Knee Stiffness After Leg Fracture Surgery: A Month Later

One month after the car accident?

Hello Doctor: I was in a car accident on the 14th of last month, resulting in fractures in my right thigh and calf.
I underwent surgery to place plates and screws in my right leg.
So far, I haven't experienced any discomfort in my right leg, but my main concern is that since the surgery, my knee has not been able to bend properly.
It can now bend to the same degree as my normal leg, but it still feels very stiff, tight, and uncomfortable.
I do knee flexion rehabilitation exercises every day, and after moving it, it feels somewhat better.
However, after being still for a while, bending it again feels tight.
I also experience soreness and discomfort near my hip area (only at certain angles), where there is a small incision from the minimally invasive surgery.
Could you please tell me what might be causing these issues?

Wang, 20~29 year old female. Ask Date: 2018/04/30

Dr. Li Yongheng reply Orthopedics

Hello, based on your condition, you have sustained fractures of the right femur and right tibia, and it has been six weeks since the internal fixation with bone nails was performed.
Currently, limited range of motion in the right knee and discomfort in the right hip are normal phenomena.
As long as you continue with rehabilitation, you should be able to return to normal function within three months.
However, since both the thigh and calf are fractured, it is important to be aware of the possibility of an associated injury to the right knee's cruciate ligaments.
Therefore, please consult your physician during your follow-up visit to inquire about any potential cruciate ligament injuries in the right knee.
Thank you for your question.

Reply Date: 2018/04/30

More Info

After undergoing surgery for leg fractures, particularly involving the knee, it's not uncommon to experience stiffness and discomfort during the recovery process. Your situation, where you are able to achieve a range of motion similar to your uninjured leg but still feel tightness and discomfort, is a common post-operative issue. Here’s a detailed explanation of what you might be experiencing and some insights into your recovery.

Understanding Knee Stiffness Post-Surgery
1. Post-Surgical Inflammation: After any surgical procedure, especially one involving bones and joints, inflammation is a natural response. This inflammation can lead to swelling and stiffness in the knee joint, which may persist for weeks or even months. The body’s healing process can sometimes cause the surrounding tissues to become tight, leading to a sensation of stiffness.

2. Scar Tissue Formation: Following surgery, scar tissue can form around the knee joint. This tissue is less flexible than the original tissue and can restrict movement, contributing to the feeling of stiffness. Scar tissue can develop not only at the surgical site but also in the surrounding muscles and tendons, which can further limit your range of motion.

3. Muscle Weakness and Atrophy: After a leg fracture and subsequent surgery, it’s common for the muscles around the knee, particularly the quadriceps, to weaken due to disuse. Muscle atrophy can lead to decreased strength and stability in the knee, making it feel less mobile and more prone to stiffness. Engaging in rehabilitation exercises is crucial to rebuilding strength and flexibility.

4. Joint Mechanics: The knee joint is complex, and after surgery, the mechanics of how the joint moves can be altered. The presence of hardware (such as plates and screws) can also affect how the knee feels during movement. Some patients report a sensation of tightness or discomfort due to the hardware, especially if it is pressing against surrounding tissues.

5. Psychological Factors: Sometimes, the fear of pain or re-injury can lead to guarded movements, which can contribute to a feeling of stiffness. This is often referred to as "kinesiophobia," where the fear of movement leads to reduced activity and can exacerbate feelings of stiffness.

Recommendations for Recovery
1. Continued Rehabilitation: It’s great to hear that you are actively participating in knee flexion rehabilitation. Continue to work with your physical therapist to gradually increase the intensity and variety of your exercises. Focus on both strength training and flexibility exercises to help alleviate stiffness.

2. Gentle Stretching: Incorporate gentle stretching into your routine. Stretching the quadriceps, hamstrings, and calf muscles can help improve flexibility and reduce tightness around the knee.

3. Heat and Cold Therapy: Applying heat before exercises can help relax the muscles and improve blood flow, while cold therapy afterward can reduce inflammation and pain. Alternating between heat and cold can be beneficial.

4. Patience and Consistency: Recovery from surgery can take time, and it’s important to be patient with your body. Consistent rehabilitation efforts will yield results, but it may take several weeks to months to fully regain your range of motion and reduce stiffness.

5. Consult Your Surgeon: If the stiffness persists or worsens, or if you experience significant pain, it’s essential to consult your orthopedic surgeon. They may want to evaluate your knee to ensure that there are no complications, such as hardware issues or other underlying problems.

Conclusion
In summary, the stiffness and discomfort you are experiencing in your knee after leg fracture surgery are likely due to a combination of inflammation, scar tissue formation, muscle weakness, and altered joint mechanics. Continuing your rehabilitation exercises, incorporating stretching, and being patient with your recovery process are key steps to improving your knee function. If you have ongoing concerns, don’t hesitate to reach out to your healthcare provider for further evaluation and guidance.

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