Knee Discomfort After ACL Surgery: Causes and Solutions

Knee discomfort?

I underwent surgery for a right knee anterior cruciate ligament (ACL) tear last September.
After the surgery, I sometimes have difficulty fully extending my knee, and it tends to remain slightly bent.
At that time, I was putting most of my weight on my left leg, which has led to frequent discomfort in my left leg.
As an athlete who engages in intense physical activity, I often experience discomfort on the left side of my kneecap.
Sometimes, it feels loose and makes a popping sound when I push it outward, which temporarily alleviates the discomfort, but it returns shortly after.
Currently, my right leg feels better than my left.
I would like to know why this is happening and how to test the tightness of my ligaments, as I am concerned about experiencing similar issues as before.
Thank you.

Chen, 10~19 year old female. Ask Date: 2016/06/26

Dr. Shi Guozheng reply Orthopedics

It may be due to overloading of the left knee, but it's still important to see a physician to check the tightness of the ligaments.
The doctor can perform a physical examination to assess for any instability by applying pressure from the front and back or from the inner and outer sides.
Additionally, an X-ray can be taken to check for any dislocations.

Reply Date: 2016/06/26

More Info

Knee discomfort after ACL (anterior cruciate ligament) surgery is a common concern among patients, especially athletes who are eager to return to their previous activity levels. Understanding the causes of this discomfort and the potential solutions can help in managing symptoms and improving recovery.

Causes of Knee Discomfort After ACL Surgery
1. Post-Surgical Inflammation: After ACL reconstruction, it is normal to experience some degree of swelling and inflammation in the knee joint. This can lead to discomfort, especially when moving the knee or bearing weight.

2. Scar Tissue Formation: The body’s natural healing process can lead to the formation of scar tissue around the surgical site. This scar tissue can restrict movement and cause pain, particularly during activities that require bending or straightening the knee.

3. Muscle Weakness and Imbalance: Following surgery, the muscles around the knee, particularly the quadriceps and hamstrings, may weaken due to disuse. This weakness can lead to instability and discomfort during movement. Additionally, if one leg is favored over the other during recovery, it can lead to muscle imbalances that contribute to discomfort in the non-injured leg.

4. Meniscal Injury or Damage: If there was pre-existing damage to the meniscus or if it was inadvertently injured during surgery, this could lead to ongoing knee pain. The meniscus plays a crucial role in knee stability and shock absorption.

5. Ligamentous Laxity: Some patients may experience a feeling of looseness in the knee, which can be due to insufficient healing of the ligaments or other structural issues. This can lead to a sensation of instability, particularly during physical activities.

6. Patellar Tracking Issues: After ACL surgery, the alignment and movement of the patella (kneecap) can be affected, leading to discomfort in the front of the knee. This is often exacerbated by activities that involve bending or squatting.

Solutions and Management Strategies
1. Physical Therapy: Engaging in a structured rehabilitation program is crucial. A physical therapist can help you strengthen the muscles around the knee, improve range of motion, and address any imbalances. Focus on exercises that target the quadriceps, hamstrings, and hip muscles.

2. Ice and Elevation: To manage inflammation and swelling, applying ice to the knee and elevating it can be beneficial. This should be done regularly, especially after physical activity.

3. Gradual Return to Activity: It’s important to gradually increase the intensity and duration of physical activities. Avoid jumping back into high-impact sports too soon, as this can exacerbate discomfort and lead to further injury.

4. Strengthening Exercises: Incorporate exercises that strengthen the quadriceps, hamstrings, and calf muscles. This can help stabilize the knee joint and reduce discomfort. Exercises such as straight leg raises, wall sits, and step-ups can be effective.

5. Monitoring Symptoms: Keep track of your symptoms and discuss them with your healthcare provider. If discomfort persists or worsens, further evaluation may be necessary, including imaging studies to assess for any underlying issues.

6. Testing Ligament Stability: To assess ligament stability, a healthcare professional can perform specific tests, such as the Lachman test or the anterior drawer test. These tests evaluate the integrity of the ACL and can help determine if there is any laxity.

7. Consultation with a Specialist: If discomfort continues despite conservative measures, consider consulting an orthopedic specialist. They may recommend imaging studies, such as an MRI, to evaluate the status of the ACL and other structures in the knee.

In conclusion, knee discomfort after ACL surgery can arise from various factors, including inflammation, muscle weakness, and potential structural issues. A comprehensive approach that includes physical therapy, gradual return to activity, and close monitoring of symptoms can significantly aid in recovery. If concerns persist, seeking further evaluation from a healthcare professional is essential to ensure proper healing and return to activity.

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