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Hi my name is Lori I am 37 years old and on 2-3-99 I had acl reconst. surgery and my medial meniscus was torn so that was trimmed. I was locked at 90 deg. for 18 days before the surg. My knee cap was not tracking properly after surg. and I was having a very hard time doing bending exercises but that is improving. My extension is -4 and my flexion in 122 deg.

I also wear a dynasplint during sleep for ext. I am having a very difficult time walking normal. I get a lot of catches in the knee and my muscles are weak. I do not walk smooth. I have had 8wks or rehab. My doctor gave me a rx. yesterday for 4 more wks. of therapy. However, my ins. co. has denied it. I am getting letters from my doctor to hopefully change their minds.

Not only do I get catches in my knee when I walk sometimes it pops and gets a quick shooting pain. Also my incision is sticking to the tissue in one spot and I am doing massage and friction to try to loosen it. Now my surg. was 2/3/99. Is there really any hope of getting the incision to loosen up? Has it been too long? Also, is it common for me to still have trouble walking. The muscle attachements on all the bones are very tender. If my ins. co. don't authorize more rehab. will it be possible for me to work this out on my own? Any advice or ideas will be much appreciated.

Thank you.

Lor

Answer:
Lori,

Given that you have not acheived full extension and it has been almost 11weeks says that there may be scar tissue formation under the patella and around/below the patella that is restricting proper tracking and end range extension.

If the knee acheives full extension after a physical therapy treatment and you can walk with a normal gait during a therapy treatment then there is a good chance that you will gain the full extension over time ( another 8 weeks).

Yes you can continue to make improvements in your condition by doing self stretching and passive stretching into knee extension i.e. - lye on stomach with your leg hanging off the edge of the bed from the top of the knee down. Your PT should be able to issue a comprehensive home program that will help you stretch into full extension. Continue to do all strengthening exercises and join a gym so that you can workout 4-5 days per week with the bike, leg press, leg curl, hip machine, in addition to the TKE's, step ups, calf raises. Stretch the hamstrings, quads, and calf often.

If you need us to send you illustrated exercises then let us know but your PT should have all the necessary info.

I have treated many ACL patients that have had a difficult time with rehab. Post surgical rehab depends quite a bit on the patients pre surgical condition. If you were in 90 degrees flexion prior to surgery then your rehab would be a bit tougher than normal. Some patients benefit greatly from having scar tissue removed. You need to consider this option with your doctor.

I would say give the knee another three weeks of hard work and stretching. If you see no improvements then speak to your doctor about other options. Other factors that play a role in time of rehab are age, weight, athletic ability, strength and physical condition prior to surgery.

Good luck and please let us know how you are doing.

I am a 38 year old female physician assistant (ob/gyn) status post my 4th left knee arthroscopy (1987 [removal of synovial plicae], 1988 [removal of scar tissue], 1993 [dx of osteoarthritis and debridement of loose cartilage], and 1999 (4 days ago: partial lateral menisectomy for what was described as a "huge" tear, and debridement for tricompartmental disease.)).

I swim at a near competitive level 5 days per week, including all 4 strokes and lead an active life. This arthroscopy has been considerably more painful than in the past, which I expected with the additional work done.

I am partially weight bearing outside with crutches and have about 40 degree flexion of the knee. What would you recommend in terms of PT: any PT? A brace? I realize the limitations of being able to advise anyone by e-mail. Thanks for whatever assistance you can offer.

Second Email:

Thanks very much for your recommendations. As it happens, the day after I wrote you I saw my orthopod, who sent me to PT. I started yesterday.

I think my physical therapist agrees it will be a long process and has started me on many of the exercises you described. Thank you again for very useful information.

Elizabeth

Now with all that said lets take a look at your knee. Four arthroscopic surgeries in 12 years will be a significant factor concerning your rate of recovery. You have built up of scar tissue and arthritis in the knee. The debridement cleaned alot of the scaring in the knee and the removal of the meniscus will help with overall range of motion upon recovery, most probably. Yes you must go to a physical therapist. Preferably one that is experienced with knee rehab. Ask one of your orthopedic surgeon friends where he sends his athletes to for rehab. Your recovery will take 8 - 12 weeks given the large amount of work done and since it is your 4th surgery. Start rehab right away to control the swelling and to regain your range of motion and strength. Go easy for the first 4-6 weeks (i.e. no running, jumping, excessive kickboarding in pool, etc.). Remember, it takes 8-12 weeks for bone to heal and you did have bone burred during the surgery.

Your rehab for the first 4-6 weeks should consist of massage (ant and post knee), passive range of motion, gentle patella mobilizations, Patella-Femoral ex's and TKE ex's, Bike, Leg Press, Leg Curls, Hip strengthening, Calf strengthening, stretching and Aquatic standing and walking movements(on your off days from rehab).
After this period you will be progressed according to your status. Remember not to rush your level of activity for the first 4 weeks. Your knee needs time to heal.
Good luck and please keep us informed of your progress and outcome.

Sincerely, Steven Login, MS,PT
PT Strategies Corp

On April 10, 1999, I fell and dislocated my right elbow. I was treated at the hospital where it was manipulated back into joint. (I was under deep sedation) I wore an immobilizer cast for 48 hours, after which it was removed by my orthopedic surgeon. He instructed me to use it as much as possible.

After two weeks, it remains very stiff & swollen at the joint. Flexion
is limited. I am in physical therapy 2/week receiving heat packs and
stretching exercises. Is there anything else I can do to facilitate
healing and recovery?

Thank you.
Linda

Steven:
I want to thank you for the excellent advice. You are rendering a great service.
This elbow's gonna take some time and a whole lot of work. Your suggestions will be helpful as I continue the rehab process.

Answer:
Linda,
Yes, you can do exercises on your own. It is very important to achieve full extension (straightening) of the elbow and full flexion (bending) of the elbow. Extension is usually the most difficult to get back and is the most important. This can take up to 16 weeks to acheive full range again. At home you can perform static stretching exercises such as holding a weight in the hand while allowing the arm to go straight. Hold this stretch for up to 3 minutes before giving the arm a rest. Repeat 3x several sessions per day. Also try to bend the elbow using your opposite hand to add static pressure while arm is in bent position. Again hold for up to 3 minutes 3x,
several sessions per day. You may want to discuss bracing options with your physical therapist. I have had good results with elbow fracture/dislocation patients who use a night brace to help with range of motion. It is called a dynasplint and can be adjusted for tension as you gain more range.

Since you are only three weeks post injury you can expect to have increased swelling and pain/soreness. In physical therapy you should be getting massage to the elbow and biceps/triceps area, manual stretching of the forearm muscles (wrist extension and flexion), and getting modalities of ultrasound, whirlpool (if avaiable) and electrical stimulation with ice all of which will aid in the reduction of swelling and thus allow greater ability for movement.

Keep in mind that this injury can be a timely rehab. Do everthing you can to gain range back ASAP (within 16 weeks) because the longer it takes the more scar tissue is likely to form.
Good luck and let us know how you do.