Question: Dear doctor,
My wife underwent an ACL reconstruction surgery on the last wee of XXXXXXX

During the first few weeks of recovery, she did less physiotherapy exercises than what may have been ideal, and this lead to her quad muscles becoming weak. After a consultation with the surgeon, she started more rigorous physiotherapy. As per doc , now phe strength and power is good

The surgeon suggested another MRI scan. The report says that the graft and other things are mostly fine, but there's stage 2 chondromalacia and osteoporosis with lot of effusion around the region.
Her leg is slightly bent, about 20degrees fixed flexion deformity as per doc and becomes almost straight if great force is applied on it during physiotherapy. She's also having a lot of pain, and the leg is mostly stiff. The deformity reduces after exercise, but it comes back after sometime, also it is worst in the morning.

She has been asked to wear the brace during sleeping and use push knee splint while walking. We consulted a specialist who is of the opinion as it is over three months now, an repeat arthroscopic procedure may be needed to perform lysis of the adhesions. We are very worried about having second surgery ,is it really required? MRI dint mention anythng about these adhesions, then what can be the cause and treatment for this?

Dear Doctor,

Thank you very much for your response.

1. Rigorous physiotherapy reduces the stiffness and provides relief that lasts for a few hours. Even during the physiotherapy, the last 5 degrees of extending the knee is extremely difficult. There has definitely been improvement since the physiotherapy started, but that last 5 degrees is being a cause of worry.

2. Since we are worried about this, we would like to know how physiotherapy alone will provide complete cure, since it hasn't been able to do so in the past couple of months.

3. In the contrary, we are also worried that this situation shouldn't repeat itself if if an arthroscopic procedure is performed for lysis of adhesions.

Again, thank you for your valuable inputs. It is of great assistance to us.

Dear Doctor,

Thank you again for your answer.

I've now attached photos of my wife's knee before and immediately after rigorous physiotherapy.

The "before exercise" photos depict her knee exhibiting a flexion deformity of approximately 5 degrees. This stiff feeling is worse in the mornings immediately after she wakes up.

In the contrary, the leg nearly fully extends for a few hours immediately following the the physiotherapy.

We've already tried about 2 weeks of extensive physiotherapy with the help of a professional. She experiences less pain during the exercises than when it was started a couple of weeks ago, but the deformity comes up a few hours after the exercise.

Can you kindly take a look at the photos and offer any further comments that you may have?

Many thanks for your valuable inputs. It's highly appreciated.