how long before heel to bum post acl recon

**dingdong** · 06-30-2008, 10:50 AM

My wife had acl recon in last week of jan this year using achilles tendon allograft. It is 5 months now, her extension is almost equal to the good leg but the flexion is still not the same. Having some pain in the medial side of the operated knee. Saw the doc today, he suggested that it might be related to some tendon that is on the outside of the knee on the medial side. It could be related to not having complete flexion on the operated knee. He diagnosed it as PF fibrosis les bursitis. Said that she need to work hard in PT to get the rest 5% of flexion back. Otherwise he will have to do MUA, if she doesn't get it in the next 2 months. I am posting this to find out how long did it take for folks to get complete flexion back i.e. heel to bum. I was always under the impression that you should try to get the extension back asap, and it is ok if flexion takes a little longer.

**Dexter Rutecki** · 06-30-2008, 11:12 AM

My experience is that you're right about extension being more important to get back immediately--once that's really gone, it seems to be gone for good.

As for being able to get your heel to your butt, my ortho on Friday explicitly told me that that's unnecessary. I'm just past 120 degrees, and that almost matches the other knee (disclaimer: the other also was reconstructed, so I think I used to have more in both legs). He said once you're up to around 120 degrees there's no need for more, and I guess he's right.
Don't know about the pain/bursitis stuff and how flexion might help with it. At five months I think generally you should have had full extension for the past few months--didn't she do that in PT?

**Noonan** · 06-30-2008, 11:43 AM

My experience was the same as Dexter - the initial focus was very much on extension. In fact my Dr. was almost manic about getting that extension and hardly said anything regarding flexion.

That being said I'm at 16 weeks post-op now and can pretty much get the heel to the butt. I can touch the good leg and get with in maybe an inch on the reconstructed leg. The slight loss of flexion range at this point doesn't really seem to be causing any functional loss.

**dingdong** · 06-30-2008, 11:43 AM

Yes, she has full extension for past few months. Doctor said her extension is fine, although not *exactly* the same as the other leg it is *almost* same. When I look at her extension I could hardly see the difference. It is her flexion that is not the same (lacking by last 5%), and seems to be the source of her knee pain right now.

**SponsoredByDuctTape** · 06-30-2008, 03:51 PM

Originally Posted by dingdong

Yes, she has full extension for past few months. Doctor said her extension is fine, although not *exactly* the same as the other leg it is *almost* same. When I look at her extension I could hardly see the difference. It is her flexion that is not the same (lacking by last 5%), and seems to be the source of her knee pain right now.

5% or 5 degrees? Either way, that's really close. I'll echo what Dex said: I just hit 120 the other day (albeit very painfully), and my PT told me that is the goal - beyond that is not "necessary." My good knee (no injuries ever) goes heel to butt easily, so it's kind of disappointing to hear that 120 is good enough, but apparently that's the industry-wide accepted practice.

On another note, I have similar pain that you described in your wife, except on the lateral side, right near the head of the fibula. No one has quite been able to figure out what it's from as it's far away from any injury or hardware. I'm going to ask the doc about it again on the 10th, and maybe he'll get an MRI of it this time. I don't know about your wife, but this pain predominates all of the other pain in my knee. Feels kind of like pinching if I flex my hamstring as far as I can while standing.

**Dexter Rutecki** · 06-30-2008, 06:43 PM

If you think about it, though, unless you're a contortionist or acrobat or something, when would you want your knee to go beyond 120? You're pretty screwed if that happens while skiing anyway. The only thing I've found it inhibits (a little bit) is normal stretching of your quad, but there are other ways to do it.

**SponsoredByDuctTape** · 06-30-2008, 09:03 PM

Originally Posted by Dexter Rutecki

If you think about it, though, unless you're a contortionist or acrobat or something, when would you want your knee to go beyond 120? You're pretty screwed if that happens while skiing anyway. The only thing I've found it inhibits (a little bit) is normal stretching of your quad, but there are other ways to do it.

I hear ya. That's what the PT says too. It's just that I can totally sit on my good knee, yoga-style, and to think that I'll likely never get close to that with the bad knee is kind of weird/disheartening. It's definitely a mental thing because I have this idea that until I can bend it like the other one, it's not completely fixed. And that's the wrong way to be looking at it.

**dingdong** · 06-30-2008, 09:06 PM

The issue with her is that her daily life involves kneeling on the knees and sitting with her bum on the heel with legs folded. She was making do without it, hoping that she will be able to do in within 4-5 months of the surgery. She is really disappointed that she is not able to do this even 5 months after the surgery. From the replies of Dex, Noonan and SBDT, it seems that it is acceptable, that you will never get heel to bum. I remember reading posts here as well as on other forums, where people were able to get heel to bum around 5 months post acl recon.

**splat** · 06-30-2008, 10:14 PM

I'm 13 days post op at 80 with a little pain.
Guess that means I can hit 160 by mid-July, no?

I've been pretty stretched and limber my whole life, so I'm sure hoping I get back to where I was. I was -2 a few days post op on extension.
I think I overstretched the hammies for high kicks when I was a wannabe karate jock.

**Woodlandclown** · 07-01-2008, 07:30 AM

Getting full flexion back completely depends - I have talked to people that got it right back, got it back after a year and never got it back. I am sure the type of surgery has an impact, as well as how hard to rehab and how soon. Just have to keep working on it.

**Jim J** · 07-01-2008, 10:26 AM

Originally Posted by dingdong

The issue with her is that her daily life involves kneeling on the knees and sitting with her bum on the heel with legs folded. She was making do without it, hoping that she will be able to do in within 4-5 months of the surgery. She is really disappointed that she is not able to do this even 5 months after the surgery. From the replies of Dex, Noonan and SBDT, it seems that it is acceptable, that you will never get heel to bum. I remember reading posts here as well as on other forums, where people were able to get heel to bum around 5 months post acl recon.

What does your wife do for a living? Yoga instructor?

I never got "full" flexion. I can touch my heel to may ass with a little pain if I really want to, but really don't ever need to. There is no pain in my knee at any other angle other than extreme flexion. I can squat and kneel with no pain.

I'm three years post op.

**FredsTrees** · 07-01-2008, 12:15 PM

at 2 months i was really close to full flexion, today i have to force it to get it all the way but it goes there....

I am now at 4 months post op....

My extension lag was worse, at 4 months, today, i am straight, but lacking a couple degrees of negative, should be able to get it back....

Best of luck....