Managing Persistent Knee Issues After ACL Reconstruction: What to Do? - Orthopedics

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Managing persistent knee issues after ACL reconstruction can be a challenging process, especially when symptoms such as catching sensations and difficulty fully extending the knee persist even two years post-surgery. Here’s a comprehensive approach to understanding and addressing your concerns.


Understanding the Symptoms
The sensation of "catching" in the knee can be attributed to several factors. After an ACL reconstruction, the knee may develop scar tissue or adhesions that can restrict movement. Additionally, there could be issues related to the meniscus, which may not have been fully addressed during the initial surgery, or there could be residual instability in the knee joint. It's also possible that the new ligament graft has not integrated properly or that there are other underlying issues such as patellar tendinopathy or chondromalacia (softening of the cartilage).


Initial Steps to Take
1. Consult Your Orthopedic Surgeon: The first step is to revisit your orthopedic surgeon or a sports medicine specialist. They can perform a thorough clinical examination and may recommend imaging studies, such as an MRI, to assess the current state of your knee. This will help identify any structural issues that may be contributing to your symptoms.

2. Physical Therapy: Engaging in a structured physical therapy program is crucial. A physical therapist can design a rehabilitation program tailored to your specific needs, focusing on strengthening the muscles around the knee, improving flexibility, and enhancing overall function.
3. Exercises to Consider:
- Quadriceps Strengthening: Exercises like straight leg raises and wall sits can help strengthen the quadriceps, which play a crucial role in stabilizing the knee.

- Hamstring Strengthening: Incorporating hamstring curls can help balance the strength between the front and back of the thigh.

- Balance and Proprioception Training: Activities such as single-leg stands or using a balance board can improve stability and proprioception, which is essential for knee function.

- Range of Motion Exercises: Gentle stretching and range of motion exercises can help alleviate stiffness and improve flexibility.

4. Activity Modification: Avoid activities that exacerbate your symptoms, particularly those that involve pivoting or sudden changes in direction. Low-impact activities such as swimming or cycling may be beneficial during this period.


When to Consider Surgery
If conservative management through physical therapy and activity modification does not alleviate your symptoms, and if imaging studies reveal significant structural issues (like a meniscal tear or instability), a surgical intervention may be warranted. This could involve arthroscopic surgery to address any remaining issues, such as removing scar tissue, repairing a meniscus, or even revising the ACL reconstruction if necessary.


Conclusion
Persistent knee issues after ACL reconstruction can be frustrating, but with the right approach, many patients can achieve significant improvements. Start with a thorough evaluation by your orthopedic surgeon, engage in a tailored physical therapy program, and consider modifying your activities to reduce strain on the knee. If symptoms persist despite these efforts, further surgical evaluation may be necessary. Remember, recovery is a gradual process, and patience is key. Always follow your healthcare provider's recommendations and stay proactive in your rehabilitation efforts.