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Orthopedics
Clinical Case Round
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28yo Athlete with 10° Extensor Lag & Patellofemoral Pain 6-Weeks Post-ACL Reconstruction
Topic Summary & Background: A 28-year-old amateur footballer underwent Hamstring Autograft ACL reconstruction 6 weeks ago. Presents with full passive knee extension, but an active extensor lag of 10° and anterior knee pain during closed-chain mini-squats (0°–45°).
Key Discussion Questions:
- Is the extensor lag primary arthrogenic muscle inhibition (AMI) or graft tightness?
- Should Open Kinetic Chain (OKC) quadriceps knee extensions in 90°–45° be introduced now or deferred?
- What specific NMES parameters should be selected on Vastus Medialis Oblique (VMO)?
Standard Clinical Consensus: Standard Clinical Consensus: At 6 weeks, graft healing is in the remodeling phase. Extensor lag with full passive extension indicates vastus arthrogenic inhibition rather than mechanical obstruction. High-intensity NMES (75Hz, 250µs, 1:3 duty cycle) combined with terminal active quad setting in supine is indicated. OKC seated extension from 90°–45° produces minimal ACL strain and safely restores quadriceps peak torque without patellar overload.
DA
Dr. Anand Kumar, MPT (Ortho)
Senior Faculty • Just now
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