Recovery After ACL Surgery: Common Concerns and Questions

Anterior cruciate ligament (ACL) tear

Hello Doctor: I had a car accident in February, and an MRI revealed that I had a torn right anterior cruciate ligament (ACL).
At that time, I was preparing for a certification exam, and the doctor mentioned that the surgery could not be scheduled immediately, so I underwent surgery a month later.
It has now been a week since the surgery.
The doctor who changed my dressings said that normally, patients should start rehabilitation the day after surgery, and by the third day, swelling should have subsided.
However, I am still quite swollen.
On the fourth day, during the dressing change, I noticed large areas around the wound that were dark red and black.
The doctor warned that if I do not start rehabilitation, there could be a risk of necrosis.
Therefore, I began rehabilitation at home and have been more diligent than in the days immediately following the surgery.
However, during the dressing change, I observed that the dark red and black areas around the wound are still increasing in size, and my entire right leg remains swollen.
Although there are slight signs of reduced swelling, they are minimal.
I called back for advice, but the response I received was completely different from my original doctor.
They said that the swelling and the dark red and black areas might take one to two weeks to resolve because it is soon after surgery, and that rehabilitation should be done moderately.
I would like to ask: 1.
Is it normal to still have swelling one week after surgery? 2.
Is it normal for the area around the surgical wound to be dark red and black, or should it start to resolve in about two weeks? 3.
I experience pain at night after only a few hours of sleep; should I return to the hospital for a consultation? 4.
Initially, walking after surgery was not too painful, but after returning home, due to the cold weather, I mostly did rehabilitation in bed, although I did walk around.
I walk about five times a day, going up and down one flight of stairs, but the pain while walking is increasing.
Is this considered normal after surgery?

Wo you wenti, 10~19 year old female. Ask Date: 2016/03/26

Dr. Chen Yongxue reply Orthopedics

Hello,
1.
Swelling may still be present one week post-surgery.

2.
The description of "black and red" is not very clear.
It is advisable to have an orthopedic physician perform a physical examination, as there are general concerns about infection or necrosis.

3.
If there is no continuous improvement, you should return for follow-up.

4.
If walking is becoming increasingly painful, please specify the location of the pain.
It is recommended that you return to the outpatient clinic for more accurate assessment.
Thank you.

Reply Date: 2016/03/26

More Info

After undergoing ACL (anterior cruciate ligament) surgery, it is common for patients to have concerns regarding their recovery process, especially in the first few weeks post-operation. Based on your description, here are some insights and clarifications regarding your questions:
1. Swelling After One Week: It is not unusual for swelling to persist for a week or even longer after ACL surgery. Swelling is a natural part of the healing process, as your body responds to the trauma of surgery. The amount of swelling can vary significantly from person to person, depending on factors such as the extent of the injury, the surgical technique used, and individual healing responses. While some patients may see a reduction in swelling within a few days, others may take longer. It is crucial to follow your surgeon's post-operative care instructions, which often include elevating the leg, applying ice, and using compression to help manage swelling.

2. Discoloration Around the Surgical Site: The presence of black and red discoloration around the surgical site can be concerning, but it is not uncommon in the early stages of recovery. This discoloration may be due to bruising, which occurs when blood vessels are damaged during surgery. Bruising can take time to resolve, often peaking in intensity before gradually fading. However, if the discoloration is accompanied by increased pain, warmth, or swelling, it may indicate a complication such as an infection or hematoma, and you should consult your surgeon for further evaluation.

3. Pain During Sleep: Experiencing pain at night or during sleep is also a common issue after ACL surgery. Pain can be exacerbated by swelling, changes in activity level, and the body's healing processes. If the pain becomes severe or unmanageable, or if it is accompanied by other concerning symptoms (such as fever or increased swelling), it is advisable to contact your healthcare provider for an assessment. They may recommend pain management strategies or adjustments to your rehabilitation plan.

4. Increased Pain with Activity: It is normal to experience some discomfort as you begin to increase your activity level post-surgery. However, if you find that walking or engaging in rehabilitation exercises is becoming increasingly painful, it may be a sign that you are overdoing it. It is essential to strike a balance between rest and activity. Gradually increasing your activity level while listening to your body is key. If the pain persists or worsens, it would be wise to consult your surgeon or physical therapist to ensure that your recovery is on track and to adjust your rehabilitation program as necessary.

In summary, while some swelling and discoloration are expected after ACL surgery, persistent or worsening symptoms should be evaluated by your healthcare provider. It is crucial to adhere to your rehabilitation plan while being mindful of your body's signals. If you have any doubts or concerns about your recovery, do not hesitate to reach out to your surgical team for guidance. They can provide tailored advice based on your specific situation and help ensure a safe and effective recovery process.

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