ACL and Meniscus Repair: Post-Surgery Pain and Recovery

Anterior cruciate ligament and meniscus repair?

Hello Doctor, I had surgery on June 29 for a complete tear of both cruciate ligaments and damage to my meniscus.
My attending physician connected the two damaged ligaments to the two intact ones.
Regarding the meniscus, he mentioned that during the surgery, he assessed it several times and determined that no screws were needed.
After the surgery, I have been wearing a brace that keeps my leg fully extended.
However, five days ago during a follow-up appointment, he adjusted the brace to a 50-degree angle.
When I returned home, I experienced pain similar to what I felt before the surgery.
I immediately called the doctor, and he advised me to readjust the brace back to 0 degrees and to return for another follow-up in two weeks.

I have observed a slight swelling in my knee, but I'm unsure if it's due to muscle atrophy or subcutaneous tissue sagging, as it appears more swollen.
Could it be possible that my meniscus has shifted again or that the ligaments have loosened? The pain I feel is located on the inner side of the back of my knee.
This is what I would like to inquire about.
Thank you.

Zhang S, 40~49 year old female. Ask Date: 2021/07/28

Dr. Chen Yongxue reply Orthopedics

Hello, in this situation, it is best for you to return to your original treating physician for further evaluation.
Thank you.

Reply Date: 2021/07/28

More Info

Post-surgery pain and swelling following an ACL reconstruction and meniscus repair are common concerns for many patients. Understanding the potential complications and the healing process can help alleviate anxiety and promote better recovery.
After undergoing surgery for an ACL tear and meniscus repair, it is essential to recognize that pain and swelling can be part of the normal healing process. The knee joint is a complex structure, and surgical interventions can lead to inflammation, which may manifest as swelling and discomfort. In your case, the adjustment of your brace from a fully extended position to a 50-degree angle may have contributed to the pain you experienced. It is not uncommon for patients to feel discomfort when transitioning to more flexible positions, especially if the knee is still in the early stages of healing.

The presence of swelling can be attributed to several factors. First, surgical trauma can lead to fluid accumulation in the joint, known as effusion. This is often a result of the body’s inflammatory response to surgery. Additionally, muscle atrophy can occur post-surgery due to immobilization, which may give the appearance of swelling or a change in the knee's contour. It is crucial to differentiate between true swelling due to fluid accumulation and changes in muscle mass or skin laxity.

Regarding your concerns about the meniscus and ligaments, it is unlikely that the meniscus has "run away" or that the ligaments have loosened so soon after surgery. However, if you are experiencing pain specifically in the posterior inner aspect of the knee, it could indicate several possibilities. One common issue is irritation or inflammation of the surrounding soft tissues, including the ligaments and tendons. Another possibility is that the surgical site is still healing, and the pain may be a sign that the knee is not yet ready for increased movement or weight-bearing.

It is essential to follow your surgeon's recommendations regarding brace adjustments and physical therapy. If you are experiencing persistent pain or swelling, it is advisable to return to your orthopedic surgeon for a thorough evaluation. They may recommend imaging studies, such as an MRI, to assess the integrity of the ACL and meniscus and to rule out any complications such as re-tear or other injuries.

In the meantime, managing pain and swelling can be approached through several methods. Resting the knee, applying ice, and elevating the leg can help reduce swelling. Additionally, engaging in gentle range-of-motion exercises, as advised by your physical therapist, can promote healing without overstraining the knee.

In summary, while post-surgical pain and swelling are common, it is crucial to monitor your symptoms closely and communicate with your healthcare provider. They can provide tailored advice based on your specific situation and ensure that your recovery progresses smoothly. Remember, patience is key in the rehabilitation process, and adhering to your rehabilitation protocol will significantly impact your long-term outcomes.

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