Hi Doctor, I had an ACL recon surgery a week ago using quad tendon graft. My surgeon didn't remove the torn ACL during the reconstruction and therefore the graft fixation was few mm away from original ACL. Could you please share your thought on the rationale behind that? Will it cause any issues in future?
Hello Dr. Steve. I recently had an ACL reconstruction surgery. I lost a lot of extension, and this was further complicated by a cyclops lesion (creating a loss of extension and "clunking"). I had a second surgery to remove the cyclops lesion and perform a small notch plasty to make more room for the BTB autograft (11mm). I gained some extension, about 0 degrees now, but I have now noticed a clunking sensation during flexion. I have looked at the MRI and I believe the tunnel was placed too vertically. Also, the graft may be too thick and is causing an impingement with the PCL. I believe this is what is making the clunking noises. If I need to get a revision surgery, can they use the same graft seeing as how it has not ruptured? I imagine I may need to make new tunnels. Thanks for your help.
Hello Dr Steve! I recently had a new ACL reconstruction and have been reading a lot about my increased chances of arthritis going forward - do you think these relatively recent advancements in ACL positioning will decrease my chances of future arthritis due to a more natural ACL placement, more stability and less rotational forces in the knee? Many thanks! Rory
Hello that’s a really good question. -Early arthritis does occur in patients who have suffered ACL tear. Most of these patients have concurrent meniscus and cartilage damage. For example if you suffered a big non repairable meniscus tear that required trimming then you are at much higher risk of developing arthritis. So you have to look at the big picture and not just technical details of the ACL reconstruction. The good news is that if the technique is good mechanics are restored and the likelihood of further meniscus damage is less. Its all about the Meniscus and the cartilage but mostly Meniscus. Hopefully your menisci are intact.
@@SteveMoraMD Hi Steve, Very much appreciate you taking the time to respond - my MRI suggested a medial meniscus Root avulsion, along with a tear in the medial third (along with a grade 1 MCL sprain and ACL tear of course). However, remarkably the root avulsion on the MRI turned out to only be partial - my surgeon once inside the knee found that it had actually already healed (he estimated a 50% tear of the meniscal root before healing) and the tear in the 3rd had also healed. So, I count myself very lucky. He also conducted a minor RF chondroplasty to my medial femoral, but no significant loss of cartilage. I have two pertinent questions following surgery which you might be willing to throw your two cents in - could a meniscus injury that has healed such as mine raise my chances of arthritis in the future - I have also read studies that suggest a healed meniscus is only around 80% as strong as a typical one. And also, I have read conflicting information on rehab of ACL reconstructions, I'm of the understanding the graft is strongest for the first two months or so, therefore returning ROM and getting walking again can happen as quickily as comfortable. However one of the physios has advised "protecting the graft" and restricting certain exercises. Do you have protocol for your patients post reconstruction? There seems to be conflicting advice from most people on the best way to rehab a ACL surgery, which given its commonality really surprises me! Thanks Rory
Hi Dr. Steve. Thank you for the detailed explanation. I suspect that this may be what happened to me. 2 years after my surgery by knee still doesn't feel stable and still hurts and gets swollen after playing sports. I have full extension but it looks like I lost some hyperextension when compared to my un-operated knee and I can't get it back no matter what rehab exercises and stretches I try. My knee also clicks and pops as well when I lock it out with some pain sometimes. I also noticed that my operated knee has more flexion than my un-operated knee (my heel can touch my butt but can't on my un-operated leg). I know that you can't say for sure but does this sound like a case of incorrect tunnel angle placement? Thanks for your time.
Sorry you’re going through this. It’s not easy figuring out why a knee remains problematic after the surgery. Many factors including cartilage and meniscus issues. Consider getting a second opinion w a Sports Fellowship trained Ortho. Be safe.
Marcos Moraes very low chance if you rehab well. I’ve seen that technique done on many pro soccer players. Most people have no issues with graft re tears. You might want to look into an ACL prevention program such as PEP or FIFA 11.
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Hi doctor. I need to ask a question what if the doctor put the graft at 11 o'clock position??
Hi Doctor, I had an ACL recon surgery a week ago using quad tendon graft. My surgeon didn't remove the torn ACL during the reconstruction and therefore the graft fixation was few mm away from original ACL. Could you please share your thought on the rationale behind that? Will it cause any issues in future?
He is smart, old acl has nerves , it will help you to gain balance and heal faster
Hello Dr. Steve.
I recently had an ACL reconstruction surgery. I lost a lot of extension, and this was further complicated by a cyclops lesion (creating a loss of extension and "clunking"). I had a second surgery to remove the cyclops lesion and perform a small notch plasty to make more room for the BTB autograft (11mm).
I gained some extension, about 0 degrees now, but I have now noticed a clunking sensation during flexion.
I have looked at the MRI and I believe the tunnel was placed too vertically. Also, the graft may be too thick and is causing an impingement with the PCL. I believe this is what is making the clunking noises.
If I need to get a revision surgery, can they use the same graft seeing as how it has not ruptured?
I imagine I may need to make new tunnels.
Thanks for your help.
What happened?
Hi there. Any updates? :)
Same question
Hello Dr Steve!
I recently had a new ACL reconstruction and have been reading a lot about my increased chances of arthritis going forward - do you think these relatively recent advancements in ACL positioning will decrease my chances of future arthritis due to a more natural ACL placement, more stability and less rotational forces in the knee?
Many thanks!
Rory
Hello that’s a really good question. -Early arthritis does occur in patients who have suffered ACL tear. Most of these patients have concurrent meniscus and cartilage damage. For example if you suffered a big non repairable meniscus tear that required trimming then you are at much higher risk of developing arthritis. So you have to look at the big picture and not just technical details of the ACL reconstruction. The good news is that if the technique is good mechanics are restored and the likelihood of further meniscus damage is less. Its all about the Meniscus and the cartilage but mostly Meniscus. Hopefully your menisci are intact.
@@SteveMoraMD Hi Steve,
Very much appreciate you taking the time to respond - my MRI suggested a medial meniscus Root avulsion, along with a tear in the medial third (along with a grade 1 MCL sprain and ACL tear of course). However, remarkably the root avulsion on the MRI turned out to only be partial - my surgeon once inside the knee found that it had actually already healed (he estimated a 50% tear of the meniscal root before healing) and the tear in the 3rd had also healed. So, I count myself very lucky.
He also conducted a minor RF chondroplasty to my medial femoral, but no significant loss of cartilage.
I have two pertinent questions following surgery which you might be willing to throw your two cents in - could a meniscus injury that has healed such as mine raise my chances of arthritis in the future - I have also read studies that suggest a healed meniscus is only around 80% as strong as a typical one. And also, I have read conflicting information on rehab of ACL reconstructions, I'm of the understanding the graft is strongest for the first two months or so, therefore returning ROM and getting walking again can happen as quickily as comfortable. However one of the physios has advised "protecting the graft" and restricting certain exercises. Do you have protocol for your patients post reconstruction?
There seems to be conflicting advice from most people on the best way to rehab a ACL surgery, which given its commonality really surprises me!
Thanks
Rory
Hi Dr. Steve. Thank you for the detailed explanation. I suspect that this may be what happened to me.
2 years after my surgery by knee still doesn't feel stable and still hurts and gets swollen after playing sports. I have full extension but it looks like I lost some hyperextension when compared to my un-operated knee and I can't get it back no matter what rehab exercises and stretches I try. My knee also clicks and pops as well when I lock it out with some pain sometimes. I also noticed that my operated knee has more flexion than my un-operated knee (my heel can touch my butt but can't on my un-operated leg). I know that you can't say for sure but does this sound like a case of incorrect tunnel angle placement? Thanks for your time.
Sorry you’re going through this. It’s not easy figuring out why a knee remains problematic after the surgery. Many factors including cartilage and meniscus issues. Consider getting a second opinion w a Sports Fellowship trained Ortho. Be safe.
I am 6 months post op and have found out my Dr made a transtibial tunnel (patellar tendon autograft). What are the chances of retearing my ACL?
Marcos Moraes very low chance if you rehab well. I’ve seen that technique done on many pro soccer players. Most people have no issues with graft re tears. You might want to look into an ACL prevention program such as PEP or FIFA 11.