Loss of full extension is the complication most likely to need a return to theatre after ACL reconstruction, and it is easiest to fix early. At each review in the first six weeks, compare passive extension with the other knee, patient lying prone or supine with the heel supported.
A deficit of more than about 5 degrees that is not improving by week 4 to 6 needs attention: intensify extension work, and consider imaging for a cyclops lesion if there is a firm block or a painful clunk on terminal extension.
- Measure passive extension against the other knee at every early review
- Heel-prop and prone-hang exercises should start in the first week
- A firm block to extension suggests a cyclops lesion rather than stiffness
- Escalate if the deficit is not improving by week 4 to 6
- Be most vigilant after quadriceps tendon grafts
Why it matters
Early recognition turns a reoperation into a rehabilitation adjustment.
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