Old ACL surgery - knee still bad

[nate99]

I am a long time lurker chiming in to see what folks might be able to contribute toward my particular issue, as there seem to be some very knowledgeable folks when it comes to sports medicine around here.

I had a patellar tendon graft style ACL reconstruction done back in 1995 when I was a senior in high school. I played football, and lifted rigorously and heavily even after the tear, which I more or less ignored (after the initial pain and swelling went down) for the better part of a year, until the knee popping out of joint became too frequent to write off as anything but a serious problem, even for the indestructible 18 year old version of Nate.

After the surgery, I went to college and apart from occasional pickup basketball game (wearing a brace), I stopped doing much of anything athletic. Flash forward to working stiff Nate, and I do even less than that. There was a time when I made a real effort to run regularly, but always had to take a day off between anything longer than a mile or so to let the stiffness and discomfort in my knee go away such that I wouldn't feel progressively worse. After getting married and moving to the 'burbs, the time required for running became prohibitive (and to be frank, it stopped being much fun), and I gave up on that as well.

I've made a few attempts to start resistance training the right way, but the knee is being even less cooperative than ever. Even with body weight squats and lunges, I get swelling and stiffness and occasional sharp pain in the patella tendon area.

Wanting to start a quality program, I need to have legs that are up to the task, but I am frustrated with the lack of cooperation from the knee.

My question then is, what is a smart next step? Should I try to go slower and work up to more frequent training paying more attention to warm up/stretching, or is it a good step, 13 years after the surgery to go ahead and schedule an ortho visit to see what they think?

I'm not overweight (6'1", 180), but I've become fairly sedentary with a busy work schedule and a 6 month old at home, and the physical discipline of a decent workout would do a lot toward maintaining my sanity. Just hoping some of those in the know might contribute their thoughts on a good way to go from here.

Thanks

So, to follow the checklist here:
1. When did the pain begin? - nagging since rehab
2. What were you doing at the time? Or did the pain come on gradually over time? - following most activity
3. Where, anatomically, is the pain? - stiffness in knee joint, dull pain in center of the knee, sharp pain around patellar tendon extraction area
4. What does the pain feel like? Sharp? Dull? Aching? Stabbing? Shooting? - see above
5. Is the pain constant, or intermittent, or only on certain motions? - constant until it fades out
6. What motions make your pain worse? - deep squats/lunges
7. What, if anything, makes your pain better? - time
8. Does your pain radiate to any other part of your body? - no
9. What things could you do before, that you cannot do now because of your injury? - N/A
10. What is your main concern regarding the pain and its consequences? - prohibiting leg workouts
11. Have you ever injured that part of your body before? If so, how? - see above
12. Is your pain getting worse over time? And if so, how much worse over what time period? - see above

[UConnJulie]

My recommendation is that after that long of a layoff from activity you need to be reassessed in person by a qualified professional. My first choice would be a good PT, but if you need an MD visit before for a script, then seeing an ortho is not a bad option (just know that they will likely tell you that your graft is strong and that you need PT).
Once you see a PT, let them know your goal is to get back into working out and you are looking to have it be painfree. Depending upon the extent of damage to your knee and how tight they made your graft, you might not ever be able to do heavy ATG squats, but you should be able to do bodyweight stuff painfree.

If this isn't an option for you for whatever reason, let me know and we'll see if we can figure something out for you.

[nate99]

Thanks for the response, I guess that I do not have anything to lose apart from the time and cost of the visit, given that I'm not doing any training presently.

[chickdiver]

I will second that recommendation. I had an ACL repair 7 years ago (I had an allograft repair)- and my knee has been trouble free since the repair. I am extremely active, and have been since before my surgery. I also don't use any type of supportive braces, etc.

[orangechic]

I had ACL repair on my left knee in 99 when I was 18, I took about 2 years off from the gym, athletics and when I first started working out again I experience swelling and pain similar to yours.

It took about 6 months to get strength and full range of motion and mobility back. I have yearly checkups to make sure everything is good and I stay active and lift and I have minimal pain now.

[nate99]

Originally Posted by orangechic

I had ACL repair on my left knee in 99 when I was 18, I took about 2 years off from the gym, athletics and when I first started working out again I experience swelling and pain similar to yours.

It took about 6 months to get strength and full range of motion and mobility back. I have yearly checkups to make sure everything is good and I stay active and lift and I have minimal pain now.

That's good to hear. I got range of motion back fairly early on, and since the surgery had the aforementioned period of time where I ran ~15 miles a week, which worked with enough rest in between.

I think that it might be at least partially a matter of never really getting the right kind of musculature (sp?) built up around it, as that leg still to this day looks a little smaller than the other one. That may be more in my head though, I've never measured.