Challenges in Recovery from Tibial Fracture and ACL Injury: Knee Extension Issues

Q: Challenges in Recovery from Tibial Fracture and ACL Injury: Knee Extension Issues

Hello： In response to your questions, you can consult your attending physician in person. <br>If you still have concerns, you may also seek advice from another orthopedic surgeon nearby. <br>The old saying goes, "It takes a hundred days to heal injuries to muscles and bones," and

Tibial shaft fracture with an intact anterior cruciate ligament injury, unable to fully extend the knee?

Hello Doctor: I had a motorcycle accident on October 20 of last year, resulting in continuous swelling below my right knee, and I did not undergo surgery until November 17.
My attending physician indicated that I had an injury to my anterior cruciate ligament, but it was not torn.
The tibia had a small fracture just below the knee, which was elevated, and a steel screw was inserted during surgery to stabilize it.
Due to ongoing issues with bending and straightening my knee, I began rehabilitation at the hospital earlier this year and have been actively rehabilitating for a month now.
My range of motion is gradually improving, but the popping sound in my knee when bending is becoming louder.
The doctor mentioned that this noise is caused by the steel screw.
However, I still cannot fully straighten my knee.
I have started walking, but I feel unstable and sometimes have a sensation of tipping over.
When I attempt to fully extend my knee, it feels very stiff, as if the bones above and below the knee are compressed together, and I cannot straighten it any further.
It has been over three months, and I have been doing rehabilitation both at home and in the hospital.
I feel like I have hit a plateau in my knee extension.

Question 1: Is it possible that the stiffness in my right knee joint is causing my leg to be of unequal length due to improper bone growth? I feel that the steel screw is quite large, and could it be preventing further extension of the joint? Currently, I am about 10 degrees away from full extension.

Question 2: What can I do to restore normal extension function in my knee? I am very anxious and afraid of potentially irreversible complications due to my lack of knowledge.

Details of my surgery:
1.
Diagnosis: Right tibial fracture
2.
Surgical procedure: Open reduction and internal fixation
3.
Reason for surgery: Displaced fracture

Nini Jin, 30~39 year old female. Ask Date: 2011/01/30

Dr. Li Wenlin reply Orthopedics

Hello: In response to your questions, you can consult your attending physician in person.
If you still have concerns, you may also seek advice from another orthopedic surgeon nearby.
The old saying goes, "It takes a hundred days to heal injuries to muscles and bones," and three months is an average timeframe; some individuals may require a bit more time.
Don't rush it, and work closely with your attending physician and physical therapist.
I believe you will recover soon!

Reply Date: 2011/01/30

More Info

Recovering from a tibial fracture and an ACL injury can be a challenging journey, especially when complications arise, such as limited knee extension and persistent swelling. Your situation, which involves a tibial fracture treated with internal fixation and an ACL injury, is not uncommon, and many patients experience similar issues during their rehabilitation process.

Understanding Your Condition
1. Knee Extension Issues: The inability to fully extend your knee can be attributed to several factors, including scar tissue formation, joint stiffness, or mechanical issues related to the hardware (the steel pin) used during surgery. When the knee joint is immobilized for an extended period, as it often is after surgery, it can lead to stiffness and a reduced range of motion. This is sometimes referred to as "arthrofibrosis," which is characterized by excessive scar tissue formation in the joint.

2. Mechanical Sounds: The "cracking" or "popping" sounds you hear during knee flexion are often benign and can occur due to the movement of tendons or ligaments over bony prominences or the hardware itself. However, if these sounds are accompanied by pain or instability, it may warrant further investigation.

3. Concerns About Bone Healing: You mentioned concerns about whether the bones are healing improperly, potentially leading to discrepancies in leg length. While it is possible for bones to heal in a misaligned position (malunion), this is typically assessed through follow-up imaging studies, such as X-rays. If you have concerns about leg length discrepancies, it is crucial to discuss these with your orthopedic surgeon.

Recommendations for Recovery
1. Physical Therapy: Continuing with physical therapy is essential. A physical therapist can provide targeted exercises to improve knee extension, flexibility, and strength. They may use modalities such as ultrasound or electrical stimulation to help reduce swelling and pain.
2. Stretching and Strengthening: Focus on gentle stretching exercises to improve your knee extension. For instance, using a towel or strap to assist in stretching the hamstrings and quadriceps can be beneficial. Strengthening exercises for the quadriceps, hamstrings, and calf muscles will also support knee stability.

3. Gradual Weight Bearing: As you progress in your recovery, gradually increasing weight-bearing activities can help improve stability and confidence in your knee. Using a brace or support can provide additional stability as you transition to walking without assistance.

4. Monitoring Symptoms: Keep track of your symptoms. If you experience increased pain, swelling, or instability, it is essential to communicate these changes to your healthcare provider. They may recommend imaging studies to assess the healing process and the position of the hardware.

5. Consultation with Your Surgeon: Given your ongoing concerns about knee extension and the mechanical sounds, it may be beneficial to schedule a follow-up appointment with your orthopedic surgeon. They can evaluate your knee's range of motion, assess the healing of the fracture, and determine if any further interventions are necessary.

Conclusion
Recovering from a tibial fracture and ACL injury requires patience and diligence. While it is normal to feel anxious about your recovery, focusing on your rehabilitation and maintaining open communication with your healthcare team will be crucial. Remember that recovery is a gradual process, and with the right support and interventions, you can achieve improved function and mobility in your knee. If you have any further questions or concerns, do not hesitate to reach out to your healthcare provider for guidance tailored to your specific situation.

Similar Q&A

Effective Rehabilitation Strategies for Knee Recovery After Tibia Fracture

I previously suffered a tibial fracture due to a car accident. I am now able to walk, but my knee still cannot fully extend like a normal leg. The doctor advised me to elevate my leg and apply pressure to the mid-thigh area to help straighten the knee. I have been doing this for ...

Dr. Shi Guozheng reply Orthopedics
Inability to fully extend the leg may be due to quadriceps weakness. After a fracture, immobilization with a cast or surgery can lead to disuse of the muscles for a period of time, resulting in muscle strength reduction. With active training or rehabilitation, it is usually possi...

Understanding Recovery Challenges After ACL Tear and Tibial Fracture

Hello, I have a fracture at the junction of the ligament and the tibia, and when the ligament tore, it pulled off a piece of bone. I have a few questions regarding my recovery: 1. It has been three and a half months since my surgery, but I still walk with a slight limp. Why is ...

Dr. Zhou Hongzhi reply Orthopedics
Xiao Lan: You should return to the hospital for an arthroscopic examination to assess the recovery status of your ligaments and bones.

Understanding Pain and Recovery in ACL and Tibial Fracture Rehabilitation

1. I would like to inquire about the pain I experience after using the calf raise machine during my rehabilitation sessions. After completing the exercise, when I attempt to extend my calf upwards, I feel a sharp pain just below the inner side of my right knee, near the hard bone...

Dr. Xu Zhaoren reply Orthopedics
The rehabilitation you are undergoing is focused on rebuilding the strength of the quadriceps muscle, which may take anywhere from 6 months to over a year. It is important to not only perform the exercises during your rehabilitation sessions but also to continue training at home....

Recovering from ACL Injury: Effective Rehab Strategies for Knee Pain

Hello Dr. Cheng, Last October, I fell off my motorcycle, resulting in a neck fracture of my left femur. At the time of the fall, my leg was straight, so my knee was also injured. However, when I was taken to the hospital, the focus was on my more severe thigh injury, and my knee...

Dr. Zheng Shunping reply Rehabilitation
In response to your question: Based on your description of the condition, the fracture should be nearly healed. It is important to actively engage in rehabilitation exercises, focusing on strengthening the hip joint's flexion and abduction. As for applying ointments, this is...