One of the most common questions I get on this site and through email regarding reconstructive ACL surgery is something like this (actual email below),
“I think I may have done something to my knee Day 11; maybe bending, too much flexing or limping in the house without crutches (no pain at the time). But I must have perhaps worked on flexion too much or something and I got swelling and I feel like my knee is buckling.
Especially when I slightly bend it feels like it gonna snap out and there’s a huge ball in there (back to square 1). I wonder if I could have aggravated the mensicus or stretched out my ACL. I rested since and today it doesn’t look as swollen but what it feels like lump around the area and it almost snaps when I bend to walk/limp – a feeling which i never had before. I got my suture out yesterday with the surgeon and saw my PT today – asked questions, but from appearance they said it looks fine.
I can also perform most of the exercises, it’s just concerningly unstable when I stand and try to limp walk which has never been the case up till Day 11. I’m afraid I did something to it internally and I was wondering if there could be anything done to prove it or help it?
I guess the only way to really find out is wait or get another MRI done (to see if I did in fact damage something) (Which I’m not sure how to approach the surgeon about since he actually apparently ‘brushed’ it off as if I was just being overly worried). I know I’m in the process of healing, but maybe you can shed some light on how I can further prevent injury or investigate. I just don’t know how to go about with that? Do you think The physio will help remove that buckling feeling?”
The short version is,
- Any sudden increase in swelling is almost always from suddenly doing too much. With a new knee, it takes time to learn what’s ok and what’s too much. Pushing the line too far is going to happen. It’s like a toddler bumping their head. They’re learning how to move. It happens.
- Weird sensations are common with this surgery. You have a tendon now where a ligament was. That tendon is going to feel out of place. You have screws in your body you didn’t have. They’re going to give odd feelings here and there. These will largely dissipate with time.
- Simply check in with the surgeon. That’s what they’re there for, and they can check the graft in no time.
Long version-
First, this is very common. I vividly remember my own instance. I was within the first month, working on my extension range of motion, and when I bent my knee up just a tad I could see this little part of my knee poke out, then back in. I immediately went “WHAT THE FUCK WAS THAT?!?”
It scared the hell out of me. I immediately thought either I did something to screw up the surgery, or the surgery was screwed up itself.
I went right to my phone, called the doctor, and asked if I could bump up my next follow up. “Been having some weird sensations I’d like to get checked out.” They said sure, and got me in, I think it was two days later, when my follow up was 10 days out.
So this is our first takeaway here. If you have a good surgeon, you should be able to immediately get something like this checked out. I’ve worked with a good deal of people after they’ve had a surgery. I’m continually dumbfounded how many do not press the doctor’s office for help. You are their patient. You are their customer. If you just went to the mechanic to get work done, then not long after something seemed up with your car, you’re going to press that mechanic for information. You will call them, you will stop by the office, you will expect they see you perhaps not instantaneously, but you expect to get in sooner than some random person who has never been there before. You should expect the same from your surgeon!
If your doctor is not receptive to this, if you can’t get them on the phone, if they don’t call you back -I’ve had clients this has happened to- either make your name known, or get a new surgeon.
Making your name known does not mean leaving a second message. “Hi, blah blah blah, please call me back.” It means you call them incessantly. It means you drop by their office and demand help. You don’t go cursing and raving at them, but you tell them sternly you need their assistance. They’re on vacation? There should be an on-call doctor. You should be able to see them.
You should be having regular check ins with your doctor anyways. It should go along the lines of,
- Within 24 hours of surgery you find out what exactly was done
- Whoever is with you during your surgery should get a briefing after it’s done. For example, my Dad gave me the rundown he was given (from the surgeon).
- You should get some information when you first wake up. I had a nurse and my anesthesiologist fill me in.
- The surgeon may very well be in another surgery when you wake up. (Mine was.) I called them maybe eight hours post up. It was the day before Christmas Eve, and they answered. In fact, they were expecting my call. I was given his personal cell phone number. (I’m pretty sure they were Christmas shopping.) Again, you don’t just go performaing invasive surgery on someone then not talk to them about it for weeks afterwards. You should not be treated like a sheep or a number.
- ~10 days post op
- Six weeks post op
- Three months post op
- Six months post op
- Nine months post op
For most, the first month or two is when this weird stuff happens. (It still happens later on. It may happen forever. But you get used to what’s normal weird and what’s not, and it lessens in frequency month by month.) You are / should be going to see your surgeon multiple times around this period. Talk to them about it. You are almost guaranteed to hear “Oh yeah, that’s completely normal.”
Furthermore, they should be assessing your graft anyways. Every appointment! That’s the whole reason for you going there. Not to have some every month check in of “So, how are you feeling?” You could do that crap on the phone.
It takes them like 15 seconds to do this. They should be doing this with their hands. Sure, they’ll likely look at some X-Rays too -to check the hardware- but their hands will tell them 99% of what they need to know. If they merely say to you “Well, I need a MRI” without using their hands at all, that’s a lazy orthopedist.
If your surgeon is not using their hands, find one who will. You can ask them to, but if they aren’t doing it on their own, who knows how well they’re going to do it when they’re asked to.
-> Unfortunately, if you’re at this point, you may very well have had the wrong person perform your surgery to begin with.
No, they don’t know everything just from a MRI or X-Ray. No, your physical therapist is not a good substitute. I have had this happen to clients as well, where the doctor deemed a MRI was all they needed. No manual assessment or anything else. I mentioned this to another surgeon and he shook his head and started laughing. “What a croc of shit.”
This client of mine had an ACL surgery ten years ago, then a recent meniscus surgery. Out of nowhere, three months into the meniscus post op, her knee is giving way on her. I personally physically assess her knee, and tell her she really needs a good ortho to check it out. I didn’t like what I felt, but she needed more trained hands than mine. Time to check in with the surgeon.
She goes back to the doctor, who doesn’t touch her, and merely orders a MRI. MRI comes back good, so “you just need more time. Nothing’s torn. Nothing can be done surgically.”
I send her to an orthopedist I like. He can feel the laxity in her knee on a physical assessment. No, her ACL isn’t torn. No, nothing else is torn. But because of the injury history, her knee is not as stable anymore. You couldn’t see that or know that only from imaging -you could perhaps guess it, but you wouldn’t know it- yet you could feel it (know it) immediately with your hands. (Even I could feel it!)
Plus, you could know the ACL wasn’t torn based on a physical assessment anyways. The MRI wasn’t needed to begin with. (Other than for $$$.)
Karen
June 3, 2018
Good advise. I’m 2 months post-op on my second ACL (other leg) and understand the anxiety over weird sensations and lumps. It’s a big commitment with a long-ass recovery. I never want to have to do this again.
b-reddy
June 5, 2018
Oh geez, sorry to hear you’ve already had two surgeries. Once is certainly enough for one lifetime.
Good luck; hopefully you won’t!
Rob
July 31, 2018
Hi Brian, I hope you are well.
This is Rob, we have spoken a few times in the past, I was hoping if I may please have your opinion on my current circumstances?
I am 17 months post primary ACL recon (right knee) with hamstring graft from same knee.
in the last couple of months, i have had tightness at the back (crook) of the knee towards the lateral side and extending through to my calf muscle. In addition, when doing a squat or any kind of knee bend; I noticed that on straightening of my knee that there was a lot of crunching/cracking. nothing too alarming but nevertheless it felt like more than scar tissue popping (esp. at this stage). More disconcerting has been the knee feeling like its moving out too much laterally when in a bend (mid-squat) position and even when standing it can feel like that and more so if I exaggerate putting weight the the lateral side of my foot (I noticed this when I had developed plantar fasciitis in the right foot three months post op).
to be on the safe side i booked an appt with my surgeon and through my dr arranged an MRI scan. Both my Dr and physio felt the knee was stable when doing the anterior draw and a version of the lachmann test (but as we know Brian, it’s the surgeon’s that know best with that test) and it does feel certainly more stable than before the surgery.
i see my surgeon in a fortnight; the MRI test results are as follows: –
– Small peripheral undisplaced horizontal tear of posterior horn of medial meniscus.
– Evidence of prev ACL recon – buckling and marked signal alteration of ACL Graft suggesting partial rupture.
i’m hoping that may not sound as bad as it appears to read. I was wondering if you may please give your thoughts on
what seems to be the current state of play;
if there is anything I may have been doing to cause this (i honestly can’t recall any event that was significant since the surgery)
what are the possible outcomes I am looking at? (surgery again, nothing?) and anything to keep tabs on?
Kind Regards,
Rob.
b-reddy
July 31, 2018
Hey Rob,
Nice to hear from you, though sorry to hear about the new MRI. Some out of order thoughts-
-The fact you’re stable in day to day life tells you a lot. In the least, you wouldn’t need surgery for that reason. At least not yet.
-However, and this is where the knee gets hard, that doesn’t mean your ACL is fine. For instance, if you haven’t been doing much that would push the ACL e.g. dynamic cutting sports, then you might not feel the lack of stability right now.
The anterior drawer test of course matters, but you could conceivably have a lax knee assessment wise but a stable knee day to day life wise.
-I’ve had a few clients who had partial ACL tears who were, by and large, fine. Not perfect; not normal, but solid.
-I do not have expertise in this, but I would have a fair amount of reservation about a radiologist’s interpretation of a MRI with a reconstructed ACL on it. I can’t imagine the average radiologist sees this with any kind of regularity. But the surgeon likely does. What looks like a banged up ACL to them might be just how a reconstruction looks.
-It does sound like you’re starting to feel some lack of stability in more intense activities. Where if that’s where you want to (understandably) keep heading, the MRI is of course not the kind of results you want to see.
The meniscus may be something you can be perfectly fine with. Many tears and people can do quite a bit of activity.
The fact the tear is in the periphery is also good. That’s where healing is most likely. Whether without surgery or with a meniscal repair. I would be lessening any kind of deep squatting right now though. That places more strain on the meniscus.
-But coupling a meniscal tear on a potentially ACL deficient (lax) knee is a tougher combination. The laxity can very well make the meniscal tear more likely to get worse, eventually causing displacement, all but guaranteeing surgery.
-ACL failures happen. I believe it’s something like 2-5% fail. Hamstring grafts are a bit more likely.
If you don’t feel you had any noteworthy event -people pretty much always remember when they tore an ACL- and you didn’t do anything crazy in rehab, particularly in the first couple months -it’s pretty damn hard to even attempt to do something really stupid so early on due to all the inflammation, pain, and drugs- then the surgeon could have messed this one up.
They may have jacked up the graft; not seen the meniscal tear in surgery (that’s harder to believe but it’s on the table), etc.
Doesn’t mean you have a bad surgeon. Unfortunately, nobody (at least in America) knows a given doctor’s complication rate. But I’d imagine it happens to the best of them. Hell, they made have had a fellow or resident with them who missed something that they missed. (Though that’s still on the head surgeon.)
They actually could have done everything right but had some defective equipment when they tightened your graft.
Point being, it happens, but it would certainly be enough for me to get a second surgeon’s opinion no matter what the original says about the MRI. I’d want to hear a group of people have the same conclusion.
-Getting a revision is a bigger deal than getting the original. If you need one, I would highly recommend you find someone who has extensive experience doing them. Obviously, not because they’re screwing so many up, but because they have enough people coming to them for whomever screwed up the first time, where they’re the fixer.
You may need to travel a fair amount to find such a person. James Andrews group in Alabama is the only place I can immediately think of for this. Based on your email address I understand that’s more than a little trip for you, but calling them and seeing if they know anybody closer to you may work.
Rob
August 2, 2018
Dear Brian,
Thank you for your comprehensive reply.
The re-assuring about what you have to say is that I feel similarly about pretty much everything you say (with the exception about the squats which I did not know but now as I do I will be stopping those for a while- certainly I do not do weighted squats anymore).
I’ll reply in order of your points: –
– yes as soon as I was informed the results I immediately didn’t panic as I knew I am fine in day to day… but my mindset has updated to accepting down the road I may need to go under the knife once more.
– I think this is the crux of it. So- I have tried cutting movements on grass in shoes, I’ve played badminton which has tremendous amount of cutting, sudden stops and other types of movement and I have zero problems with my knee. certainly no noteworthy event. The main issue is with simply standing still and trying to weight bear evenly and keep knee alignment the same. I’ve come to appreciate that as the graft doesn’t tighten (due to lack of nervous tissue) as a native acl does and given the hamstring tendon removal I firmly believe I have been trying to make my knee basically be like it was before and not just accept that it can’t position and hold in the same way. Luckily I never have a buckling or giving way sensation, but it doesn’t feel great and it’s in squats that it starts to feel peculiar. Naturally the smart play is to stop doing anything which feels bad. running, sprinting, rock climbing, soccer dribbling, basic exercises I’m all good with. If I take anything from the results it’s to simply focus on what feels good and not try to believe I can somehow make things the same. As an aside, I find my gait has altered since the surgery and similarly I tried to make it as before but I think not enough is said about how having hamstring tendon removed and knee surgery alters it pretty much permanently.
– yes the tests the physio and gp did were encouraging as they didn’t feel unstable to them or me at all but the surgeon is always a bit more rigorous and that will be the acid test I think.
– QUESTION- Could the plantar fascitiis have caused to my place unwanted strain on the graft? I’ve worn in-door shoes for nearly a year after i felt the tear in my foot (only recently, after the scan, gone back to walking bare feet) as it helped me walk better and place more weight through the foot.
– I fully agree that the radiologist is, and to their credit, saying it may suggest a tear but my hope is the surgeon will say it’s normal for a recon (maybe the buckling could be possibly linked to the fact it doesn’t have two bundles where one contracts when the leg is straight tracking could be linked?)
– so my surgeon did tell me at the time part of the meniscus was “wavy” and decided not to operate on it because he wants me to keep as much of the meniscus as possible. whilst on the topic of the surgeon, i agree with you that even if i have fallen into the low % category of failure or because of poor equipment etc the graft wasn’t placed correctly; it makes sense to now consider a second opinion which I have started the ball rolling on. I still find value in my surgeon’s opinion but have to be pragmatic and go it could be him and I might be safer with someone else. You made me laugh when you noted the distance I’d need to travel to see james Andrews group. But I will be looking after I see my surgeon for the opinion of someone specialising in revisions.
P.S. I still intend to keep my word and make a donation when I can because the help you have given has been invaluable and much appreciated. As i’ve said this before I want to add, without going into too many specifics, that the last few years I’ve been assisting someone close with health issues caused by alleged malpractice (lawsuit is ongoing) so it’s been a challenging time to say the least.
b-reddy
August 3, 2018
-Curious what you mean by holding the knee in a certain alignment? What can’t you do / what feels much harder now?
I have seen a surgeon reorient a knee after, if memory serves me right, a reconstruction. The patient was not happy about it. Their tibia was laterally rotated a good 15 degrees compared to the other side. From an aesthetic perspective, it was alarming.
I didn’t know this person’s history so I don’t know what really happened, but not being properly aligned after a surgery i.e. the surgeon messes this up, is a risk.
That’s actually why I’ve been told a revision is harder. The original remnants of the ACL aren’t there, so it’s tougher to properly align the (second) graft.
Like you said though, and what this person did, was they gave in to that new alignment. Trying to fight it wasn’t going to work, short of getting another surgery. Can be hard to know what situation you’re in though. Whether it’s a muscular imbalance or surgical.
-I don’t think the foot problem would be the culprit. It could certainly make the knee feel like crap, but it shouldn’t be the cause of a possible ACL tear.
An ACL tear should almost always be from an intense activity. Opposed to some slow degradation of the ligament. That’s in contrast to something like the rotator cuff, which can progressively deteriorate, like from impingement. At least I’m not aware of any situation analogous to this for the ACL. I do know how an ACL tear can be made more likely from daily life, but suffering the tear from low intensity daily life? I don’t believe so.
The meniscus is a different story. Degenerative tears are very common. A significant change in gait could be a factor for it.
-Very good point about not having two bundles. Hell, I should write about that in terms of further illustrating why the surgery doesn’t fully replicate what a normal ACL does.
That’s a perfect example of what I mean about not being sure what the radiologist is aware of. I just don’t think their anatomy is quite at that level, but I don’t know for sure.
-Happy to help! Hopefully you’ll get some clarity soon and won’t have to deal with any malpractice issues of your own. One the worst things as a patient is finding out you’ve done everything right, but the person you trusted didn’t.
Rob
August 7, 2018
Hey Brian, sorry for the delayed response. I hope you had a nice weekend.
Thanks for the reassurance about the foot. I wasn’t sure if I was wearing it down over time by not being able to weight beat properly but as you say an ACL tear is unlikely to be from low intensity daily routine so I feel better because I can’t recall any possible movement to have damaged it.
As best as I can describe what I meant- so when standing still and looking in a mirror and down at my knees, I noticed my injured knee is more straight (extended) but my good knee has more (only slight) nature of a bend to it. In other words you would think when I’m standing still that I am slightly hyper extending the bad knee even though in my mind I’m just standing still.
I also see in the mirror I have more weight on my good knee and hips aren’t quite leaving me symmetrical but are closer to the good side. Again. Not by much.
So I would try to put a slight bend (hinge) into my good knee and have a bit more weight. But this then feels weird and it’s my belief (granted with no real backing as I’m clearly not medically trained or otherwise) that the ACL bundles not now existing in my knee mean that it doesn’t align the same as into didn’t before the injury and so my stance and gait are different. But if I try to make things even/same as the good side it feels worse and like I’m making my knee take strain in a position where there is nothing naturally there to hold in that place.
I’m sorry if that’s not clear (and come to mention it my previous reply was pretty badly written, you did well to make sense of it).
So long story short I’ve stopped trying to do that and just work on hamstring, quad and proprioception and co-ordination. I read the Mayo clinic suggest two year recovery before going back to previous sports etc. I’ll be 18 months soon and figure that’s a good time to start increasing resistance and pressure on it (bar awaiting the outcome from my surgical appt next week).
Rob.
b-reddy
August 10, 2018
For the alignment, you have to consider the possibility the good knee is too bent as well. That what looks like hyperextension on the bad side is actually just a straight knee.
Regardless though, when it comes to flexion / extension, barring the person not having full extension ROM yet, that’s not usually too hard to correct. Often just a matter of having to think about it. But I haven’t had any experience trying to get an ACL patient to bend their knee more while standing. It’s usually trying to get it straighter. And when I spoke of alignment issues earlier, that was more about rotation.
Off the top of my head, I can’t think of why the ACL graft would be causing you to stand with some hyperextension. Certainly worth asking the surgeon about. Sorry I can’t be more help there.
I wouldn’t be surprised if eventually doctors and therapists stop telling people ACL recovery is “6-9 months” in favor of “12-18 months.” Tommy John is approached this way. I think that could help a fair amount in people’s recovery. Tommy John has a way better success rate, and I bet that’s one reason why. Hell, even WedMD will say Tommy John can take up to two years. At this point, it’s clear ACL surgery is similar.
Rob
August 10, 2018
Ah, yea it could be the left knee is bent. I should have prefaced by saying it’s when I’m really being nit-picky and really scrutinising my form. When I’ve asked others to look, they see no difference. Could of course be I’m imagining it and thankfully I have full extension so it’s something I’ll get my surgeon to tell me when I see him next week. I’ll drop you a message letting you know how it goes, I’m sure we’re both curious to know how he interprets the MRI.
Yea my rule of thumb having been through 5 joint reconstruction surgeries is to double all recovery times given and know that whatever they “fix” usually means creating some new damage to achieve it. In many ways my knee feels lousier than it did after the injury but not without benefits. I do think it would be far better for all concerned if there was more transparency and honesty about what realistically happens and the expectations. I can’t stand this whole “in 9 months you’ll be fully recovered”.
Have a good weekend. Rob
Rob
August 16, 2018
Hey Brian,
I had my appointment yesterday. Typical NHS; the surgeon hadn’t been given the MRI report- lucky I explained the details from it (albeit i couldn’t remember the exact terms and my phone had no signal in the hospital). At least he had seen the images and an x-ray I had. He was satisfied everything fine.
Moment of truth- I had the lachmann and pivot shift tests. He is pretty robust when checking them (i find Doctors and physios are pretty tame in comparison, though in fairness it’s not their area of expertises).
He found that my operated knee did have more laxity than the un-affected knee (even accounting for the degree of hypermobility i have with all my joints) . He reassured me this isn’t entirely un-common with hamstring grafts but the re-assuring thing is that there is a definite end-point and on the pivot shift test there is no abnormal movement at all.
He explained due to my slight hypermobility he placed the tunnel for the graft a little bit further back than usual but that he felt it is the graft tissue itself that is the cause of the laxity, not the placement of the graft. He felt as I don’t have instability issues and that the graft from his point has a definitive end-point (certainly I felt it and it re-assured me) that there is no need to do anything further stage.
I believed him. Do you still feel a second opinion is still warranted? part of me thinks it would be prudent and there’s no detriment, but another part says do i really need it? my knee gives no pain or instability and I know even when a joint reconstruction is a perfect success it will always feels lousy in certain stress positions which at the moment is the only time it is a bother. Feeling the end point to the graft (maybe a little later in the movement than i’d have liked) tells me what could they do anyway to better what I have?
In any case thank you Brian for your opinion and thoughts. I personally feel that the best thing to do is simply work harder on strengthening the hams and quads.
Kind Regards,
Rob.
b-reddy
August 17, 2018
Nothing he’s saying sounds highly dubious, but I’d still get another opinion if it were my knee.
He is right some laxity is common after ACL surgery. I’ve seen many studies showing this over the years. And that hamstring grafts are more prone to this. It’s something you have to weigh against the higher risk of arthritis in patellar grafts.
As we talked about, how you feel is also the biggest factor. Little is going to tell you how stable your knee is over the longterm better than your life experience.
However, like you said, there is little downside in a second opinion, beyond possibly confusing you some. But when something is so subjective like this, what one thinks is fine another may think is too lax, I’d like to hear what another surgeon says.
I’d want to hear what another surgeon has to say about the tunnel placement. I can’t remember anything about that, but I’d be wondering how valid their rationale is / do others agree with him.
I’m not sure how standardized operations are with the NHS, but I can tell you in America, that’s a nuance of surgery that could be highly debated. Every month the American Journal of Sports Medicine has 3-4 papers on ACL surgery technique. They clearly don’t all do it the same way.
One reason I’d want to know all this is if it’s the tunnel placement, that gives you more grounds for potentially thinking about another surgery in the future.
If it’s the tissue though, considering another surgery gives a lot of concern the same laxity will come about again. This is a separate topic, but to some degree I’m of the opinion if you’re getting an allograft, you probably shouldn’t be getting the surgery.
So if another surgeon echoes this one’s opinion, that’d give me some peace of mind. Rather than have the uncertainty of what another surgery might be able to do for you, you can get on to accepting what this one has done, and work with what you have.
Rob
August 19, 2018
Cheers Brian, again I appreciate your feedback.
TBH, as soon as I posted the message to you I thought i’ve answered my own question and have requested a second referral; though I agree my current OS hasn’t said anything worrying.
As a final question for you re: graft laxity; based on your experience and the studies you’ve read; is there anything I may doing that might have contributed to the laxity that I can work on? I understand that any laxity I already have is not going to improve, but if i’m doing something that may be contributing I’d be keen to curb it.
I assume not though, as you mentioned in a previous post that ACL’s/grafts don’t really break due to wear and tear as so much high impact trauma is pretty much the cause of the majority of issues.
I so suspect my tissues are a little more lax (my dad has bow legs and hypermobility) than the average and so i’ll bear in mind that any future surgery may end up with a similar outcome.
I’m not sure if NHS does have a standardized method (other than ham grafts are the most common done) and i imagine when dealing with any degree of hypermobility they will probably just leave it to surgeon’s discretion. I’ll be sure to ask about the tunnell placement and how it may impact a revision surgery
Have a nice weekend and I’ll be in touch down the road.
rob.
b-reddy
August 21, 2018
Trying to hyperextend the knee regularly can be a factor. Wrote about this with some references here: https://b-reddy.org/an-underappreciated-aspect-of-acl-injury-prevention-and-rehab/
Post-op, I haven’t seen that with anyone though. It’s always more worrying they get enough extension as opposed to too much, but I could see it happening.
One way to assess is if the surgery knee now has more extension than the non-surgery leg. That could be a sign the person stretched too much.
Granted, if the person is generally lax to begin with, and the surgery leg ends up just getting to normal, then, for that person, normal may mean lax. But a lax or functionally torn ACL isn’t typically categorized that way. It’s more in relation to the other knee.
Rob
August 28, 2018
Hey Brian. Apology for the late reply. My family member had major surgery last week and I’ve had a tooth abscess to boot.
I think you may be onto something there in that when I stand my operated knee to me appears to be a bit more extended than the good knee and both knees clearly have some hyper extension.
I’ve never really over stretched in the recovery but I did focus on a lot of VMO exercises (the contraction one in particular where you basically tense the muscle as much as possible which straightens the knee). So maybe that has been placing my knee at a greater degree of extension than the other?
On a more positive note I had chance to use a rowing machine last week and my knee felt really good for a couple of days. I think it shows I’m not pushing my hamstrings enough and I’ve got a second opinion appointment in a month or so.
Hope you’re well and speak soon.
Rob.
b-reddy
August 28, 2018
Hope everything is alright!
The VMO work, if you were also hyperextending the knee while doing it, could be noteworthy. If you weren’t getting much ROM during it though, then I don’t think that would impact the graft. Though you could possibly get into quad vs hamstring dominance, but VMO work is typically much more an activation drill than a strengthener.
Rob
October 15, 2018
Hey Brian, how’s tricks?
i hope you’re well.
I have seen another OS who looked over the same MRI, did another xray and was through with all usual tests. His conclusion… pretty much same as the original OS though he did say in his opinion is more lax than would just be what would expect with a hamstring graft but said if no real issues (pain, instability) then monitoring and increased physio is the best course for now. He does not see any obvious reason for the cause of the laxity, and feels the original OS has done everything that he would expect to see in terms of tunnel placement etc.
What was nice is that he showed me the actual area of laxity on the MRI as well as where it looks like it is tight.
Since we last spoke I have done extra work on my knees and i have to say the symptoms that prompted me to get this looked at again are less. The OS felt I may have a tight IT band and may be a little bit of tracking issue with the patella as the leg reaches full extension; but exercise can help address those issues.
Overall I’m satisfied nothing more can be done and once thank you for your help and guidance.
Kind Regards,
Rob.
b-reddy
October 16, 2018
Thanks for the update!
Always nice to hear another opinion as confirmation. Sounds like you have a good course of action at this point. Hope you keep feeling better!