ACL reco. hamstring graft results is hamstring tendonitis?

[arniar]

Hello

Please help me if you can. I have been off running for almost 1 1/2 years. That makes a dedicated runner like me very sad.

I had an ACL reconstruction surgery nearly 11 months ago, with hamstring autograft. My knee seems to be ok, as shown by post-op MRI.

The problem lies in the graft donor area. The hamstring was very tight for long time, causing knee problems. But with proper massage and streching the knee has gotten better. However, there are no further improvements and the hamstring gets tight after exercising. I need to massage several times each day. The hamstring tendon is swollen all the time. I can feel two knots in the muscle. I cannot bend the knee fully. I feel numb in my sole. The problem affects my walking.

This may sound like hamstring tendonitis. Can ACL with hamstring graft cause hamstring tendonitis?

With hope of getting help,
Arni

[Canuck Physio]

Hello,

I doubt that you have hamstrings tendonitis, unless you have been completing repeptive and strenuous or high load training recently. but post op?

It is more than likely that you still have shortening of the hamstrings. If not shortening some form of myofascial issue/scarring.

Massage, although useful, would not necessarily enhance collagen alignment and fibroblast production like a good blast of Physiotherapy!

also, how is your stability? Foot position post op? Or most importantly flexibility! Hamstrings are a significant stabilizer and without training it is unknown if the 'exercise' (which one) that you are doing is exacerbateing problems.

[arniar]

Hi again

So far as I can tell, I think my flexibility and balance is normal. Also my foot position.

I am also very sore in the particular hamstring muscle close to the hips(the middle one, the others are without problems). I think I can also feel a bump up there. That would be the 3rd bump in the muscle I know of

The muscle gets very tight after long walking or 10 minutes jogging. So I am rather no exercising except biking.

I am working on getting a new physiotherapist. Had 2 therapists so far with no success.

[arniar]

Furthermore,

I feel tight in the morning after sleep, and after sitting for a prolonged period. There is no pain in the muscle, but when the hamstring gets very tight I start to feel pain in my anterior knee.

I do stretching and massaging several times each day, and sleep with a heating pad fixed on the hamstring.

[arniar]

My hamstring becomes tense when I bend the knee. It is like I am fighting against the muscle.

What could be causing this?

[arniar]

It turned out to be a failed regeneration of the harvested Semitendinosus tendon. The muscle is loose and shortened.

I dont know what can be done to fix this. If anyone knows something about this condition, please inform me.

I have an appointment with an orthopedist late this month.

[Physio Dace]

Arnier,

Can I ask how you came to conclusion that it was failed regeneration of the semitendinosus? Did you have investigations or was it a clinical diagnosis?

From reading the posts up until the last one I was swaying more towards a neural tension disorder of the sciatic nerve (tibial branch perhaps) - this may explain the distal foot symptoms and local. However without more info you have to consider the hamstring to be the most likely source - so good luck with your rehab and ortho review.

[arniar]

Hi Dace

I met an orthopaedist who told me this.

The semitendinosus muscle is very stiff at all times. And I can move it a bit to the sides. No stretching or massaging has helped.

A surgery seems to be the only option.

I am wondering if improper rest after the acl reconstruction operation could have played a role in this. Only 5 days after the operation, I was back to (office) work. However, I read it takes 6 weeks for the harvested tendon to grow.

Thanks for your good wishes,
Arni

[physiobob]

Yep the hamstring tendon graft nearly always causes hamstring problems for at least 12-18 months post the surgery. It is pretty basic 'blind' carpentry when harvesting the tendon and everyones anatomy and recuperation ability is different. That said I myself would rather than than a patella tendinitis following a graft from that region.

You are not alone in your issue. I see this more often than not which perhaps means the surgeons should look at the way they make the harvest. As for the muscle it sounds like it is reacting in a normal way to excessive leads placed upon it to soon.

Suggest working with a good remedial massage therapist and PT to work on a graded approach to your return to activity. This plan make take another 6 months. Of course if a scan has shown a problem in the tendon then perhaps a surgical investigation and clean up might be useful as well.

Good luck.

[arniar]

Thanks Physiobob

What really surprises me is that you are saying that this is common. That makes me feel better, because it'd help me to find a way out of this.

I am actually feeling better now than two months ago. I can bend my knee and often without hearing any clicks in the knee. But I cannnot jog for more than one minute as a am quite unstable. I am biking nearly everyday in the gym for 30 minutes+.

Today I will see another orthopaedist.

I found this article describing a case very similar or same as mine,

Failed regrowth of the harvested semitendinosus tendon: a rare complication of tendon harvest after anterior cruciate ligament reconstruction.

[arniar]

I went to see a doctor last Monday. I gave him my MRI images since July. He couldn't see anything abnormal there. Also, he concluded that my knee is doing fine and the new ligament is firm. That is good news.

But regarding my hamstring, he was quite surprised to see how tight the Semitendinosus really is. He booked an ultrasonography examination and I will need to wait until January for that. He could not diagnose my problem, and said this was a rare case.

I also met a physiotherapist. His advice to me was to strengthen the hamstring since it is visible smaller on the operated leg than the other. I should take heavy weight, about 9-10 repititions, all out.