Post-ACL Reconstruction: Knee Swelling Years Later

After anterior cruciate ligament reconstruction, a few years later, there is swelling below the left side of the knee at the surgical site?

Hello, doctor.
My right knee was injured during exercise in 2016, and I underwent anterior cruciate ligament (ACL) reconstruction.
The recovery after surgery went well, and I am able to exercise now.
However, in the fifth year post-surgery, I noticed that the area near the surgical site, close to where the temporary fixation screws were placed, has slowly started to swell.
At first, there was no significant swelling or discomfort, so I didn't pay much attention to it.
But in the past few days, I have observed that it has swollen to about half a circle, measuring approximately 4-5 cm in length, 2 cm in width, and a protrusion height of about 0.5-0.8 cm.
Currently, there is no pain, but I feel a foreign body sensation, and it feels somewhat hard to the touch.
I researched and thought it might be a keloid, but upon closer inspection, it doesn't seem to fit that description, although it does share some characteristics of a keloid.
It seems to be growing larger, and since my job involves a lot of climbing, I wonder if it could be related to my work.
However, there haven't been any significant issues for so many years post-surgery, and I try to monitor my activity level and protect my knee as much as possible.
I have scheduled an appointment for an examination at the hospital at the end of the month, but I wanted to consult with you before that.
Thank you for taking the time to read my message.

Suyang, 20~29 year old female. Ask Date: 2023/03/10

Dr. Chen Yongxue reply Orthopedics

Hello, it is possible to have edema at the site of the fixed screw.
Further examination can be conducted.
Thank you.

Reply Date: 2023/03/10

More Info

Post-ACL reconstruction, it is not uncommon for patients to experience various changes in their knee joint over time, including swelling or the development of lumps. Your description of a firm, raised area near the surgical site, which has gradually increased in size, raises several possibilities that warrant consideration.

Firstly, it is essential to understand that after ACL reconstruction, the body undergoes a healing process that can lead to the formation of scar tissue. This scar tissue can sometimes become more pronounced, leading to what is known as a keloid or hypertrophic scar, which may resemble the characteristics you described. Keloids are raised areas of fibrous tissue that form at the site of an injury or incision and can continue to grow beyond the original wound boundaries. However, they are typically associated with discomfort or itching, which you have not mentioned.

Another possibility is the formation of a seroma or hematoma. A seroma is a pocket of clear fluid that can develop after surgery, while a hematoma is a collection of blood outside of blood vessels. Both can occur post-operatively and may present as swelling or a lump. These conditions can sometimes resolve on their own, but if they persist or increase in size, further evaluation may be necessary.

Given that you have been active and your work involves activities like climbing, it is also possible that repetitive stress or minor injuries could contribute to localized swelling or irritation in the knee area. Overuse can lead to inflammation of the surrounding tissues, which might explain the gradual increase in size of the lump you are observing.

It is good to hear that you are planning to visit your healthcare provider for further evaluation. During this visit, it would be beneficial to discuss the following:
1. Imaging Studies: An ultrasound or MRI may be warranted to assess the nature of the lump and determine if it is fluid-filled, solid, or related to the underlying structures of the knee.

2. Physical Examination: A thorough examination by your physician can help differentiate between a keloid, seroma, or other potential issues such as a Baker's cyst, which is a fluid-filled cyst that can develop behind the knee.

3. Symptom Monitoring: Keep track of any changes in size, shape, or associated symptoms such as pain, warmth, or changes in mobility. This information will be valuable for your physician.

4. Activity Modification: If your work involves significant knee strain, it may be worth discussing with your physician whether modifications or protective measures are necessary to prevent further irritation.

In conclusion, while it is not uncommon to experience changes in the knee post-ACL reconstruction, it is crucial to have any new or concerning symptoms evaluated by a healthcare professional. Your proactive approach to monitoring the situation and seeking medical advice is commendable and will help ensure that any potential issues are addressed promptly.

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