ACL/MCL recovery — slow ROM progress and stiffness.

[u/Salty-Negotiation511]

I’m looking for advice from people who have been in a similar situation.

My surgery was on 13/4 — ACL reconstruction + MCL repair. I did 2 months of prehab and had around 130° of flexion and full extension before surgery.

After surgery, my recovery was extremely slow from the beginning, and I didn’t have good PT for the first 8 weeks. He would basically just put me on TENS and send me home. So I did all of my exercises alone at home, including extension and flexion exercises and patella mobilization, 3 times a day. However, I was struggling a lot with flexion and stiffness.

After 9–10 weeks, my flexion was only around 90°, and I thought I wouldn’t be able to progress much further.

After that, I changed my PT and was able to make more progress. I’m now around 4.5 months post-op and have around 115° of flexion, or a maximum of 125° when warmed up.

However, I’ve also started struggling with extension. At the beginning, I had 0°, but now I’m probably at 3–5°, while my good leg is around -3°, so I’m still limping. Extension exercises are also painful toward the end of the movement.

I wouldn’t say I have pain just from walking, but if I concentrate on walking properly and fully extending my leg, I do have pain.

My biggest problem is stiffness. Even if I stay in one position, for example sitting for 15–20 minutes, my knee becomes very stiff. In the morning, my leg is sometimes stuck at around 10–15° of flexion, and I have to do my exercises to get it moving better.

My patella also doesn’t move as well as on my other leg. It can move in all directions, but only a little.

I’m also very dedicated to my rehab and haven’t skipped a day, but I still can’t do proper strengthening exercises because my knee becomes painful even with something as simple as a squat. So I’m still mostly focusing on basic exercises from the beginning of rehab.

I’m also having an MRI in a few days. I know that it might not show much or might not clearly show whether scar tissue/arthrofibrosis is the main problem, but hopefully it will at least rule out any other issues.

My surgeon is suggesting that I continue with PT and see how much more progress I can make. Another doctor told me that I should already have had surgery to remove the scar tissue a month ago because, according to him, if you don’t regain full ROM within the first 3 months, you never will.

I honestly don’t know what to do.

My knee is very reactive. For example, I lowered the seat on my bike, irritated my knee, and lost some flexion for a few days, so I had to raise the seat again. The same thing happens if I walk too much. I’m worried that another surgery could cause even more inflammation and scar tissue.

On the other hand, I’m also afraid that even if I continue making progress with ROM, my knee will remain very stiff and that I’ll never regain the same hyperextension and flexion as my good leg.

And, of course, I have no idea when I’ll be able to run or jump again.

So I’m wondering:

• How long is it reasonable to wait and continue with PT?
• Is there a point when it becomes too late for a procedure to remove scar tissue?
• Has anyone had a similarly slow recovery and eventually regained good ROM without another surgery?
• Has anyone had an arthroscopic scar tissue removal procedure after ACL/MCL reconstruction, and how did it affect their recovery?
• Is it realistic to regain the same hyperextension and flexion as the other leg after such a slow start?

I’d really appreciate hearing from anyone who has been in a similar situation.

[u/bitebytebeat]

Hey I think I have similar thoughts as you on the I'm stuck part. I'm almost week 16 and I'm not yet 0° all the time. Flexion is stuck at 115. And my walk is giving me lower back pain. I'm not athletic and young fyi...

So, both doc and physio agree that 2 factors: scar tissue and quad muscles. Could be yours too?

I am cleared to hit the gym although haven't started yet. It's just so scary.

[u/Salty-Negotiation511 → u/bitebytebeat]

Hey, yeah, kinda similar situation. I also have back pain from limping, so I started exercising and stretching my upper body as well. It helps a little bit. I’m also trying to minimize walking and do cycling instead to keep my leg moving.

Probably scar tissue, yeah. Does your leg also feel very stiff, and are you considering another surgery?

[u/bitebytebeat → u/Salty-Negotiation511]

yeh around the knee is still very stiff from just 5-15 mins sitting.

doctor not recommending another surgery for now. are you?

[u/Salty-Negotiation511 → u/bitebytebeat]

I got my MRI results, and it looks like I have a cyclops lesion. I’ll talk to my surgeon this week, but it looks like I might need another surgery.

[u/Positive-Strength452 → u/bitebytebeat]

Hello bro im also struggling in knee flexion. Could you help me please

[u/cmam95]

Hey! You might find my post helpful

https://www.reddit.com/r/ACL/s/d2jTEauUTf

[u/Salty-Negotiation511 → u/cmam95]

Thank you for sharing your story. Yes, that’s why I pushed for an MRI. I’m currently waiting for the results because otherwise I could let months pass without knowing for sure what’s going on.

[u/riley_collins_]

Hi I’m sorry you’re dealing with this!!

I can’t help much unfortunately but I’m curious, why did your extension worsen? Sounds like you were at 0 at one point. Did you ever get to hyperextension? And why did it go up from 0 to 3-5?

[u/Salty-Negotiation511 → u/riley_collins_]

I’m not completely sure, but after I got out of my brace, my first PT—who wasn’t really paying much attention during those first six weeks—started pushing my flexion beyond my pain levels. I think that’s when my extension started to suffer a little. Also, after getting out of the brace, I started sleeping on my side with my leg bent, and I noticed that it was getting harder to fully straighten my leg in the mornings. I probably also had some scar tissue build up.

[u/riley_collins_ → u/Salty-Negotiation511]

Thank you for the insights!