Possible Torn ACL Graft - anterior cruciate

Hi,

I had an ACL reconstruction almost 7 years ago on my left knee, followed by the same procedure on my right knee 2 years later. Both times my ACL was ruptured and meniscus damaged although due to my age was left to repair on its own (20 and 22 years old respectively). Both reconstructions were done using a hamstring graft and there has been no need to remove the pins from my legs.

I have had a number of issues with my left knee since the initial reconstruction, and required additional arthroscopic surgery 6 months post-op to clean out osteophytes and scar tissue that were hindering my recovery. An MRI had shown a possible graft failure although upon opening my knee the surgeon determined that it was in fact intact and strong.

I returned to high level sport and have been relatively issue free for the last 5 years. Occassionally my left knee feels a little weak and I wear a knee guard as a precaution, which is what I should have done on Saturday when it felt clunky and not quite right. Unfortunately I didn't have it with me and was only going to be doing light exercise so figured it would be fine.

I slipped on some wet grass and my knee twisted quite sharply. I heard the loud crack that I am attributing to meniscus damage, however, I do not recall any popping like I did when I initially tore my ACLs. I am confident that I have not damaged any of my other ligaments as I didn't feel that really acute intense pain that comes with ligament damage, only the pain from cartilage. However, I am assuming that I am not going to actually feel any pain to do with the graft if that is ruptured. The attachment sites are not painful to touch, although I don't know if they would be anyway.

I guess what I am wondering is, is there some way to determine whether my graft has in fact been damaged. Can a physio still test for laxity? That knee has always been looser than my other since the ops so I don't know that comparing the 2 will work particularly well anyway. Or is it a pretty definite give in the joint once the ACL/graft is gone?

Is there any way for me to know? Would the graft have made a noise if it snapped? My joint feels reasonably stable but as it is only 2 days after I am keen to rest it and not test it out too much. I have definitely damaged something in there, it has swollen up similar to the initial injuries, so I would like to keep it rested to aid the recovery from whatever it is I have actually done. I am able to walk around on it and there is no additional pain to weight bear, but that is not necessarily a great indication for me. I have a pretty high pain tolerance anyway and was walking in the hospital after my 2nd reconstruction so this doesn't even really compare with that pain wise.

Unfortunately where I live it is not possible to actually see a physio in person at this point in time so I am doing things on my own for the time being. Any ideas would be great :) I have completed a reasonable amount of sports medicine training at university level so have a pretty good understanding of what people tell me.

Thanks for any help you may be able to provide,

Bec

Hi Bec, thanks for the informative post. As you can't see a Physio at this stage I would suggest that the best answer here is the stability. If you feel that the knee is now much more unstable than it was prior to the weekend then you may have strained the graft or caused it to fail. The crack would not be from the meniscus but more the joint line or the patellofemoral joint. A good meniscal tear will also swell over about 24hrs so that something to look for. There are manual tests for instability more than laxity which a PT can perform but as you say you feel that the knee was always lax post-operatively and so this may have been positive prior to the recent slip.

See how you go after a few days on the stability/instability front. You can definitely see the effect even a simple knee brace has on the proprioception about the joint. I would continue to only play with that. Worse case (or some might suggest even better) you could tape with some functional taping (kinesiotaping concepts) if the brace was left at home.

Hi,

Just a quick update. I spoke to a few people with better contacts down here than me (all my previous work was done in Sydney) and managed to get in to see a sports physio yesterday.

All ligaments appear to be intact which is good. Possible grade 1 tear to MCL but that is no surprise given it was weakened during the initial injury years ago. My most recent MRI showed that where my cartilage had repaired itself the new cartilage was much softer so we suspect that may be frayed and damaged a little but there is nothing actually inhibiting my movement so it can't be too badly damaged.

My swelling is steadily going down and I am close to full ROM again, almost full extension and flexion only reduced due to the swelling. A little pain at either extreme but nothing too bad.

My knee is incredibly clunky but it had moments like that prior to this recent injury. Its one of those things I just need to live with, although in future I will certainly make sure I strap or brace it when it is feeling weakened and not as stable as it should be.

My gut feeling was always that everything was fine, but it is good to have somebody else confirm that :)