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I was in a motorcycle crash just over two years ago. The crash produced a broken fibula as well as a severed ACL, both on my right leg. While the broken bone has not caused any discomfort, my knee is another story. I had ACL reconstructive surgery a few weeks after the crash. Since then, I cannot straigten my leg completely nor can I can sit back on my heals when kneeling down. The pain is quite bad in either case but especially when kneeling. My doctor did another MRI to see what was wrong but couldn't find anything. Lately I've had sharp pain when doing squats and other like excersises to the point I've had to stop them. Any ideas what might be wrong?
Could you ever squat after your rehab without pain or was it always painful since the surgery? (you said lately)
Did you spend a lot of time working on getting full extension? Are you still working on it?
While it is a very rare occurrance, there have been occasions where the ACL graft is too short and will limit ROM. I say it's rare because they usually check your motion while you're still under anesthesia to make sure full ROM is possible. There's even a little gadget some surgeons use to make sure they get it right.
Was there any direct or other damage to the joint itself that may have limited extension?
With a tramatic injury like yours, there could be a number of explanations such as a loose body (stuff floating around in the joint space that will block motion and cause pain), incomplete rehab, or something new that doesn't show up on the MRI (they are unfortunately not perfect...speaking from personal experience).
It's difficult to pinpoint the pain. It is definitely internal meaning it doesn't hurt when touched or pressed externally.
I did some leg presses during rehab and didn't feel any extrodinary pain. Right after my surgery, I used a machine that would bend my leg for me. No one mentioned I had to straigten it completely, rather, they focused on the bending side of it. I say "lately" in my last email because I've started a new total body workout routine in the last couple of months that I really like. I've tried to stretch and strenghten my leg in hopes it would eventually straigten out but it hasn't.
I wasn't told of any additional damage to my knee and that the ACL Reconstruct took care of everything. He even mentioned I would be 100% or better after the surgery.
To be honest, incomplete rehab may be a big factor in this. Are there any excersises I can do to help my situation? Or do you recommend I get another scope to see if that will fix me up? I guess what I'm asking is...if there is floating tissue still in there, will any amount of excersise get rid of the pain and lack of motion I'm having?
It could be something as simple as posterior capsule tightness.
A couple of low load passive stretches may do the trick.
Sit with your foot propped up on a stool with nothing else under your leg from hip to foot. Place a light weight over the leg below your patella. Hold for 20-30 mintues. Enjoy the stretch. It will be sore when you remove the weight and try to bend the knee so be careful.
Lay on your bed with your legs off the edge such that your knee just clears the edge of the bed. Let the weight of your leg stretch the back of the knee. You may need to add a light weight to the lower leg for sufficient stretch.
The key here is low load, long duration to stetch the non-contractile soft-tissues. Do not be aggressive with the weights.
What's the quality of pain? Sharp, stretch, burning, piercing or something else? I'm just concerned that it's more than a restricted ROM here, especially if the pain is occuring at other points in the range of motion other than the extension end-point.
At full extension the pain is pretty dull. At full compression the pain is sharp and very uncomfortable. No way for me to sit on my right heal while kneeling. No sweat with the left. I feel no pain at all while running or walking. I get a sharp pain during the "lift" portion of a squat but not on every squat.
My doctor told me what you said, Bill, in that it might be loose tissue floating around. I can see how that would be painful. However, when I try to sit on my right heel, the distance between my heal and my rear is about 5-6 inches. It seems it would have to be either really big pieces of tissue or a lot of them.
Yes, I can obtain full extension on my own. However, my full extension is not full extension. There is probably a 4-6 degree permanent flex at the knee so my leg never really gets to straight or negative as with my left knee. I can get my heel to within 9 inches of my rear without using my hand to pull it towards me. There is no pain if I don't pull on it with my hand. The pain comes when I pull my heal towards me.
I think what you're describing requires an exam that's more thorough than anything we could talk through a forum about. I'd see if you can see your surgeon for a follow-up.
My doctor recommended another scope to clear out any floating tissue that remains. He said there was no way to be sure that's what was causing my pain and inability to straighten or compress my leg completely though. I'm trying to avoid another surgery if possible. If there is remaining tissue, is there any way to alleviate the situation through training? Or is the scope the only way to fix it up?
Thanks for taking the time guys...I know this is a difficult subject to tackle without a proper exam.
If there is remaining tissue, then there aren't really many options other than surgery to remove them. And, given the inflammatory consequences of floating tissue within a joint capsule, you'd be wise to get them out--as this is how osteoarthritis proliferates within a joint. However, it seems like your doctor is suggesting surgery, while admitting he has no idea whether you have floating material in there or not. I'm not sure what the feasability of imaging for loose particles is--Russ would probably know, but it seems...casual to suggest an additional 'scope, as common as diagnostic scopes are. I suppose if there's no other way to tell, you'd have to get scoped though.
Loose bodies can shift around a bit which results in variable changes in ROM, recurrent inflammation, and symptoms. This doesn't seem the case. If there is something in the way, I can't see how any form of exercise will help.
That was my biggest concern Bryan...that he wasn't entirely sure it would fix the problem. I don't like the idea of going through another surgery only to find out that wasn't what was wrong.
You're entirely right, Bill. The pain is not different from day-to-day. It is the same pain in the same place at the same point in the motion. EVERYTIME.
Sounds like a second opinion is the best thing to do at this point. Thanks for helping me figure that out. I'll keep you posted on the results so maybe someone else can benefit from this.
I had a scope done on Tuesday (11-4) with hopes my knee will finally get back to normal. I have a follow-up appointment next Monday but was wondering what you'd recommend for the first 5 days after the scope?
Unfortunately not yet...I won't find out until my follow-up. My knee has a lot of padding around it (bigger than a softball) and my leg is wrapped in a stocking then with 3 or 4 wrapped bandages. I'm pretty limited in ROM and the nurse says I've got to keep all of this on until Monday. I'm pretty bummed as lack-of-motion early-on after my last surgery is why I feel I'm in this position now. I've been stretching as much as I can with what I've got to work with though. I've got a good amount of pain when trying to extend my leg completely so I'm a little worried about that. But, my doc said he was going to check for full ROM while I was under so maybe it's just sore.
It's been a while but I've been busy with work and rehab.
My follow-up with my doc revealed much scar tissue and a few calcium deposits. They were cleaned out and I'm happy to say, my knee feels fantastic! I still have some moderate pain at full compression but nothing like it used to be. I can almost obtain full extension (flex is now 2 degrees...down from about 7 before surgery). My PT feels like we can definitely get there with a little work. I think I remember him saying I'm at 126 degrees of flex, totally unassisted. He said 130 degrees is normal so I'm not far off.
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