Knee Rehabilitation Progress After ACL and Meniscus Surgery

Rehabilitation progress

It has been two months (nine weeks) since my left knee anterior cruciate ligament reconstruction and bilateral meniscus repair surgery.
I used crutches for over five weeks and continued with a single crutch for a little over a week (I still carry a crutch when going out to prevent issues with stairs or slight inclines).
I am still wearing a knee brace (I try not to wear it while walking or standing).
Currently, the rehabilitation therapist says my knee flexion is at 90 degrees, and I am 5 degrees short of full extension.
I am unsure how the flexion angle is measured.
When I first sit down with the knee brace on, the angle is about 70 degrees (at its worst, it is 60 degrees), but after a while, it increases to 80 degrees, and I can push with my right foot to reach 90 degrees.
If I sit on the bed with the knee brace on and pull on the straps and angle disc towards my chest, I can achieve 100 or 110 degrees (the angle is worse without the brace).
However, every day when I take off the knee brace and try to bend my knee with a resistance band, I can only achieve 50 or 60 degrees.
The angle seems to regress daily, and I wonder when I will be able to surpass 110 degrees.
What is the actual flexion angle? If the therapist says it is 90 degrees, is this progress after two months sufficient, or would I need manual therapy under anesthesia to improve? Additionally, every time I lie in bed and try to lift my leg, it takes several minutes to start lifting it.
When I stand up from a seated position or get out of bed at night to use the bathroom, my legs feel weak, and I have to wait a while before I can take a step.
Even now, while lying in bed, my knee often experiences sudden involuntary spasms.
When walking with the knee brace, it feels like I am leading with the injured leg and dragging the healthy leg, resulting in a limping motion and swaying of my body.
Does this indicate weakness in the knee muscles? Is doing 20 repetitions of leg lifts and resistance band exercises twice a day, along with some scattered massages, insufficient? What additional exercises and repetitions should I be doing? Furthermore, my knee is still inflamed and swollen, and I am particularly concerned about intermittent pain in the front right area of the knee (the therapist said this is normal around the bone screws).
Recently, when bending my knee to sit down (also moving slowly while holding onto furniture) or extending my leg, I hear a grinding noise from the bones, which is alarming.
Most of the time, it feels like the large, round bones are grinding, but occasionally, I feel a thin, scraping sensation (possibly from the meniscus).
Could this indicate bone displacement? The shape of my healthy knee is rounded at the top and bottom, while the injured knee appears rounded at the top and elongated horizontally at the bottom.
When sitting and looking down at my knees, it feels like the injured knee is shorter than the healthy one.
Are there any other concerns?

kimochi, 40~49 year old female. Ask Date: 2012/02/02

Dr. Shi Guozheng reply Orthopedics

The recovery period for anterior cruciate ligament (ACL) reconstruction of the knee joint typically lasts about 6 to 9 months, during which time there may still be uncomfortable symptoms.
Rehabilitation must be approached step by step, and the range of motion should progressively improve.
Whether to perform manipulation under anesthesia should be discussed with the attending physician.
Muscle strength training is also a key focus, and the extent of this training should be discussed with a physical therapist or rehabilitation physician.
In summary, the rehabilitation journey is not easy.

Reply Date: 2012/02/02

More Info

After undergoing ACL reconstruction and meniscus repair surgery, it's understandable to have concerns about your rehabilitation progress, especially at the two-month mark. The recovery process can be complex and varies significantly from person to person. Here’s a comprehensive overview of what you might expect and some insights into your current situation.

Understanding Knee Rehabilitation Progress
1. Range of Motion (ROM): Achieving a full range of motion is crucial after knee surgery. The goal is typically to reach at least 90 degrees of flexion by the end of the second month. Your reported range of motion (90 degrees flexion and 5 degrees short of full extension) is within the expected range for this stage of recovery. However, the variability in your measurements (70-110 degrees) suggests that your knee may still be experiencing swelling or stiffness, which can affect your ability to flex fully.
2. Importance of Consistent Rehabilitation: It’s essential to engage in consistent rehabilitation exercises. The fact that you can achieve 100-110 degrees with manual assistance indicates that your knee has the potential for greater mobility. However, the difficulty in achieving this range independently suggests that you may need to focus on strengthening the muscles around the knee and improving your overall flexibility.
3. Muscle Weakness and Atrophy: The feeling of weakness and the need to wait before standing or moving could indicate muscle atrophy, which is common after surgery due to reduced activity levels. The knee's instability and the sensation of "dragging" the healthy leg while walking may also be signs of muscle weakness. Strengthening exercises targeting the quadriceps, hamstrings, and calf muscles will be beneficial.
4. Pain and Swelling Management: The inflammation and pain you’re experiencing, particularly around the area of the bone screws, are not uncommon. It’s crucial to manage this swelling through ice application, elevation, and possibly anti-inflammatory medications as advised by your physician. Persistent swelling can hinder your rehabilitation progress.

5. Additional Rehabilitation Techniques: Beyond the exercises you are currently doing, consider incorporating:
- Aquatic Therapy: Exercising in water can reduce the load on your knee while allowing for greater movement.

- Strength Training: Focus on low-impact exercises that strengthen the muscles around the knee without putting too much strain on the joint.

- Manual Therapy: If your physical therapist recommends it, manual therapy techniques can help improve mobility and reduce stiffness.

6. Concerns About Noises and Sensations: The sounds you hear during movement, such as grinding or popping, can be concerning. These noises may result from the healing process, scar tissue, or the interaction of the hardware with the surrounding tissues. However, if you experience significant pain or instability, it’s essential to discuss these symptoms with your orthopedic surgeon.

7. Future Considerations: As you progress, it’s vital to maintain open communication with your healthcare team. They can provide tailored advice based on your specific recovery trajectory. If you feel that your current rehabilitation is insufficient, don’t hesitate to ask for additional exercises or modifications to your program.

Conclusion
In summary, your recovery from ACL and meniscus surgery is on track, but it requires patience and consistent effort. Focus on your rehabilitation exercises, manage pain and swelling effectively, and communicate any concerns with your healthcare providers. With dedication and the right support, you can work towards regaining full function of your knee and returning to your daily activities without a limp.

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