Arthroscopic arthrolysis for ACL knee stiffness

Lorraine underwent an arthroscopic arthrolysis under my care in mid-March 2018.

When I first met Lorraine back on the 12th of February 2017, she had severe anterior pain with loss of extension following a significant skiing injury which had occurred two to three years previously in the French Alps. She had been very active and really enjoyed her skiing but when she fell she heard a 'snap!' and she was told she had damaged her collateral ligament and the ACL, and also chipped her fibula.

Knee Stiffness after ACL injury

Following this injury she couldn’t extend her knee despite having significant amounts of physiotherapy for six months. She underwent an ACL reconstruction locally, and had an arthroscopic arthrolysis following this and she still couldn’t go straight and had severe posterolateral knee pain.  She had another arthroscopy to try and settle this down but continued to be unable to extend her knee. The knee was very stiff and although it felt stable, she did have episodes of giving way as well. She limped
when she walked. She struggled on the stairs. She used to be very active and really everything had ground to a halt as a result of this very significant injury.

When I went in at arthroscopy it was interesting that she had a significant fragment of lateral meniscus sitting in the notch and a very tight
notch with the ACL impinging or catching, so I had to release the notch and do a notchplasty and also release part of the ACL and the bone around the notch to get the leg out straight. With a combination of this notchplasty work and also dealing with the torn lateral meniscus, we were able to get the knee virtually straight on the operating table.

I am delighted that Lorraine says that her knee has not felt this good in three years and she is doing so well. Arthroscopic arthrolysis really can play a very powerful role in a stiff knee, even at this late stage.

Lorraine tells her story ...

I had a ski accident in France. I suffered a ruptured ACL, a chipped fibula and ligament damage on the inside and outside of my right leg. My leg was put in a brace designed to keep my leg straight and I was given crutches. On my return to the UK I discovered I had missed the window for immediate surgery and after having a MRI Scan and a consultation with a surgeon at Rosshall Hospital, I began physio therapy to get mobility and extension in my leg as well as building the muscle around my knee. This was aided by a second brace designed to allow mobility in my knee after 3 months (July) of physio and much pain, the leg was far from straight and therefore I had an arthroscopy after which my consultant said that there was a lot more wear and tear than he would have expected and to continue with physio to achieve full extension. 3 months (Oct) after the arthroscopy my knee gave way which resulted in me once again using crutches and and the consultant settling on a date in November for surgery.

After my ACL reconstruction I worked hard with the physio to get the leg straight ( 4 days per week in the hydrotherapy pool and gym for 7 months) still the leg would not straighten and still I walked with a limp and still I was in pain on a daily basis, now particularly behind my knee and there was a what felt like a tight band across my knee. I then was in surgery for a second arthroscopy after which the pain had gone from the back of my knee but the pain on my knee was still there as was the tight feeling . At the last consultation in Rosshall around September 2016, I was told by the consultant that there was nothing else he could do for me. For the next 14 months I accepted this pain and inability to walk more than 1 mile without great pain. I could cycle and swim a few lengths and that was my limit. After being very active, this got just too much for me to accept and I pursued the possibility of a knee replacement so that I could get some quality of life. I was soon back at Rosshall at a different surgeon who referred me on to Professor Adrian Wilson.

I travelled from Scotland to Basingstoke for a consultation at which point he gave me more hope than I had dared dream of - without a knee replacement. After a MRI scan and X-rays I received my 3rd arthroscopy in April 2018 which was carried out by Professor Adrian Wilson. After coming out of the anaesthetic, I thought my mind was playing tricks on me or that my knee was still numb because for the first time in 3 years, I could straighten my knee and I walk without a limp. It was a very emotional morning for me. For at least 8 hours per day for 10 weeks I wear a spring loaded brace that keeps my leg straight when I'm sleeping and I am still building my knee back up with the original physio who is astounded at the difference in my leg and how well I can walk. I have a way to go to get my knee back to normal but now I know I am on track.

Thank you to Professor Wilson and to his staff for the wonderful work that they do and the lovely manner in which they carry it out. My words of wisdom for those reading this is that you know what your body should feel like, persevere and push for a solution, I did and fortunately I was referred to Professor Adrian Wilson.



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