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ACL Problem..  
User currently offlineEWS From , joined Dec 1969, posts, RR:
Posted (8 years 6 months 4 weeks 1 day 21 hours ago) and read 769 times:

Hi folks..

As many of you are aware I had a reconstruction of my ACL (Anterior Cruciate Ligament). The rehabilitation has been fairly good from my point of view, its quite painful at times and does cause many sleepless nights due to it being seriously incapable of being comftable.

I went back to Sheffield today for my 2 week post-op appointment with the surgeon, everything has been going well so far with rehabilitation and physiotherapy I assumed that he would tell me that everything was ok and I could go and he would see me in a months time. Sadly he didn’t..

He examined my leg and removed the stitches then asked one of his collegues to come into the room, I presumed this was normal for a second opinion, the other doctor didn’t even feel my leg he just said “something’s seriously wrong I see” I then went into a bit of a panic.. It turns out that the ACL reconstruction has gone right, but from what I could gather from all the medical terms he said to me my ligament isn’t reacting with my body as it should. I’ve been having intense physiotherapy on my leg (4 times a week) and I’m doing exercises at home as instructed.. But my knee will not straighten fully, even when being forced, or pushed on. The surgeon tried several times to push my knee straight, it wasn’t painful at all but it simply wouldn’t go. He then went on to tell me that he is seriously concerned about my knee and has never seen this before, as all his ACL operations have had no complications like this previously.

He has given my a new protocol for physiotherapy but he has warned me that if my knee doesn’t go straight my knee will be permanently bent which will cause difficulty in walking e.t.c. He said he didn’t want to operate on it again for my sake.

Are there any medical buffs out there who can advise me more on this situation?

Thanks in advance,

22 replies: All unread, jump to last
 
User currently offlineCosec59 From , joined Dec 1969, posts, RR:
Reply 1, posted (8 years 6 months 4 weeks 1 day 21 hours ago) and read 762 times:

I'm no medical expert by any stretch of the imagination, but I wish you good luck Lew

User currently offlineAirbusA346 From United Kingdom, joined Dec 2004, 7437 posts, RR: 2
Reply 2, posted (8 years 6 months 4 weeks 1 day 21 hours ago) and read 760 times:

OMG Lew.

All the things you've gone through now this.  Sad

Good luck mate, from me.

Tom.



Tom Walker '086' First Officer of a A318/A319 for Air Lambert - Hours Flown: 17 hour 05 minutes (last updated 24/12/05).
User currently offlineCastleIsland From , joined Dec 1969, posts, RR:
Reply 3, posted (8 years 6 months 4 weeks 1 day 21 hours ago) and read 754 times:

Well, I strained/partially tore my ACL twice back in my late 20's. I never had surgery, but I can only straighten my left leg about 95%. It's not enough to greatly affect me, but I could see how this could happen. Best of luck with the PT.

User currently offlineEWS From , joined Dec 1969, posts, RR:
Reply 4, posted (8 years 6 months 4 weeks 1 day 21 hours ago) and read 750 times:

Quoting Cosec59 (Reply 1):
I'm no medical expert by any stretch of the imagination, but I wish you good luck Lew

Thanks Phil  Smile

Quoting AirbusA346 (Reply 2):
Good luck mate, from me.

Thanks to you Tom!  Smile

Quoting CastleIsland (Reply 3):
Well, I strained/partially tore my ACL twice back in my late 20's. I never had surgery, but I can only straighten my left leg about 95%. It's not enough to greatly affect me, but I could see how this could happen. Best of luck with the PT

Thanks buddy, I cannot bend it anywhere near straight at all, and even if its forced, or pushed down whilst laying on a bed, it simply just wont go, so i hoping theres a easy fix to this.

Lew


User currently offlineKlaus From Germany, joined Jul 2001, 21487 posts, RR: 53
Reply 5, posted (8 years 6 months 4 weeks 1 day 21 hours ago) and read 742 times:

At first I wasn't sure what exactly this was about, but this page seems to have a pretty good overview:

What Is The Anterior Cruciate Ligament?

I don't know anything about it, but a second independent opinion might not hurt when your doctor is talking about things he's supposedly never seen before...

Anyway, I hope you'll overcome this one as well; All the best to you!


User currently offlineABfemme From , joined Dec 1969, posts, RR:
Reply 6, posted (8 years 6 months 4 weeks 1 day 21 hours ago) and read 736 times:

Hi Lew just Im you
Claire


User currently offlineEWS From , joined Dec 1969, posts, RR:
Reply 7, posted (8 years 6 months 4 weeks 1 day 21 hours ago) and read 730 times:

Quoting ABfemme (Reply 6):
Hi Lew just Im you

Hi claire, i just got it will reply shortly.. Just on the phone.

Lew


User currently offlineEWS From , joined Dec 1969, posts, RR:
Reply 8, posted (8 years 6 months 4 weeks 1 day 20 hours ago) and read 720 times:

Quoting Klaus (Reply 5):
Anyway, I hope you'll overcome this one as well; All the best to you!

Many thanks, im hoping one of the medical buffs will be able to advise on this..

Lew


User currently offlineRedngold From United States of America, joined Mar 2000, 6907 posts, RR: 44
Reply 9, posted (8 years 6 months 4 weeks 1 day 19 hours ago) and read 708 times:

Okay, I know I have sounded like an expert in the past but I'm not, to just remind you...

...but it sounds more like a buildup of scar tissue or a cartilage problem than a ligament problem. The A.C.L. is supposed to stabilize lateral motion of the knee (that is, to keep your thigh from sliding sideways off your lower leg) and should not affect your ability to straighten the knee. That is probably why he's so puzzled.

Did he say anything about your patellar tendon?



Up, up and away!
User currently offlineEWS From , joined Dec 1969, posts, RR:
Reply 10, posted (8 years 6 months 4 weeks 1 day 19 hours ago) and read 705 times:

Quoting Redngold (Reply 9):
Did he say anything about your patellar tendon?

The patella tendon wasnt touched during the operation, the new graft came from the hamstring. I could straighten it no problem before the operation and should be able to now, but i cant.. its not thats its to painful it simply wont go.. the doc was using two hands with force to try and bend it.

Lew


User currently offlineBristolFlyer From United Kingdom, joined May 2004, 2302 posts, RR: 0
Reply 11, posted (8 years 6 months 4 weeks 1 day 15 hours ago) and read 688 times:

Quoting EWS (Thread starter):
Are there any medical buffs out there who can advise me more on this situation?

I aint no medical buff, come to think of it I don't know anything about this sort of thing, but there are many many threads about ACL surgery on the forums of www.wakeworld.com. It's a website for wakeboarding, and ACL damage is very common in this sport.

I've heard that it hurts like hell, hope you recover ok.

How did you do it?

BF



Fortune favours the brave
User currently offlineEWS From , joined Dec 1969, posts, RR:
Reply 12, posted (8 years 6 months 4 weeks 1 day 9 hours ago) and read 677 times:

Quoting BristolFlyer (Reply 11):
How

As a job on the side i used to take skiing trips of school children out to Italy. We arrived 3 years ago, set the kids off into groups, went off on our own (3 of us) and launched ourselves off a 40ft ledge unintentionally i must add!! The sun was direcltly infront so we had no chance of seeing it..

Lew


User currently offlineFrancoBlanco From , joined Dec 1969, posts, RR:
Reply 13, posted (8 years 6 months 4 weeks 1 day 8 hours ago) and read 668 times:

Hi Lew,

sorry to hear bad news from you!

Do you know the exact range of motion of your knee? Normal would be a flexion of up to 140 degrees and a slight hyper-extension of 10 degrees. An extension deficit of about 10 degrees would still be tolerable but anything more could present a problem to you, depending on your activities.

Keep in mind that I am also not an expert, I am still working hard on becoming an orthopedic/traumatologic surgeon once.

Once I saw a special procedure done by a knee expert where the patient (suffering from an extension deficit after the implantation of a knee prosthesis) had his knee hyper-extended in general anaesthesia (it would have hurt a lot, otherwise). As far as I understood that procedure the trick was to hyper-extend the knee once so that the bones (in that case the prosthesis), the ligaments and everything else "relax", a kind of an post-operative release, so that a greater range of motion would be achieved.

I don´t know if that could help you in your case, your doctor should tell you exactly what the state of your knee is and what possibilities he has in order to improve your situation, otherwise you should get a second opinion.

Best luck,

Sebastian


User currently offlineEWS From , joined Dec 1969, posts, RR:
Reply 14, posted (8 years 6 months 4 weeks 1 day 8 hours ago) and read 665 times:

Quoting FrancoBlanco (Reply 13):
Do you know the exact range of motion of your knee? Normal would be a flexion of up to 140 degrees and a slight hyper-extension of 10 degrees. An extension deficit of about 10 degrees would still be tolerable but anything more could present a problem to you, depending on your activities.

Hi Sebastian, thanks for the reply. Im at physio today and ill ask her for the range of motion today and ill get back to you.

Quoting FrancoBlanco (Reply 13):
had his knee hyper-extended in general anaesthesia

Don't like the sound of that! lol

Lew


User currently offlineAirbusA346 From United Kingdom, joined Dec 2004, 7437 posts, RR: 2
Reply 15, posted (8 years 6 months 4 weeks 1 day 6 hours ago) and read 659 times:

Quoting EWS (Reply 10):
the new graft came from the hamstring

It sounds like a problem with your hamstring, and I'm no medical buff.

Tom.



Tom Walker '086' First Officer of a A318/A319 for Air Lambert - Hours Flown: 17 hour 05 minutes (last updated 24/12/05).
User currently offlineEWS From , joined Dec 1969, posts, RR:
Reply 16, posted (8 years 6 months 4 weeks 1 day 3 hours ago) and read 647 times:

Howdy Sebastian,

The range on my knee is 15-90 (i think thats what she said) my bending has continue'd to improve by 10* but from last physio to this session, straightning still remains at 15*.

Lew


User currently offlineFlyingbabydoc From , joined Dec 1969, posts, RR:
Reply 17, posted (8 years 6 months 3 weeks 5 days 7 hours ago) and read 623 times:

Hi Lew. Sorry you have been going through all this. I am sending you an IM with my opinion about what might be going on with you.

Quoting Klaus (Reply 5):
I don't know anything about it, but a second independent opinion might not hurt when your doctor is talking about things he's supposedly never seen before...

That is not necessarily the best option in many cases. You know that physicians tend to have an ego inversely proportional to their capacity of acknowledging mistakes. Besides, the first doc operated on him and has a better knowledge of what was done than any following doctor - sticking to one is sometimes better, or you have to start from ground zero again.

Quoting Redngold (Reply 9):
but it sounds more like a buildup of scar tissue or a cartilage problem than a ligament problem. The A.C.L. is supposed to stabilize lateral motion of the knee (that is, to keep your thigh from sliding sideways off your lower leg) and should not affect your ability to straighten the knee. That is probably why he's so puzzled.

I am sorry to say, Redngold, But sometimes what you look up in the books cannot be applied to the reality of the patients. I am sure you mean well, but in a case like this, the pure information of "should not affect" is not correct. The dynamics of a knee involve more than the ligament, and probably the instability generated by the operation creates a "bone blockade" to the movement, which may be related to additional ligaments that were moved/distended/fixated during surgery.
What I mean to tell you is that some medical advice may be quite wrong even though they "fill the gaps" of what books say. Medicine is not a precise science, and you must see and take each patient personally to have a full picture.
Just a friendly note for future reference, no harm meant.

Alex


User currently offlineFlyingbabydoc From , joined Dec 1969, posts, RR:
Reply 18, posted (8 years 6 months 3 weeks 5 days 7 hours ago) and read 620 times:

Quoting FrancoBlanco (Reply 13):
Once I saw a special procedure done by a knee expert where the patient (suffering from an extension deficit after the implantation of a knee prosthesis) had his knee hyper-extended in general anaesthesia (it would have hurt a lot, otherwise). As far as I understood that procedure the trick was to hyper-extend the knee once so that the bones (in that case the prosthesis), the ligaments and everything else "relax", a kind of an post-operative release, so that a greater range of motion would be achieved.

This should not be a problem if during the reconstruction the femur and the tibia were not falsely juxtaposed and fixated together with the ACL reconstruction. If it is as I presume, hyper-extending will either lead to a fracture or to a new rupture of the ligaments. Remember, you are talking about a patient with a prosthesis, not a real knee.

In my opinion, the next step would be a MRI with function testing to see how the dynamic of the bones is during the extension of the knee.

Alex


User currently offlineEWS From , joined Dec 1969, posts, RR:
Reply 19, posted (8 years 6 months 3 weeks 5 days 7 hours ago) and read 620 times:

Quoting Flyingbabydoc (Reply 17):
Hi Lew. Sorry you have been going through all this. I am sending you an IM with my opinion about what might be going on with you.

Thanks Alex, ill keep my eyes peeled to the notifications.

Lew


User currently offlineFrancoBlanco From , joined Dec 1969, posts, RR:
Reply 20, posted (8 years 6 months 3 weeks 5 days 7 hours ago) and read 612 times:

Quoting Flyingbabydoc (Reply 18):
Remember, you are talking about a patient with a prosthesis, not a real knee.

Exactly. I know better about prosthesis than ACL reconstruction, at the moment.

I´d also say a functional MRI would be the best right now.

Sebastian


User currently offlineEWS From , joined Dec 1969, posts, RR:
Reply 21, posted (8 years 6 months 3 weeks 5 days 6 hours ago) and read 606 times:

I'm not going to see the surgeon now until the 26th April, he's hoping that physio will sort it out, I'm having it now 3 times a week.

What are the long term effects if physio wont sort it? Limp for life? Or what surgery is available to fix?

Lew


User currently offlineFlyingbabydoc From , joined Dec 1969, posts, RR:
Reply 22, posted (8 years 6 months 3 weeks 5 days 6 hours ago) and read 601 times:

Quoting EWS (Reply 21):
What are the long term effects if physio wont sort it? Limp for life? Or what surgery is available to fix?

As I told you in the IM, depends on what the trouble is. I don't think Physio will solve this alone - but again, I have not examined you or seen your imaging exams.

The point in your favor is that you are young, so even complicated surgery can bring good results.

The point against you is that once you start messing around with the dynamics of the knee, you never seem to be able to get it quite right again.

You will not become limp for life - there are other procedures that can be done to your femur to correct an axis deviation of the knee.

The only thing I can almost with certainty say, is that it is going to be a rather long process, unfortunately, either way it goes.

But you will have your A.net friends and many others supporting you, I am sure.

Alex


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