Squat pain after ACL patella graft

I had a Patella graft on my right knee three months ago today; tore it a year ago last month skiing at Baker landing sideways out of a spin. Things went really well right after the surgery. I regained ROM within a couple weeks and strength started coming back fairly quickly. My physical therapist and surgeon were both really impressed but things went downhill from there. Currently, I’m experiencing a lot of anterior knee pain when I try to squat; going down stairs is tough too and I seem to favor the injured leg to compensate. At this point I can only go down about four inches when I try to squat. The first physical therapist I had said that I should be doing mini squats at about five weeks post-op even though it was really painful on the tendon. I listened to her and just tried to push through the pain for about three weeks at which point I switched therapists. The new therapist basically said STOP doing anything that causes tendon pain because I could develop tendonitis. Seems like it’s too late for that now. So everything else in my rehab is still going well. Balance and strength are coming back. I can do leg presses and leg curls with no pain but the squats are just killer. I have no problem starting from a squat and standing up but the pain kicks in as soon as I try to go down. This really concerns me because I imagine it could be a big problem with skiing. I’m now wearing a patella strap, which helps a little and applying a non-steroidal anti-inflammatory cream but things seem slow. If I do anything that involves squatting (I’m trying to avoid it for now), the damn thing gets sore for a day or two although I’ve noticed it’s not staying sore as long or as bad so maybe things are improving. I ride the bike about 40-60 minutes a day…I don’t know what I’d do without it. Anyone out there had similar experiences or know how long it takes to get the squat back. Will it ever happen or am I doomed? My doc doesn’t seem that concerned with it and the therapist is kinda wishy washy. Any advice would be awesome!

Be patient. Three months isn't that long out from a patellar tendon graft. I had one three years ago and I think I made the right choice. I also had microfracture and a bunch of miscelaneous scrapage done.

At 3 months I was doing ok with a lot of things but still had a lot of pain in the patellar tendon when going down stairs. Basicaly I couldn't do it and had to kind of walk down sideways. But I went to PT religiously three days a week and to the gym just about every day that I wasn't in PT. At 4 1/2 months I tele skied on sand dunes. It still hurt but I didn't push too hard into areas that were causing extreme pain. When I got out on snow a couple of months later, it hurt a bit more, maybe due to the cold, but I skied a full season that year. I stopped using the brace in May and haven't missed a month of turns since then.

The patellar tendon will be sore a lot and it will take time to regrow where they took the graft. As long as you don't overdue the things that cause it to flare up, and massage it often, it should slowly get better. FWIW, that spot on mine is still sore after nearly three years but it doesn't cause any severe pain anymore unless I crawl around in gravel on it. :eek:

At this point I would say if squatting causes pain don't do it. Do the things that don't hurt while trying to still make progress.

Ask about some modalities like ultrasound to your patellar tendon. Heat before rehab ice after and stretch your hamstrings.

Chances are, in the long run this will go away.

walking downstairs was the slowest thing to return to normal after my patellar graft. if i have been sitting for a while, it still hurts (11 months post op) when i go down stairs.

I had something similar happen. I didn't get tendonitis in the knee with the patellar tendon graft, but I did in the OPPOSITE knee, a year later, after favoring it so much. I knew I had tendonitis but just kept ignoring it until the pain was just too much. I knew any doctor I saw would just tell me not to ski and that really wasn't an option ;) Anyway, finally I really couldn't walk anymore without limping. When tendonitis gets bad, it gets bad. Try to lay off of it before it get's that bad, that's all I have to say. I spent months in physical therapy. Stupid anti-inflammatory drugs and ultrasound, even e-stem did only slight improvements. I was wearing a knee strap, but I was still having a lot of pain.

The thing with tendonitis is that it's difficult to heal when it gets bad b/c your tissue is essentially dying due to the swelling (at least that's my understanding). The only way to help it heal is to increase bloodflow. The swelling hinders bloodflow and decays the tissue. They told me if it came down to it, they'd cut me open and put little slices in my tendon in order to induce blood/healing. Well, I didn't really like the sound of that, and when my doc said the success rate was about 50%... well, that wasn't good enough for me.

Two things saved me:
1) My friend, osteopathic doctor, recommended a "hot-cold" towel treatment. Put a towel in hot water, as hot as you can possibly stand (I usually just stuck it under the faucet in my bathtub, with only the hot water on). Hold it over your knee for a minute or 2. Then do the same with a really really cold towel (I usually use a bucket of ice water). Keep alternating for about 16-20 minutes or so. This helps induce bloodflow, therefore healing, but will help keep the tissue from actually swelling further. It made a noticable difference for me in just a week. I couldn't believe it.

2) Once I got up and about and doing some physical things again the knee strap wasn't good enough. It caused pain on the patellar tendon, but not enough support. I needed something that would be more supportive, but didn't feel like it was cutting off my circulation. So I investigated and found the Cho-pat Dual Action Knee Strap.
https://secure.cho-pat.com/products/...roduct_type=10

My tendonitis is still an issue, 7 yrs later. But thanks to these 2 things I can pretty much keep it at bay so it doesn't bother me too much any more!

You must be psychic mtnbikerskierchick. I started wearing the knee strap yesterday and it seems to bite at the tendon without providing as much support as I'd like. As you well know, it's really easy to aggravate the damned thing! Seems like one day something will bother it and the next it won't. The squats are definitely a big no no at this point. I was doin wall sits with a ball between my legs but that puts pressure on the tendon so I stopped doing that as well. Right now my morning regime consists of heel slides, quad flexes, ham flexes and stretches, leg bridges with a soccer ball under foot and 3 way leg kicks with elastic bands. Then in the late afternoon I go to the gym and ride the bike for 30-60 minutes everyday. Every other day, I follow up with about 400 leg presses (very low weight because as the weight increase, the tendon becomes more aggravated and I get general knee discomfort). Then I do about 150-200 leg curls. At night I work on balance improvement by doing single leg pillow balances (eyes open and closed), single heel leg raises, 4-way elastic band hip kicks, lunge and balance drills, braiding, and pattern hopping...all of course while trying not to aggravate the tendon. Any suggestions on more things to do or things I should stop? I'm gonna schedule some ultra sound soon so we'll see if that makes a difference. I'm also gonna try the hot/cold towel method.

Fez, I assume that if you have pain walking down stairs that you can't even attempt to do squats???

Thanks for everyone's advice!

I'm having similar issues right now, but with my IT band. I have to agree with mtnbikerskierchick: lay off before it gets bad! My therapists are telling me to avoid unnecessary activity until I can get it under control. I'm also doing all the usual things - anti-inflammatories, RICE, heat, stretches, etc.

I'm a musician, so I have tendinitis problems in my wrists from time to time. I've learned that the only way for it to get any better is to completely stop doing whatever's irritating it, and then once it feels better, get back to your activities gradually. As a musician, that's not always what I want to do :) but it's really the only way I've ever been able to feel any relief (aside from using better technique).

at a certain point past the knee injury, does it make more sense to ice or use heat?

i'm ~10 months post-op and still get swelling (as i'm unable to sit on the sidelines and must do something every day), and i have been icing/elevating. i've been wondering if heat is a better option.

thoughts?

if the swelling is post activity after workout/rehab etc) then ice. If your knee is just swollen and has been that way from some time now then heat would be ok.

Quote:

---

Originally Posted by Vinman

if the swelling is post activity after workout/rehab etc) then ice. If your knee is just swollen and has been that way from some time now then heat would be ok.

---

Thanks much, Vinman.

The activity causes the initial swelling, but there were a few days where I didn't get to ice, so know I'm more at a constant state of swelling. I will try the heat.

Much appreciated.

Quote:

---

Originally Posted by BakerBomber79

Fez, I assume that if you have pain walking down stairs that you can't even attempt to do squats???

Thanks for everyone's advice!

---

actually squats aren't bad at all. it hurts a little, but not much and it doesnt feel like a 'bad hurt' if that makes any sense. I've been doing squats on the smith machine with about 150#, mostly working on form, stability, and getting a good deep squat. im hoping to move to free squats in the next couple weeks. probably step down to 90# (+bar).

if you think about it, the movement involved in stepping down a stair is slightly different from the movement squatting. its that slightly forward movement to step down that still gets me a little. as long as my knee stays over my ankle and doesnt get forward of my toes, im fine. I also do bulgarian squats, lumberjacks, lunges, and leg presses as part of my leg workout. at this point, the down stairs pain is pretty minor and i mostly ignore it. but it really took a while after surgery before i could walk down stairs normally.

I had (and still have, to an extent) the same problem w/walking down stairs after patellar graft/mensicus repair, but I had that same experience as above that it didn't affect squats that much, so I think it's unrelated. And I was suprised that after my first days back on skis, there was no problem - I thought that the problems I had going down stairs would really be aggravated by skiing, but luckily not. I walk up and down many flights of stairs every day, and concentrate on taking slow, deliberate steps and isolate the quads and muscle just above the kneecap, maybe that helped. Sure, the progress was veeerry incremental, but I have to get to the top of the bldg one way or the other anyway. For a while I tried taking two steps at a time going down, but that felt just plain wrong. And when you think about it, that's kind of an unnatural angle for your knee, so I didn'tsee any point in it.

I had a hamstring graft about 4 years ago. It honestly takes about 18-24 months before you feel normal and stop having set-backs.
I had tendonitis, IT band pain, weakness, popping, grinding, etc at some point. I was skiing Vail 2 years out and had major grinding and creeking in my knee each night after skiing. But now I am mostly pain and swelling free.

The best advice is to be patient, keep rehabbing, and stay strong.