A Hypothesized Bio-tensegral Model for Scar Tissue, Observed in Anterior Cruciate Ligament Reconstruction Surgeries: A Case Report Series 

Keywords: Scar Tissue, ACL, Rehabilitation Outcomes, Knee Surgeries, Bio-tensegrity 

Brandi Higbee, LMT 

Abstract  

Purpose: 

Scar tissue can impact healing and rehabilitation, causing pain and limiting the knee's active range of motion (AROM). This case report series examines how anterior scars restrict a joint’s AROM and proposes that scar tissue affects areas beyond the immediate scar, engaging predictable lines of restriction within the soft issue, even years after surgery. It aims to observe the existence of these restrictions across different participants and assess outcomes after myofascial release on the hypothesized pattern. 

Participants:  

Ten clients, aged 20 to 70, had moderate to high activity levels before sustaining grade III knee tears and undergoing ACL reconstruction. Their scars, fully healed within ten years post-surgery, still showed moderate limitations in AROM, affecting their previous activity levels.  

Intervention:  

Five 50-minute sessions were conducted. Light to medium myofascial release techniques and palpation of the hypothesized restrictions were used at each session. AROM measurements were taken with a goniometer before and after.   

Results:  

Restrictions were found in all knees, showing the same identical patterns. After five sessions, clients reported a 40-60% increase in active range of motion (AROM) for flexion and extension. They also experienced less pain and guarding, improved circulation, proprioception, and balance.  

Conclusion: 

These channels of tension are deeper than the dermis and superficial to the musculoskeletal tissue. They appear to pin down and moderately restrict all biological structures and tissue in the direction and circumference of the scar. This fascia engagement could explain the limb’s restriction of AROM. They indicate biomechanical compensations creating a retinacula-type structure for the scar. Potentially enabling new channels for biofeedback, assistance in wound healing and closure, localized protection, mechano-transduction, and to re-establish a pre-tensioned fascia system, in accordance to principles of bio-tensegrity. Months after the study, participants still exhibited improved AROM, suggesting restrictions are unnecessary after the wound is healed. Therapists are potentially already attenuating these restrictions with the use of manual therapy. Further research on functional outcomes and specific myofascial techniques on these restrictions could provide more clarity of how scar tissue inhibits AROM. 

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