Post- ACL reconstruction with OA 12 years later

It's often not possible to prevent osteoarthritis from developing in the operated knee after more than a decade of the Anterior cruciate ligament reconstruction. This active gentleman who regularly trains and keeps his lower limb muscles in shape and runs on the pitch often came by asking what he could do as his knee did not feel much difference despite doing a recent Hyaluronic acid injection (high molecular weight) 2 months ago. 

Thankfully, he did not have much joint effusion but a quick ultrasound of the knee joint revealed multiple osteophytes in between the kneecap and the femur, and slightly fewer osteophytes with narrowing of the inner joint space (medial). He did not want to pursue a surgical 'clean-up' offered by his surgeon yet. We then embarked on a 15 minute session identifying the painful lesions and using the osteophyte breaking effect of focal shockwave where is was causing impingement. 

He survived the session and felt relief when it felt that his affected knee felt lighter and was able to squat and lunge with much ease. I informed him that he would need to still avoid high impact training and running on tar roads. I will see him again and review his response to make sure he allows time for the joint to heal with proper rehabilitation. He will still see his surgeon for follow-up if he is not better, but perhaps a little later.