ACL - 20 months later

So, I had a PT graft done in Mar '05 and am having knee issues again.

I didn't do a lot of formal PT, but have done a ton of biking, hiking, b/c skiing, and other forms of activity since the surgery. My muscle is still SIGNIFICANTLY smaller on my surgery leg.

I skied all last winter (mostly b/c) with no significant issues. The only thing I really fought was a muscle imbalance that caused me to favor my good leg all the time (which probably didn't help much for continuing to build strength in the bad one!). This summer, I skied a month in Las Lenas, and my knee swelled up like it hadn't since 3-4 months post op. I lost flexion and it was super painful. I iced, took a bunch of vitamin I, and the swelling came and went. There was no "incident" that caused this . . . I attributed it to skiing super variable conditions in serious terrain - it's just harder on your body than perfect powder fields :rolleyes2

Now I'm back and skiing early season, but the swelling continues, it hurts to go up stairs and to push into my binding, and I have some pretty impressive crepitus that I didn't have before. I just saw a PA and he said my ACL and MCL feel tight (aka not retorn!).

So, does anyone have any thoughts?!? I am on a program of more focused strength building in that leg, as well as planning to go back to PT. Also, my doctor never had me use a brace and I wonder if maybe that would help at all. I have to admit I'm a bit worried that it's a) just never gonna get better or b) re-injured. Yikes!!!

Thanks in advance for your insight!

Sounds like a meniscus problem.

I've had and acl reconstruction on one and meniscus repair on two. It's possible you may have done some damage with the acl (although a doctor should have seen it in surgery) OR you could have been using your gimp knee at funny angles for a while, irritating it in ways unrelated to the acl issue.

Both my knees do this on long summer hikes or when running. The ibuprophen and ice help.

That's my guess.

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Originally Posted by Kellie

it hurts to go up stairs and to push into my binding

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Can't you just click in downstairs?

Kellie--I hope it's not reinjured and/or never going to get better.

That said, as great as activities are for PT, focused training is important because we have tremendous ability to compensate in ways we're not even aware of.

For instance, while cycling is awesome, it is very easy for the non-injured leg to take over a bit more of the duties. I'm not saying it's 100/0 or 90/10, but when you stand up to do a climb there's a subtle shift that takes some of that maximum stress off the injured leg. i see it happen for me all the time, and i consciously have to fight it.

I think that by doing what you're doing to attack the muscle imbalance and do exercises such that you CANNOT recruit other elements of your body to compensate (complement is OK; compensate is not) is the right path.

If you're seriously concerned about reinjury, then it doesn't hurt to have someone check it out.

Kellie clicks in on rooftops.........and starts her day with a little drop.

Do ACL injuries even hurt? I got a bone bruise from a femur clack when I did mine but I don't remember any pain specifically related to just an acl. Like everyone else here, I've known people with a torn (partial and complete) acl/mcl who didn't even know it.

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Originally Posted by kidwoo

Do ACL injuries even hurt? I got a bone bruise from a femur clack when I did mine but I don't remember any pain specifically related to just an acl. Like everyone else here, I've known people with a torn (partial and complete) acl/mcl who didn't even know it.

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I recall my initial pop kinda hurting but nothing to drastic. After the swelling went down it was fine and I went a long time playing soccer, riding bikes before I came to my senses and got it checked it out.

I've had a bone bruise before too on the top of tibia associated with a minor MCL tear. The bone bruise hurt alot more than my acl tear too.

now the ACL rehab is another story...

k - will call ya 'bout this manana. I have some knee issues I'm dealin with too & just made an appt. with my ortho (nothin too serious I think, but just want to get it checked out. It'll be nearly a 2 year anniverary when I see him...should I get him something? ;) )

Well firstly, my ACL hurt like hell when i did it. I do wonder whether I would feel it if my new ACL bust though

I'd recommend a few sessions with a physio to pick up on any subtle favouring of your uninjured leg. Last season was my first proper one after my op and I went to see a physio towards the end. She picked up on one or two minor movement issues and prescribed a few stretches to help with them.

I've not had any problems since my op like yours. However, the symptoms do sound a bit like a meniscus problem I had a little while back

There something else going on, I think. Meniscus injury may explain some of the pain (e.g., going upstairs), but I don't recall that degree of swelling associated with insult to the meniscus.

I'll just sit back and watch this unfold.

Best o' luck, Kellie-Grrrl!

As always, thanks for the suggestions! I am leaning toward thinking I've done some meniscus damage because something is super funky in there and I'm not sure what else it could be. It's not surprising either because my left leg is not very strong comparatively and my overcompensation is not what I'd call subtle. I guess all that leaves the left knee super vulnerable. Unfortunately I have to wait 2 weeks before I can get to a PT . . . bummer, dude!

Kellie- be ever so careful of favoring your leg! That's what I did.... I skied and biked when my knee was sore after the surgery. My leg was still atrophied. In the end, it caused SEVERE patellar tendonitis NOT on the knee that I had surgery on, but the OTHER knee. The tendonitis began to manifest itself 1.5- 2 yrs after ACL surgery. To this day (9 yrs after surgery), the knee I had ACL reconstruction on doesn't cause me any pain, although it is weaker than my other knee and literally creaks when I walk up stairs ;) My other knee, however, is ALWAYS causing me pain. You see me wearing a knee brace in my bike pics... that's because I have chronic tendonitis. A year of PT and it won't go away. Only the brace helps.

As for feeling pain in your knee- it could be because your knee (the muscles around it) still isn't strong enough. Have you been lifting? You need to get your muscles balanced. The inner quad needs to be balanced with the outter quad or it can cause a mis-tracking of the patella (knee-cap) which can cause a lot of pain and swelling too. When I lift weights, I make sure to do one leg at a time now in order to prevent favoring legs b/c inevitably it will happen. That's the only way to ensure that you aren't favoring them.

It might be worth a visit to the doc to see why your knee is causing problems. I remember my ski coach telling me (when I'd be in tears after skiing with the pain) that it would take a year before I would be skiing w/o pain. She was exactly right. It took a year. It's been well over a year for you and you probably shouldn't be feeling the pain you're feeling, except maybe every now and then....

Hope that helps :)

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Originally Posted by Viva

There something else going on, I think. Meniscus injury may explain some of the pain (e.g., going upstairs), but I don't recall that degree of swelling associated with insult to the meniscus.

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I'd get some swelling on hikes, especially summer backpacking kind of stuff (lots of weight with downstepping etc.). The first problem I ever had was in high school during crew practice. It started as a little distinct sharp pain which then grew till finally it pretty much locked up.....not physically, I just couldn't take the pain of moving it. But it was definitely swollen. Shortly after was my first meniscus surgery. It happened again about 3 years ago at the end of a 3 day backpacking trip where I had to walk about 20 minutes, then stop for about 40 while I stuck it in a cold creek. I couldn't move it otherwise. But that was going up, down, accross a bunch of stair steppish granite. It's a very characteristic pain and I know when it's coming. The fact that it builds up and ice helps kind of verifies what I usually see with my eyes as far as swelling being a factor. It may be something else but every doctor I've talked to reccomends another meniscus surgery. I choose to just ride a bike whenever possible since I don't think I have a whole lot of tissue left to mess with.

Let us know what you find out K.

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Originally Posted by Kellie

I didn't do a lot of formal PT,

My muscle is still SIGNIFICANTLY smaller on my surgery leg.

The only thing I really fought was a muscle imbalance that caused me to favor my good leg all the time (which probably didn't help much for continuing to build strength in the bad one!).

my knee swelled up like it hadn't since 3-4 months post op. I lost flexion and it was super painful.

There was no "incident" that caused this . . .

but the swelling continues, it hurts to go up stairs and to push into my binding, and I have some pretty impressive crepitus that I didn't have before. I just saw a PA and he said my ACL and MCL feel tight (aka not retorn!).

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All of these things you wrote are significant.

you still have atrophy of your quad and probably your hamstring. This alone can cause some issues in with the tracking of your patella. Combine this with some crepitus in your knee (assuming under the patella) and I'd be suspicious that you have some patello-femoral or articular cartilage issues going on.

The fact that you do not remember a specific re-injury is avery good thing. If you have torn your graft or your meniscus you would likely have known it immediately. You also do not describe mechanical symptoms like locking catching clicking etc.

I'm not sure what your flexibility is like, but something to look at would be how flexible your hams are. If you have tight hams, that can also play havoc with your knee.

One other area I would be curious about would be glute and core strength. If you are having any type of postural asymetry ( on foot turned out more than the other, one shoulder lower than the other etc..) you might have some lingering weakness in your glutes or core which can effect your knee mechanics.

The swelling you describe is the concerning part here. Occasional swelling can sometimes be expected but if you weren't havin any until this trip.... Patello-femoral syndrome can sometimes cause swelling but not usually that much...The big X factor here is me not being about to do an exam on your knee, but I would definitely recomend getting an exam.

I made a PT appt. since I'm sure I'll benefit regardless. I am toying with going to see an ortho regardless, but maybe the PT will be able to tell me if she thinks that's necessary. Too bad I don't have any trips home planned so I could just go see my surgeon . . . maybe if Baker gets some snow it'll be worth a trip ;)

Wow Kellie, so sorry to hear this. There is always good advice passed around here (as above), but we all know how hard you workout, so I would guess you have done everything right (Except maybe going into a gym? Do you do that now with your two week work schedule??).

Britney still has concerns over her ACL knee, and has been thinking about going to my surgeon (Orr) to just get an opinion. She doesnt have major complaints (serious pain and swelling) but it has never fully recovered to be equal to her other one (and she has had a couple wierd pop situations in the last two and half years). Mine, I feel lucky to say, is great (probably 100%)....but my "good knee" is now my problem. I miss the carefree lower twenties, when I hucked my meat with complete carefree and reclass abandon.

Hopefully you just pushed too hard too soon. It may simply need rest.

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Originally Posted by Huckwheat

Wow Kellie, so sorry to hear this. There is always good advice passed around here (as above), but we all know how hard you workout, so I would guess you have done everything right (Except maybe going into a gym? Do you do that now with your two week work schedule??).

Britney still has concerns over her ACL knee, and has been thinking about going to my surgeon (Orr) to just get an opinion. She doesnt have major complaints (serious pain and swelling) but it has never fully recovered to be equal to her other one (and she has had a couple wierd pop situations in the last two and half years). Mine, I feel lucky to say, is great (probably 100%)....but my "good knee" is now my problem. I miss the carefree lower twenties, when I hucked my meat with complete carefree and reclass abandon.

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I actually do spend some time on the weights now with my schedule. We have a pretty good facility at work, so that helps a lot.

Bummer to hear about your "good" knee acting up - I worry about that too! And major bummer about Britney's knee . . . I remember her having some wierd swelling awhile after her surgery that I never knew the reason for. Did she ever figure it out? I was actually hoping her situation would shed light on mine!

And, 4matic, I do acknowledge that I may be too hard on my body, although I do feel like b/c skiing helps to mitigate the body-beating that happens on skis. It is hard to know when laying off is the right answer. Maybe my 2 weeks on, 2 weeks of schedule is perfect for that . . . at least then it'll have a chance to recover a little! Or maybe I'll have to take up ice climbing for more "down" days. :cool:

Kellie,

I have no idea what's causing your pain. I have pain in my non-ACL ruptured knee and in my non-achilles ruptured achilles! WTF is that all about?

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Originally Posted by kidwoo

Do ACL injuries even hurt? I got a bone bruise from a femur clack when I did mine but I don't remember any pain specifically related to just an acl. Like everyone else here, I've known people with a torn (partial and complete) acl/mcl who didn't even know it.

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I had exactly 1 second of a hot searing pain as it happened and then just a wee bit of a queasy feeling when i finally stood up after tumpling a few hundred feet down the slope. The swelling began within minutes but it was not really painful again until after the surgery.

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Originally Posted by Kellie

And major bummer about Britney's knee . . . I remember her having some wierd swelling awhile after her surgery that I never knew the reason for. Did she ever figure it out? I was actually hoping her situation would shed light on mine!

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That is great that you do gym time now! I swear you do everything right, training wise, the problem is just bad luck. Britney's is not bad but just not great. Just feels about 80%, and fairly random sore days (not directly related to one activity). You should call us Sun if you have some time (we should be around most of the day).

My only/best idea (which I live by preseason and during season), is one day a week in the gym is solely balance and core (think PT exercises - ball stands etc). I dont know if it really prevents, but it is my one personal vow so that is get injured again I will feed I did everything I could to prepare. I also have finally taken your advice and started swimming (kick board and all).

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Originally Posted by Kellie

And, 4matic, I do acknowledge that I may be too hard on my body, although I do feel like b/c skiing helps to mitigate the body-beating that happens on skis. It is hard to know when laying off is the right answer. Maybe my 2 weeks on, 2 weeks of schedule is perfect for that . . . at least then it'll have a chance to recover a little! Or maybe I'll have to take up ice climbing for more "down" days. :cool:

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"It is hard to know when laying off is the right answer."

I was 26 once.. At that age it's easy to just ignore pain and train through it. To me it sounds like you ignored the pain and now have a chronic injury.

Chronic injuries require 100% rest.

My advice is if you are going to ski don't train your legs at all. None! Ice after skiing and a good make sure you are warm prior to skiing.

Rest means rest. It doesn't mean PT, or stretching or balancing. Rest means complete rest. The only thing you can probobly do is swimming but even then you need to be careful doing turns.

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Originally Posted by 4matic

"Rest means rest. It doesn't mean PT, or stretching or balancing. Rest means complete rest. The only thing you can probobly do is swimming but even then you need to be careful doing turns.

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Not even if the chronic injury is being caused by muscle imbalance and tightness? So while she is sitting aournd resting she gets tigher. looses cariovascular conditioning and her muscles become weaker?

If you really had a clue about what you were saying you'd understand much it doesn't make sense.

There is a difference there between complete rest and relative rest which means doing specific exercise directed at retstoring flexibiity and correcting muscle imbalance without irritating the injury.

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Originally Posted by Vinman

There is a difference there between complete rest and relative rest which means doing specific exercise directed at retstoring flexibiity and correcting muscle imbalance without irritating the injury.

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This has proven very true with my recent shoulder injury. The PT is helping a lot without aggravating the injury.

Kellie, my sister had something similar happen to her. She was a year out from her surgery and had skied a few times without incident. They she went on a heli trip in Canada and her knee swelled up like a balloon. It turned out to be her meniscus. She had torn it in two places on her initial injury and had it fixed. So I don't know whether it was too much too soon or she just re-injured it. But it sounds similar.

Well, I did some lifting and knee-friendly cardio at work and the swelling went away, and so did the pain for the most part . . . The amount of pain is definitely less with the more activity I do (knee-friendly activity that is). For example, walking up stairs is super painful the first time I do it after awhile, but diminshes over time with frequency. Wierd.

Anyhow, I skied yesterday and it hurt a ton on the way up, and then I barely trusted it on the way down . . . swelled a little afterwards.

I went to PT yesterday night and she said that I have a weak butt on the left, and am tracking inward causing excessive overpronation and causing strain on the patellar tendon. She also mentioned patello-femoral sydrome, but I'm not sure exactly what that means. Anyhow, she did some myofacial release (read: massage) and a few other excercises and gave me a few things to do. She also taped my leg/butt so as to encourage the "right" muscle use . . . Today it feels pretty good - swelling is gone . . . I go back Friday for more!

So you took her advice and aren't skiing today. Good job.


Is this stalking?

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Originally Posted by Kellie

Well, I did some lifting and knee-friendly cardio at work and the swelling went away, and so did the pain for the most part . . . The amount of pain is definitely less with the more activity I do (knee-friendly activity that is). For example, walking up stairs is super painful the first time I do it after awhile, but diminshes over time with frequency. Wierd.

Anyhow, I skied yesterday and it hurt a ton on the way up, and then I barely trusted it on the way down . . . swelled a little afterwards.

I went to PT yesterday night and she said that I have a weak butt on the left, and am tracking inward causing excessive overpronation and causing strain on the patellar tendon. She also mentioned patello-femoral sydrome, but I'm not sure exactly what that means. Anyhow, she did some myofacial release (read: massage) and a few other excercises and gave me a few things to do. She also taped my leg/butt so as to encourage the "right" muscle use . . . Today it feels pretty good - swelling is gone . . . I go back Friday for more!

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Glad to hear you're figuring things out!

Glad to hear it Kel.

Try some bridging exercises for your hamstrings and glutes, ask your therapist they will know. Also add in some abdominal hollowing while you do those to work on core stability. And strech your hamstrings!!!!

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Originally Posted by Camel Toad

So you took her advice and aren't skiing today. Good job.


Is this stalking?

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But I'm gonna today . . . may even get a kite out!

Thanks for the insight and words of encouragement all!

sounds like you're getting it all figured out, but to add my 2 cents..

i'm a believer in pt, go if you can, as often as you can. although my situation was different (partial tear of acl & mcl), pt helped more in muscle recovery than i thought. after a knee injury your surrounding muscles compensate for the weakness. as such, the simple firing of the quadricep muscle during simple movements was lacking compared to my healthy knee. i wouldn't have noticed it had i not had an electrical device that measured the firing of specific muscles. pt helped condition the target muscle to fully contract which ultimately helped stabalize the knee.

unknowingly favoring the good knee and continued atrophy (lack of muscle development) of the bad knee could be indications of some important leg muscles not adequately supporting and motioning the knee which would lead to alignment issues, pain, yada, yada.

hopefully all goes well, and you'll get your knee dialed in...

Not trying to throw a bum trip in the report here, but since this was the top thread on acl injuries, I thught I'd paste this up for anyone scheduled for
an operation using cadaver tissue:



Hospitals asked to return cadaver tissue after patient is infected
POSTED: 2:23 p.m. EST, November 22, 2006
Adjust font size:
(AP) -- A Minnesota patient apparently was infected with an unusual germ from cadaver tissue used during routine knee surgery -- a discovery that has led the nation's largest tissue bank to ask 750 hospitals around the country to return 2,400 tendons and other body parts as a precaution.

A hospital reported the bacterial infection in September to the Centers for Disease Control and Prevention, which launched an intense, nationwide effort to search for more cases.

None have been found, but the incident shows the dangers that patients face when receiving such tissue and how dependent they are on the companies supplying it to ensure its safety.

A three-month investigation by The Associated Press, published in June, detailed problems that can arise from cadaver tissue used in more than a million medical procedures each year in the United States, especially knee and back surgeries.

Two scandals involving tissue suppliers have occurred in the last year, and the federal Food and Drug Administration has formed a task force to look for regulatory gaps that threaten safety.

The new case involves a company that many health officials and tissue company executives regard as an industry leader and standard-bearer: Musculoskeletal Transplant Foundation, or MTF, of Edison, New Jersey. In more than 20 years of supplying 2.7 million pieces of bone, skin and other tissues, this is the company's first reported infection, said a spokeswoman, Cindy Gordon.

In April, MTF noticed an increase in the number of tissues rejected for not passing sterility tests at its Jessup, Pennsylvania, processing plant -- one of two such facilities it operates. Tissues were quarantined and about 150 that failed tests were destroyed, Gordon said.

In September, the CDC notified the company that an unusual infection had been reported in a Minnesota patient who received MTF-supplied tissue during surgery to fix a torn ligament a week earlier. Fluid from the patient's knee joint grew Chryseobacterium meningosepticum -- a germ never previously linked to tissue or organ transplants, said Dr. Arjun Srinivasan of the CDC.

"It's a very rare cause of infections in the health care setting," so the agency asked more than 1,000 public health officials, infectious-disease doctors, microbiologists and orthopedic surgeons around the country to search for additional cases, he said.

Five other people had received tissue from the same donor and none developed infections. MTF retrieved a sixth sample, and tests at CDC revealed it had the same bacteria as the Minnesota patient.

As a precaution, MTF decided to go back six months before the Minnesota case -- to February -- and try to retrieve as many of the 4,700 tissues supplied by the Jessup facility as possible, Gordon said. About 2,300 had already been implanted, and no other infections have been reported, she said. Hospitals have been asked to send back the remaining 2,400.

"This was not something that the FDA or the CDC asked us to do," but a voluntary action to ensure patient safety, Gordon said.

The Minnesota patient made a full recovery after antibiotic treatment and still has the cadaver tendon, said Joel Osborne, MTF vice president of quality assurance and regulatory affairs. MTF would not identify the hospital or give details about the patient.

Srinivasan praised the company's handling of the case.

"They've been very aggressive working with us" to try to locate the source of the germ, which may have been introduced during processing rather than originating with the donor, he said.

FDA spokeswoman Julie Zawisza emphasized that this case is not like the two earlier scandals in the human tissue industry, "where the suitability of the human donors was called into question." She said MTF is cooperating with the FDA on the case.

Copyright 2006 The Associated Press. All rights reserved.This material may not be published, broadcast, rewritten, or redistributed.

Although infected allografts are exceedingly rare, they can't absolutely assure a sterile specimen. The supplier can do absolutely everything right and it can still happen.

That being said, if my ACL goes, I am getting a cadaver graft.

How about a current report for all your fans Kellie? :D

Hope it is doing better!! In Tahoe right now, we dont even know if skiing hurts our knees.......so, dont feel bad about skipping a few days.

Good days and bad days - I have had some pain free days and am realizing that I need more strengthening to be sure. I also realize how important stretching the rectus femoris is and that it really does play into my pain. I have been working on hero pose in yoga, which is challenging from a flexion standpoint, but great for releasing the rectus femoris. I am actually pretty amazed at how much it helps. I haven't skied on it again since going to PT - Wednesday should be the big day - gotta admit I'm a bit nervous, but hopeful I can at least keep the swelling down so my muscles will fire enough to protect the darn thing.