Case Study: A Complicated ACL Injury

Recently, our sports therapist Sonal Patel experienced a complicated ACL Injury at our London St Pauls Clinic. Here is what Sonal had to say about this case study.

What was the background of your client?

She enjoyed endurance/adventure long-distance running. Completed 6 out of 7 marathons based on different continents. She was also an ex Basketball, track, and volleyball player. She went to regular Yoga/Pilates classes and did Crossfit weekly. On top of all that, she also completed the Maratona Cycle in Italy.

Did she have any past injuries/surgery performed?

She has had the following;

• Right knee: 1994 ACL surgery using patella graft
• Right knee: Revision in July 2016 using cadaver graft
• Left knee: May 2016 ACL surgery using hamstring graft

Who has she seen in the past?

She has seen a private physiotherapist recommended by her surgeon. After seeing the private physiotherapist, who recently moved abroad, they recommended her to see our Sports Therapist Sonal Patel. She now continues to see an osteopath for maintenance of lower back pain.

What sort of symptoms was she presented in the initial appointment?

She could not fully flex the knee (decreased range of motion, left particularly) and had difficulty walking down the stairs. She suffered from decreased control with balance which decreased her confidence in participating in a sport for the future. Her Gait mechanics altered and suffered from pain/crepitus when walking/general movement across both knees.

What objective measures did you take Sonal?

We needed a starting point, usually, therapists would compare with the non-surgery leg, however finding a baseline was difficult due to both Knees undergoing surgery.

We started off with an active range of motion. Using a goniometer I measured her Flexion (Bent knee) and extension (straight knee), this gave figures in degrees. I then looked at the Quads bulk. Using a tape measure, measured 2 circumferences on each leg, 10cm and 15cm above her patella. Single leg balance: Using a stopwatch, markers kept in place to make it more replicable when it came to repeat testing

We then went onto Single leg balance. Using a stopwatch, markers kept in place to make it more replicable when it came to repeating testing. Finally, we looked at an exercise assessment. Analysing techniques, picking up weaknesses, noting psychological barriers, joint position sense, and balance.

What was the next step?

We have been completing 1-hour rehabilitation appointments (2 x weekly) for several months. The objective markers will be remeasured within the next few weeks, this will give us guidance on the progress she has made. During the rehabilitation sessions, she has broken psychological boundaries of being able to move better, the simple task of hoping was made possible with an exceptional difference in her gait mechanics. Her quadriceps bulk and power has increased as she can load movement patterns with added weight compared to the beginning of her journey.

Every session she has shown dedication and in the future would like to complete her last marathon. Return to running was on the agenda this week, she completed 10minutes on the Alter G (anti-gravity treadmill). I started her off at approximately 70% of her body weight, this allowed her to find her stride, trust her legs, and push her knee. In the next couple of weeks, we will continue with increasing her load with weight training and running, continue with balance, plyometrics, and agility. In the next couple of weeks, we will continue with increasing her load with weight training and running, continue with balance,

In the next couple of weeks, we will continue with increasing her load with weight training and running, continue with balance, plyometrics, and agility.

What are the clients’ thoughts?

Improvements:

Walking a lot better, stairs used to be an issue but not anymore, confidence, lower limb strength, jumping, balance, and being able to simply hop.

Unchanged:

The range of motion still decreased in the mornings but better than it used to be, knee still pops but no pain, mild tenderness occasionally at the front of her knee, muscle bulk left leg still needs to play catch up.

Here is an amazing review left by the client of her experience with Sonal

“Frustrated with my rehab journey so far slow, disjointed progress working in partnership with sports rehab and osteopathy was the multi-disciplinary approach that finally started working for me. I needed a therapist that understood that I wanted to push to return to sport, but that the challenge was more than just strength in my knee. There were movement patterns I couldn’t do anymore, there was a lack of confidence in my body to support me, and there was a frustration at the slightest niggle or swelling.

Sonal focused on building a programme that both progressed quickly and was based on building blocks of the movement pattern so that I didn’t just get frustrated at not being able to do the activity in full. I had mini-milestones to feel successful, gain confidence, and understand how they would get me to the full movement. The complementary therapy with Vijay allowed me to push my body while caring for the soft tissues which were being challenged. I wasn’t held back by strained muscles and ligaments because we addressed any irritation and inflammation before it became uncomfortable.

Overall, the progress I have made in the last 4 months has been greater than what I accomplished in the last year. I took my first run in over a year last week. It was 10 minutes and I was winded, but my legs moved fluidly, my knees didn’t hurt and I had a big smile on my face.”