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Suggest Treatment For Flexion Deformity
Question: Dear Doctor XXXXXXX
My wife had a full ACL tear on 24th XXXXXXX 2014 while working out in the gym. She underwent an ACL reconstruction surgery on the 28th of XXXXXXX 2014.
For the first month, she underwent light physiotherapy and exercises. This lead to her muscles being weak. After consulting with our doctor, since the second month of surgery until now, she's been undergoing extensive and regular physiotherapy.
According to the physiotherapist, the muscle strength is good now to grade 4+ and there's no muscle lag. The flexion also has improved.
The problem she has is that she's unable to achieve 100% extension. The doctor says it's fixed flexion deformity (about 5 to 10%). This reduces to some extent immediately post physiotherapy, but the deformity comes back.
The doctor diagnosed this as arthrofibrosis, and that it can be corrected with an arthroscopic arthrolysis. He also mentioned about some capsule release and about a fixature in some extreme cases.
Can you please guide us with your opinion on her case, and provide some details about this surgery?
Many thanks for your help.
My wife had a full ACL tear on 24th XXXXXXX 2014 while working out in the gym. She underwent an ACL reconstruction surgery on the 28th of XXXXXXX 2014.
For the first month, she underwent light physiotherapy and exercises. This lead to her muscles being weak. After consulting with our doctor, since the second month of surgery until now, she's been undergoing extensive and regular physiotherapy.
According to the physiotherapist, the muscle strength is good now to grade 4+ and there's no muscle lag. The flexion also has improved.
The problem she has is that she's unable to achieve 100% extension. The doctor says it's fixed flexion deformity (about 5 to 10%). This reduces to some extent immediately post physiotherapy, but the deformity comes back.
The doctor diagnosed this as arthrofibrosis, and that it can be corrected with an arthroscopic arthrolysis. He also mentioned about some capsule release and about a fixature in some extreme cases.
Can you please guide us with your opinion on her case, and provide some details about this surgery?
Many thanks for your help.
Brief Answer:
I think you can wait for some more time
Detailed Answer:
Hello,
I have studied your case. I think it is too early for any surgery as it is only five months since surgery. As you said that she is doing physiotherapy since beginning so I think this flexion deformity is not due to arthrofibrosis. I believe that it can be due to wrong position of the tunnels in bone. It prevent full extension.
Other cause can be cyclops syndrome, In which there is increase growth of tissue at ACL which notches in front of the bone.
So I would recommend you to get MRI of the knee joint. You can share that report with me. Do not rush for surgery as I do not think this will give any benefit in case of wrong tunnel position.
I am waiting for your repeat MRI. According to that we can plan further management. Till than continue with physiotherapy.
Thanks.
I think you can wait for some more time
Detailed Answer:
Hello,
I have studied your case. I think it is too early for any surgery as it is only five months since surgery. As you said that she is doing physiotherapy since beginning so I think this flexion deformity is not due to arthrofibrosis. I believe that it can be due to wrong position of the tunnels in bone. It prevent full extension.
Other cause can be cyclops syndrome, In which there is increase growth of tissue at ACL which notches in front of the bone.
So I would recommend you to get MRI of the knee joint. You can share that report with me. Do not rush for surgery as I do not think this will give any benefit in case of wrong tunnel position.
I am waiting for your repeat MRI. According to that we can plan further management. Till than continue with physiotherapy.
Thanks.
Above answer was peer-reviewed by :
Dr. Raju A.T
Dear doctor,
We did another MRI on 02 Sep 2014. I've now attached the MRI report with this thread.
Kindly take a look and let us know what you think.
Thank you for helping.
Regards,
XXXX
We did another MRI on 02 Sep 2014. I've now attached the MRI report with this thread.
Kindly take a look and let us know what you think.
Thank you for helping.
Regards,
XXXX
Brief Answer:
You can plan for arthroscopy
Detailed Answer:
Hello,
I have studied your MRI I report. Luckily your ACL is intact and well positioned with no impingement. So at present you can continue with physiotherapy. If there is no further deformity correction in next two months than you can plan for arthroscopy release. Till that time your graft will be well incorporated and arthroscopy will not cause any damage to graft. If there will be any need of some pressure, that can also be applied.
I hope this answer will be usefulf for you. Let me know if there is any other followup questions.
Thanks
You can plan for arthroscopy
Detailed Answer:
Hello,
I have studied your MRI I report. Luckily your ACL is intact and well positioned with no impingement. So at present you can continue with physiotherapy. If there is no further deformity correction in next two months than you can plan for arthroscopy release. Till that time your graft will be well incorporated and arthroscopy will not cause any damage to graft. If there will be any need of some pressure, that can also be applied.
I hope this answer will be usefulf for you. Let me know if there is any other followup questions.
Thanks
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Answered by
Dr. Dr. Naveen Kumar Sharma
Orthopaedic Surgeon, Joint Replacement
Practicing since :2002
Answered : 4486 Questions
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