cut by the surgery? It's interesting that the doctors say that's what's happened to you arniar.

Has anyone ever been able to figure out a treatment for this problem that was successful? I would love to finally feel normal again after all this time.

[arniar]

My semitendinosus muscle ruptured from the pelvis due to massive degeneration of the muscle in the following of the harvesting. The doctors say it is probably caused by either too aggressive harvesting or physical therapy after training. I described my physical therapy that I got and they agree that the training was way too harsh.

A good doctor should be able to diagnose muscle semitendinosus rupture by using his fingers and ultrasound sonography. If the muscle is ruptured from the pelvis then it should be little loose there when you stretch the muscle and also some atrophy should be visible at that place.

Later on my gracilis muscle ruptured, first from the pelvis and then from knee. I have had a total of 5 successful operations to correct the mistakes from the first surgery. My doctors are Uffe Jorgensen, Parkens Privathospital, Copenhagen , Denmark and Sakari Orava, Mehilainen, Turku, Finland.

I advise you to find a world class doctor who can help you.