Leg Length Discrepancy After Knee Arthroscopy Surgery

After undergoing arthroscopy of the knee, it was discovered that there is a leg length discrepancy?

Hello, Doctor: I would like to ask if undergoing arthroscopy on the knee can cause leg length discrepancy.
I can confirm that I did not have this issue before the arthroscopy.
The main reason for the procedure was that I had a knee sprain and after a period of physical therapy, the internal pain in my knee was not resolved, leading to the decision for arthroscopic treatment.
The surgery revealed a meniscus tear that was repaired.
About a year post-surgery, I noticed that the angle of the knee on the operated leg was significantly more posterior compared to the non-operated leg.
After consulting several doctors, I received various explanations: 1.
It could be due to pain preventing full extension post-surgery.
2.
It might be caused by post-operative adhesions.
3.
The posterior cruciate ligament (PCL) in the operated leg is tighter than in the non-operated leg.
A physical therapist also indicated an issue with the medial collateral ligament (MCL).
I have some questions regarding the doctors' explanations: 1.
Regarding the pain preventing full extension: After surgery and throughout my physical therapy, I have been doing stretching exercises almost daily.
During this process, I was surprised to discover the difference in the knee angles.
I have specifically focused on stretching the leg that has less extension.
After seven years, I would expect some improvement, even if not a complete return to normal, but the angle difference remains unchanged.
2.
Concerning post-operative adhesions: If this is the cause, can an MRI detect it? A recent MRI showed fluid accumulation behind the knee of the operated leg, and the physical therapist said it was not a concern.
Is that true? Can fluid accumulation be left untreated? 3.
Regarding the tighter versus looser PCL: Two doctors mentioned that I naturally have looser ligaments behind my joints, which causes my joints to extend more posteriorly.
However, I am puzzled about what caused the PCL in the operated leg to become tighter.
If this is the case, what methods can be used to address it?
These questions have been troubling me for a long time.
Each time the pain subsides, I feel it is essential to identify the underlying cause of the pain for a proper resolution.
Two years ago, I followed the physical therapist's advice to wear corrective insoles, but I still noticed no significant improvement.
I continue to wear them, and while walking on flat surfaces is fine, I experience noticeable discomfort on the outer side of the operated knee when going up and down stairs or slopes, while the inner side of the non-operated knee hurts.
Thank you, Doctor!

kina, 20~29 year old female. Ask Date: 2012/03/04

Dr. Hong Ximing reply Orthopedics

Hello Tina! Undergoing arthroscopic surgery should not cause a leg length discrepancy.
Based on your description, it seems that the difference in the extension angles between your legs may be due to muscle or ligament fibrosis post-surgery, which can create the sensation of having one leg longer than the other.
This can also affect your gait, leading to different loading on the inner and outer sides of your knees.
I recommend consulting with a rehabilitation specialist; physical therapy methods should be more helpful in your case.

Reply Date: 2012/03/04

More Info

Leg length discrepancy (LLD) after knee arthroscopy surgery is a concern that can arise due to various factors related to the surgical procedure and the recovery process. While knee arthroscopy is a minimally invasive technique, it can still lead to changes in the biomechanics of the knee joint, which may contribute to perceived or actual discrepancies in leg length.
1. Post-Surgical Changes: After knee surgery, it is common for patients to experience pain and discomfort, which can lead to compensatory movement patterns. If you are favoring one leg due to pain or stiffness, this can result in a temporary change in how you use your legs, potentially leading to a feeling of leg length discrepancy. The body often adapts to pain by altering gait mechanics, which can create the illusion of uneven leg lengths.

2. Scar Tissue Formation: Adhesions or scar tissue can form after surgery, which may restrict movement in the knee joint. This can lead to a reduced range of motion in the affected knee, causing it to appear less straight compared to the non-operated knee. If the knee is not fully extending due to scar tissue, it may seem as though one leg is shorter than the other. MRI can sometimes reveal the presence of scar tissue, but it may not always provide a clear picture of how this tissue is affecting movement.

3. Ligament Tightness: The tightness of the ligaments, including the posterior cruciate ligament (PCL), can also contribute to perceived discrepancies. If the PCL on the operated side has become tighter due to surgical intervention or changes in muscle tone and strength, it may limit the knee's ability to extend fully. This can create a functional leg length discrepancy, where one leg appears shorter due to its inability to achieve full extension.

4. Muscle Imbalance: After surgery, muscle atrophy can occur, particularly in the quadriceps and hamstring muscles. If the muscles surrounding the knee joint are not equally strong, this can lead to altered knee mechanics and potentially contribute to a feeling of leg length discrepancy. Engaging in a targeted rehabilitation program to strengthen the quadriceps and other supporting muscles can help restore balance and improve function.

5. Fluid Accumulation: The presence of fluid (effusion) in the knee joint can also affect mobility and comfort. While some fluid accumulation post-surgery can be normal, persistent swelling may indicate an underlying issue that should be addressed. If the fluid is causing discomfort or limiting your range of motion, it may be worth discussing with your physician whether further evaluation or intervention is necessary.

6. Orthotic Devices: You mentioned using corrective shoe inserts. While these can help with alignment and comfort, they may not fully address the underlying issues contributing to your symptoms. It may be beneficial to consult with a physical therapist or orthopedic specialist who can assess your gait and provide tailored recommendations for orthotic devices or exercises.

In conclusion, while knee arthroscopy itself is unlikely to directly cause a leg length discrepancy, the subsequent changes in movement patterns, muscle strength, and joint mechanics can contribute to the perception of uneven legs. It is essential to work closely with your healthcare team, including physical therapists and orthopedic specialists, to address these concerns comprehensively. They can help you develop a rehabilitation plan that focuses on restoring strength, improving range of motion, and addressing any biomechanical issues that may be contributing to your symptoms. Regular follow-ups and assessments will be crucial in monitoring your progress and making necessary adjustments to your treatment plan.

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