Recovering from ACL Reconstruction: Managing Setbacks and Concerns

Slipping during rehabilitation after anterior cruciate ligament reconstruction?

Hello, Doctor.
I previously asked you about the rehabilitation progress after my anterior cruciate ligament (ACL) reconstruction and bilateral meniscus repair surgery on February 2nd.
Now, three months and one week post-surgery, the doctor said my flexion angle is 110 degrees, but I cannot fully extend my leg while sitting, indicating muscle weakness.
Therefore, I still cannot remove the brace.
Unfortunately, I had an accident and slipped, causing me to squat down forcefully on my injured leg.
Although I was wearing the brace, my knee, which often feels stiff, bent to 120 degrees suddenly, resulting in pain and swelling.
I just had an MRI, and the doctor mentioned that my knee is swollen, and I cannot lift my leg while lying down.
The MRI showed a white area near the upper side of the knee bone, suggesting possible muscle contusion or near rupture.
After the fall, I resumed using two crutches and adjusted the brace to a 20-degree extension.
The uncertainty of my injury has made me hesitant to engage in any rehabilitation for over two weeks now.
My knee can hardly bend, reaching a maximum of about 30 to 40 degrees with effort.
Initially, I was concerned about adhesions, so I massaged the surgical site, but after reading online that muscle strains should not be massaged, I stopped.
I am unsure how much more my legs will atrophy, given that there is a two-centimeter difference in circumference between my legs.

I would like to know the status of rehabilitation after ACL reconstruction, especially if I encounter a muscle strain or even a rupture.
Would surgery be necessary? Is there a possibility of further injury to the ligaments or meniscus? It has been three months and three weeks since the reconstruction, and my rehabilitation has been interrupted for over two weeks.
I am concerned about how long it will take to continue rehabilitation after this injury heals.
Is there still hope for the reconstructed ligament? Will my knee be able to bend again? Are there any potential long-term effects (what are they)?

kimochi, 40~49 year old female. Ask Date: 2012/03/23

Dr. Shi Guozheng reply Orthopedics

Your MRI report is not very clear, and the extent of the knee joint injury is uncertain.
However, the conditions you mentioned are all possible.
The most important thing now is to establish a diagnosis before determining the treatment or rehabilitation plan.
There is still a chance for recovery after healing.

Reply Date: 2012/03/23

More Info

Recovering from ACL reconstruction can be a challenging journey, especially when setbacks occur, such as the unfortunate incident of slipping and injuring the knee again. It’s understandable to have concerns about the implications of such an event on your recovery and the overall integrity of the reconstructed ACL and surrounding structures. Let’s address your questions and concerns systematically.

Understanding ACL Reconstruction and Recovery
ACL (anterior cruciate ligament) reconstruction is a common surgical procedure aimed at restoring stability to the knee after an ACL tear. The surgery typically involves replacing the torn ligament with a graft, which can be taken from the patient’s own hamstring tendons or other sources. Post-surgery, rehabilitation is crucial for regaining strength, flexibility, and function in the knee.

Setbacks and Their Implications
1. Impact of Slipping and Falling:
- When you fell and put excessive force on your knee, it could have led to various outcomes. The MRI findings indicating swelling and potential muscle strain or near-tear suggest that there may be soft tissue damage. This is concerning, as it can affect your recovery timeline and rehabilitation process.

- The swelling and inability to fully extend your knee are common after such incidents. It’s essential to manage swelling through rest, ice, compression, and elevation (RICE protocol) to facilitate healing.

2. Muscle Weakness and Stiffness:
- The inability to fully extend your knee and the difference in circumference between your legs indicate muscle atrophy and stiffness, which are common after surgery and can be exacerbated by inactivity following an injury.

- It’s crucial to engage in gentle range-of-motion exercises as tolerated, even if it’s painful. Avoiding movement can lead to further stiffness and complications like adhesions.

3. Potential for Further Injury:
- Yes, there is a possibility that the reconstructed ACL or other structures (like the meniscus) could be injured again, especially if the knee is subjected to sudden stress. However, the risk of re-injury can be minimized with proper rehabilitation and gradual return to activities.

- If there is significant pain or instability, further imaging or evaluation may be necessary to assess the integrity of the reconstruction and surrounding tissues.

Rehabilitation Considerations
1. Resuming Rehabilitation:
- Once you have consulted with your physician and any acute issues have been addressed, it’s important to gradually resume rehabilitation. Focus on gentle range-of-motion exercises and strengthening exercises for the quadriceps and hamstrings.

- Physical therapy can help you regain strength and flexibility, and a therapist can provide tailored exercises to avoid further injury.

2. Monitoring for Complications:
- After any setback, it’s crucial to monitor for signs of complications, such as increased swelling, persistent pain, or instability. If these occur, further evaluation may be warranted.

- Common complications after ACL reconstruction include stiffness, re-tear of the graft, and issues related to the meniscus if it was also repaired.

3. Long-term Outlook:
- Many patients can return to their pre-injury level of activity after ACL reconstruction, but this often requires a dedicated rehabilitation effort. The timeline for recovery can vary widely based on individual circumstances, including the extent of the injury and adherence to rehabilitation protocols.

- It’s essential to have realistic expectations and understand that recovery can take time, especially after setbacks.

Conclusion
In summary, while setbacks like slipping can complicate recovery from ACL reconstruction, they do not necessarily mean that the reconstruction is doomed or that you cannot regain function. It’s vital to communicate openly with your healthcare team, follow their recommendations, and engage in a structured rehabilitation program. With patience and diligence, many individuals successfully return to their desired activities post-recovery. Always remember to listen to your body and prioritize your knee's health during this process.

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