ACLR and arthrofibrosis

Ask a PT

156 Posts
 
Posted - 06/08/2007 :  13:41:42  Show Profile  Reply with Quote
Our user asked: "Hello, Sorry History first. I am 45 y/o F,w Unhappy Triad in Sept 06 while in Spain. Sought OS in Spain who recommended against repair, returned to US sought OS here who recommended an allograft. Found that ins. would not cover surgery here in US D/T preexisting cond in Spain. Had BTB Patellar Autograft in Murcia Spain in Feb 07. Poor pain control, no cryo tx, no CPM, and poor PO explaination by OS (language barrier). Never achieved symmetry w other leg. Returned to US in mid May returned to 2nd OS (I trust fully) and found ROM +15 and 120. Good leg -10 and 145. Arthroscopic LOA, trimming of meniscus, and shaving of chondramalicia. 2 wks PO now w CPM, PT BIW, cryo, PROM and PT regimine at home. Question, what is the likelyhood of the arthrofibrosis returning at the stage? In Spain I had PT PO 5 days a week for 8 weeks, but my quads had totally shut down for >6weeks PO D/T poor pain control. I am doing my PT, and passive ROM and using 10# wts above and below knee to give extension TID. Can I do anything else??"

Ask a PT Response: "It sounds like you have been through alot. Just to sum it up, with the unhappy triad you mentioned you had underwent an ACl reconstruction with the patella tendon autograft in Spain in Feb and then underwent a menisectomy, and chondroplasty in the USA in mid May. You are now over two weeks post op and attending PT twice a week, utilizing a CPM and performing a home exercise program. Your current range of motion is 15-120deg. Given this information it sounds like you are where you should be. If you are achieving 15-120deg of knee active range of motion already you are doing excellent and the likelihood of you developing arthrofibrosis in conjunction with your plan of care (PT BIW, HEP & CPM use) appears to be greatly reduced. Your physical therapist that is working with you can give you a better prognosis on this as he or she knows your condition best. You mentioned your quads had shut down on you in the past. Electrical stimualtion or biofeedback to your quadriceps muscle can help facilitate strengthening and a faster recovery as well. You did not undergo a meniscus repair but rather a meniscectomy which allows you to advance to weightbearing exercises sooner. You could check with your therapist to see when he or she feels you are ready for this as weight bearing exercises will help you return to your prior level of fucntion sooner. Every surgeon is different and has different requirements for progression so this has to be taken into consideration. If you would like to see examples of progression of therapy, than visit the CyberPT Classroom and look under "Sample Physical Therapy Protocols" and click on the ACL protocols. I hope this helps. Good luck with your recovery and feel free to contact us again should you have additional questions."