Thread: Question re: pain 7 mos post-op allograft ACL

Boo. I was hoping to never have to post one of these, but here we go.

7 months out from ACL surgery (allograft, you can find my original thread here ) and i'm having some issues, looking for ideas/advice. have an appointment with the surgeon but he's booking three weeks out, so i can't get in to see him 'till the end of may. any ideas on what it might be in the meantime?

here's the deal. my repaired (left) knee knee is super sore on the inside bottom right under the long incision scar where they slid the graft in. pretty much hurts every step i take these days. its been like this for about a month and i've been ignoring it hoping it'd go away. but it hasn't.

the knee also consistently (like, every time) pops and cracks when i do squats or bend it...the popping and cracking takes place just above my knee, toward the outside. maybe related to scar tissue?

it also hurts like HELL when i go up stairs and simultaneously try to extend it (hyperextend) all the way.

hurts too much to run anymore. my right side hip is starting to bug me and its never given me problems before- probably from compensating for my left leg?

any ideas? i've been slacking and not hitting the gym as regularly lately. still doing basic exersizes (lunges, bridges, etc.) at home, but no squats or leg press on the machines. not riding the bike as much either. could be related, but i doubt it.

help? thanks folks.

That sucks! sorry for you.

When did you stop running? What type of a runner are you--how far, on what surface?

I do know some people who have had ACL replacements and couldnt run for a year or more. If you havnt stopped running for long, I would try that. If the pain goes away, you'll know why. I stopped running a while ago--I was getting all sorts of pain, and also in my hip. This was way before i injured my acl though.

Do you bike? I would stick to biking and strength training right now and less of the high impact stuff.

Anyway - good luck and hopefully you'll get some good advice!

Less running more XC. Seriously, my knee was just not ready for any type of impact until 6 months. I'd rather waste my swelling time on tele then a mind-numbing urban jungle jog.

The Cinco de mayo lines were hellish so I switched to XC gear on skied the bunny runs. (Note to self remember to readjust poles.)

Originally Posted by ikkin

the long incision scar where they slid the graft in.

What scar now? Did you not have arthroscopic surgery? I just have one little scar below my patella.

Is there any visible swelling or discoloration? Can you feel any knots or lumps when you palpate the area? I have a soreness in what sounds like the same general area but it's clearly from some weird postsurgical goop that I'm having trouble working out.

In almost every allograft case, there is a short incision (the shorter, the more mininmally invasive, it is thought) on the inside adjacent to the tibial tubericle (knob of the knee). This where the graft was inserted through the bone, through the knee, and into the femur. Of course the problem with this tiny incision is that the hardware is directly over the scar.

Most doctors use the high tech fancy fasteners or screws, metal or biodegradabe. I have commonly found that everyone has pain over that area, usually related to the metal or biodegradable hardware which irritates the scared skin. This is usually the set up for the second surgery.

{I have avoided screws, and fancy fasteners for almost 10 years, and just a smooth inert plastic button (like the kind you would buy at a lady's sewing store) on the tibial side. Its cheaper, and carries virtually no risk of further operations. When I used the fancy stuff, I ended up reoperating on nearly everyone at six months to remove the device. In the past ten years, I have only seen the need to remove two of about 2000 buttons}

I guess the use of "short" and "long" might be confusing me- I have a 3/4 inch incision, laterally oriented, about an inch and a half down and to the medial side of the bottom of my patella, and that's it. No discomfort from the bone plugs, I can kneel on it and everything. I'm six weeks out now but have been able to pressure it for at least two weeks, don't know if I tried before that.

Anyway, ikkin, hope you can cure what ails ya.

Unfortunately, this problem manifests itself over time. Most people don't have hardware related pain from the get go.

The scar contracts as it matures, which thins out the meat between the screw and the edge of the coffee table. Then when the guy walks into the coffee table, or some other object, the trouble usually starts.

ikkin so many things could be troubling you, scar tissue, poor patellar glide, IT band, scar tissue, hardware issue, tight hammiesm tight quads... the list goes on. It would be almost impossible for me to give you anything more than a guess at this point.

My best suggestion would be to take get back to the basics of your rehab first, work on hamstring and quad, IT band stretching and do whatever strenght exercises don't bother you at this point, do your patellar mobs, be consistent with heat before rehab/stretching, ice after.

Do that stuff for the next 3 wks until you see your surgeon and see what happens. Those things should help to some extent but to guess at what the root problem is just that a guess.

Originally Posted by ikkin

here's the deal. my repaired (left) knee knee is super sore on the inside bottom right under the long incision scar where they slid the graft in. pretty much hurts every step i take these days. its been like this for about a month and i've been ignoring it hoping it'd go away. but it hasn't.

the knee also consistently (like, every time) pops and cracks when i do squats or bend it...the popping and cracking takes place just above my knee, toward the outside. maybe related to scar tissue?

Mine too, over a year out. Mine is scar tissue under a twice used incision in the area you speak of. Trying to rub it out still kills to this day, 1 year, 1 month post op. I simply don't touch it anymore.

Right around my 6-7 month mark I slid down a slide with my daughter at Joe's Crab Shack, hit the bottom, knee POPPED loud and then all of a sudden, pain is gone, knee feels free. I proceeded to make sure I did not mess anything up and then sat on my heels for the first time. I broke away a ton of scar tissue.

To this day, I do several squats each morning and here snap, crackle, pops and I am not eating Rice Crispies. I do it as the knee still feels a tiny bit stiff in the am. Pop it and all is good. Hell, I do this several times throughout the day. Always a poppin.

That is about where I leave off. I did not have stair problems or extension, but it always hurt to run and still does.
Did have a bit of hip soreness for compensating and some back issues that the quaktorprator fixed up just fine. Maybe go that route?

Originally Posted by ikkin

it also hurts like HELL when i go up stairs and simultaneously try to extend it (hyperextend) all the way.

hurts too much to run anymore. my right side hip is starting to bug me and its never given me problems before- probably from compensating for my left leg?

any ideas? i've been slacking and not hitting the gym as regularly lately. still doing basic exersizes (lunges, bridges, etc.) at home, but no squats or leg press on the machines. not riding the bike as much either. could be related, but i doubt it.

help? thanks folks.

you guys come through awesomely again! thanks all.

in terms of the scar/location, dr. marks got it nailed...he's describing the location and genesis of my scar perfectly. question for the good doctor: i've heard of people needing their screws removed. i have bioabsorbable screws. if i need to have 'em removed, am i f-ed?

my initial plan is to follow vinman's advice and work on getting back to the rehab/mobs 'till i get in to see the surgeon. and do as WC recommends and get back on the bike. hopefully that'll help.

ran around tonight playing catch with my hubby. got it nice and warm before doing so and it felt better, but still not great. buzz, maybe i need to slide down some slides?

i'll keep you all posted. i'm hoping i don't need to go under again, but if cleaning out scar tissue will make it feel better i guess i'll be for it. blech.

I gave up running, but that's because of all the cartilege damage in my knees, not really the ACL reconstruction. My doctor said if I like to run, no problem, go back to running. If I'm just running for exercise, ride a bike instead. I don't miss running and I'd rather be on my bike anyway.

I've had one flare up about 2-3 years ago where the hardware in that incision spot was bothering me. But it seemed to mostly be related to overuse shortly after surgery - I was making the pes anserine (sp?) tendon swell up, it was rubbing on the scar tissue or screw or something there and hurt like hell. I scaled it back a bit and ramped up more slowly and it hasn't bothered me since.

The hardware in my other knee has never bothered me.


Anyway - your issue could be a lot of things. But I'd get back to riding the bike and doing your rehab exercises (at least whatever's not causing pain) until you can see your doc and see what's up.

If its at least several months since the surgery, and you had screw related pain, I would remove the screw, biodegradable or not. Those damm things hang around for years. For it to be actually degradable, you may need to live to old age.

Sorry to hear about your trouble as i am sitting here working over my leg hyperxtension, my last major hurdle in my rehab.

Anyway, i have found almost universally that riding the bike, even at slight resistance does wonders for stiffness soreness etc. It gets circulation into areas in my knee that cant and wont happen without the bike. So stretching, flexion, hyperextension progress way better after a 30 min spin. No matter what i would say get on the bike and stretch after.....

Good luck.

okay, here's what the PA said...makes sense to me, see what you think...

He did a couple tests to see if it was a screw issue and determined that it wasn't. Then he started testing the hammy. Apparently the hamstring comes attaches right at the spot where my pain is. Had me lay on my back while he held my foot and told me to pull my heel toward my butt. I did, it killed, he said, "yep, it's your hamstring". I guess a nerve, the hammy's and a bursa SAC all convene in that area, so he said I've got some tendonitis/bursitis general irritation going on. That make sense to you folks?

He also took an X-ray, it was super cool to see the healing tunnels in my bones. I could make out perfect tunnels of less dense bone right where they drilled. Amazing.

Anyway, he gave me a script for PT and told me to take it easy on the hammy exersizes...which I'd already been taking it easy on. Also said "relax, you're only 7 months out". PT is only suppossed to do ultrasound/stim stuff to get the swelling down.

So, other than the fact that I haven't been hitting the rehab that hard (so why would I have tendonitis?) it makes sense to me. The story continues...

It doesn't make sense to me. Pain in the back of the knee is more often related to the patellofemoral joint, or some other cause of knee swelling than tendonitis of the hamstring tendons, something that I dont know if I have seen more than a few times in my career.

By this late date, the tunnels should be dissapearing, rather than being so prominent. Perhaps the ligament isn't healing.

hmmm...

so dr. mark, the pain isn't in the back of the knee, it's right near that incision scar. that test where he had me try to pull my foot toward my butt is what really made it hurt. any ideas on what it might otherwise be? i really just want it to get better and am willing to do pretty much anything to make that happen.

and the tunnels weren't super prominent...i could barely make them out, but i could see them if i looked for 'em hard enough. stability wise the knee feels solid. i think its healing...at least i hope it is.

man! i go back in three weeks if its not better.

If it hurts need the medial incision, is there hardware in there? If so, it needs to come out. Its no longer necessary anyway.

update.

went to first PT session for this issue yesterday. long story short, PT girl heated the area via ultrasound and then RAILED on the scar tissue with her thumbs. she said she could feel all sorts of crunchies breaking up. the spot feels about a million times today, so i'm psyched! can't believe something that's been bugging me for 2 months could be so simple, but i'm hoping it is!

i go to PT again tomorrow...she'll probably crunch some more...hopefully this fixes it!

psyched.

Originally Posted by ikkin

update.

went to first PT session for this issue yesterday. long story short, PT girl heated the area via ultrasound and then RAILED on the scar tissue with her thumbs. she said she could feel all sorts of crunchies breaking up. the spot feels about a million times today, so i'm psyched! can't believe something that's been bugging me for 2 months could be so simple, but i'm hoping it is!

i go to PT again tomorrow...she'll probably crunch some more...hopefully this fixes it!

psyched.

wow--too bad it took so long to figure out. did it hurt? anyway--good for you--glad you are feeling better! i want to know where it all goes.

I just had acl surgery on my L knee I've noticed a bit of pain near the right of the quad tendon that gets worst with biking. Also speaking of scar pain I had a 8in pin put in the middle of my right collar bone because of a double break. The 2in incision has pain it sends down my shoulder from time to time. Is that normal Dr. Mark. Sorry if I switch the topic.

post the X-ray of the collar bone.

That will take a while due to getting it from the doctor. What I can do is get it back to you later in July when they do a follow up on my acl. The problem is he uses older x-ray film which isn't on computer database.

Originally Posted by Woodlandclown

wow--too bad it took so long to figure out. did it hurt? anyway--good for you--glad you are feeling better! i want to know where it all goes.

thanks WC! yeah, it hurt when she was grinding it but the pain really wasn't that bad at all. the gross crunchy crunch sensation was actually worse. like when you don't mind the taste of something but can't stand the texture.

anway, it is literally like having a brand new healthy feeling knee. crazy. i thought about/worried about that pain virtually every step i took over the past two months and one 5 minute session with the magical healer PT lady seems to have fixed it. SO glad to have space in my brain again! going for a second crunching session tonight. i'll keep you posted.

Originally Posted by ikkin

like when you don't mind the taste of something but can't stand the texture.

like water chestnuts!

thats so cool that its just gone--i'll file that away in the old noggin just in case.

Originally Posted by ikkin

, PT girl heated the area via ultrasound and then RAILED on the scar tissue with her thumbs. she said she could feel all sorts of crunchies breaking up.
psyched.

When they did this to me, I passed out. Got that warm feeling in the back of the head coming forward and lights out. Worst pain ever.

I have figured out that I will simply not touch the area thus keeping the pain away. Just scar tissue, no screw there. Amazing the pain level is.

(I sound like yoda)