Recovery After ACL Injury: Common Concerns and Solutions

Rehabilitation

Hello Doctor: At the end of January this year, I suffered a torn anterior cruciate ligament and a fracture in my right knee due to a car accident.
I had a metal plate inserted, and the doctor advised me to keep it immobilized for a month without bending or putting weight on it.
After a month, the immobilization was removed, and I started rehabilitation.
About a month and a half later, I stopped using crutches and began to walk with weight-bearing.
I would like to know if this could affect the healing of the bone.

I hear a popping sound in my knee when bending and straightening it (there is no pain), and when I exert force, there is a loud noise that sometimes others can hear and sometimes they cannot.
When the popping sound is loud, I feel like my knee is a bit looser and not as tight, while the surrounding area often feels stiff and clunky, making it feel less like my own leg.

Now, five months later, I still have a slight limp when walking (though it's not very obvious, it looks a bit odd, and others think I am in pain).
Sometimes, I experience pain behind my knee during exercise, and it feels like my knee tends to tilt inward while walking.
I still cannot fully straighten my leg; when standing with both legs straight, the curvature of my knee is less pronounced than the other leg.
I am unsure if this is due to tightness in the muscles or another reason.

When I sleep, the back of my knee does not feel like a healthy leg that can lie flat on the bed; it feels a bit suspended and requires slow stretching to reach the bed.
Bending is also not as easy as with my healthy leg; it feels like both straightening and bending are about ten degrees off.
Will these conditions improve further? I really want to return to the state of my original leg.
Is it because I stopped using crutches too early? Or do I need to continue with rehabilitation? I would appreciate your guidance.
Thank you!

laney, 20~29 year old female. Ask Date: 2006/06/25

Dr. Chen Xianchang reply Rehabilitation

(1) Generally, at one month post-injury, weight-bearing should be limited to 1/4 to 1/3 of body weight.
The popping sound in the knee indicates ligament laxity, and strength training is necessary, focusing on both the anterior and posterior thigh muscles (important).
(2) Rehabilitation should continue, incorporating deep thermal therapy (ultrasound, laser), along with enhanced strength training and joint range of motion exercises.
(3) It is recommended to visit a medical center's rehabilitation department for further management.

Reply Date: 2006/06/25

More Info

Recovering from an ACL (anterior cruciate ligament) injury can be a complex process, especially after a significant injury like a tear accompanied by a fracture. Your concerns about the healing process, the sounds from your knee, and the overall function of your leg are quite common among patients who have undergone similar injuries and surgeries.

Firstly, regarding your question about whether starting to bear weight and walking without crutches after a month of immobilization could affect bone healing: generally, once a doctor has cleared you to begin weight-bearing activities, it is a positive sign that your bone is healing properly. However, it is crucial to follow your doctor's specific recommendations regarding the timeline for weight-bearing and rehabilitation exercises. If you feel any significant pain or discomfort while walking, it is advisable to consult your physician or physical therapist to ensure that you are not putting undue stress on the healing bone.

The sounds you describe, such as popping or cracking noises (often referred to as "crepitus"), can be common after knee injuries and surgeries. These sounds can occur due to several reasons, including the movement of tendons or ligaments over bony structures, the presence of air bubbles in the joint fluid, or changes in the cartilage. If these sounds are not accompanied by pain, they are typically not a cause for concern. However, if you experience pain or a sensation of instability in the knee, it is essential to have it evaluated by a healthcare professional.

Your observation of a slight limp and the feeling of tightness or stiffness in your knee is also common during the recovery phase. After an ACL injury, it is not unusual to experience some degree of muscle atrophy and joint stiffness, which can lead to a noticeable difference in the range of motion compared to your uninjured leg. The tightness you feel when trying to fully extend or flex your knee may be due to scar tissue formation or muscle tightness, which can often be addressed through targeted rehabilitation exercises.

To improve your knee function and range of motion, it is crucial to engage in a structured rehabilitation program. This program should include exercises that focus on strengthening the muscles around the knee, improving flexibility, and restoring balance. Physical therapy can be particularly beneficial, as a trained therapist can provide you with personalized exercises and monitor your progress. Stretching exercises targeting the quadriceps, hamstrings, and calf muscles can help alleviate tightness and improve your overall mobility.

As for your concern about whether you started walking too soon without crutches, it is essential to listen to your body. If you feel that your knee is not ready for full weight-bearing activities, it is okay to use crutches for additional support until you feel more stable. Gradually increasing your activity level while ensuring that you do not push through pain is key to a successful recovery.

In summary, while some of the symptoms you are experiencing are common after ACL injuries and surgeries, it is essential to maintain open communication with your healthcare providers. Regular follow-ups and adherence to a rehabilitation program will significantly enhance your recovery and help you regain the function of your knee. With time, patience, and the right approach to rehabilitation, many patients can return to their pre-injury levels of activity.

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