Post-ACL Surgery: Key Concerns and Recovery Tips for Patients

Post-operative issues related to cruciate ligament surgery?

Hello, doctor.
In mid-December, I injured my left knee while playing basketball.
After some time for swelling to subside, it was determined that I had damage to the anterior cruciate ligament (ACL) and a complete tear of the posterior cruciate ligament (PCL).
I underwent ligament reconstruction surgery on January 17.
During the arthroscopy, it was observed that the PCL injury was classified as grade 4, while the ACL was classified as grade 2.
Therefore, I only had the PCL reconstruction, using a graft from the medial collateral ligament (MCL) of my left knee.
I asked my attending physician how the graft was attached, and he mentioned that it was secured with screws.
It has now been six weeks since the surgery, and I have been wearing a BREG extension-flexion brace.
I can bend my knee to over 120 degrees, but I still cannot fully flex it.
My thigh muscles seem to have atrophied a bit due to limited activity.
I have been consulting the rehabilitation department for some rehabilitation methods and have started strengthening my thigh muscles.
However, the therapist advised me not to squat too low while standing, as it may risk re-injuring the ligament.
Therefore, I would like to ask the doctor the following questions: 1.
Under what circumstances can the reconstructed ligament re-tear? 2.
My knee still has some swelling post-surgery; how can I reduce this swelling? 3.
How long should I use crutches before I can safely stop? 4.
How long will it take for the graft from the MCL and the injured ACL to heal? 5.
Recently, I have been doing more rehabilitation exercises involving bending my knee, and I have experienced some soreness below the patella.
Is this likely to cause significant damage to the patella?

Sam Wang, 20~29 year old female. Ask Date: 2005/02/28

Dr. Ye Qingnian reply Orthopedics

If you have undergone anterior cruciate ligament (ACL) surgery, you should consult your orthopedic surgeon regarding rehabilitation and care, as they are most familiar with your injury and surgical details.

Reply Date: 2005/02/28

More Info

Post-ACL surgery recovery is a critical phase that requires careful attention to rehabilitation and lifestyle adjustments. Here are some key concerns and tips for patients who have undergone ACL reconstruction, particularly focusing on your specific situation.

1. Risk of Re-injury: After ACL reconstruction, the newly formed ligament is still maturing and may be vulnerable to re-injury, especially in the first few months post-surgery. Factors that can lead to re-injury include returning to high-impact sports too soon, improper technique during physical activities, and inadequate strength in the surrounding muscles. It’s essential to follow your physical therapist's guidelines regarding activity levels and to gradually increase intensity as your strength and stability improve.

2. Managing Swelling: Post-operative swelling is common and can be managed through several methods. Elevating the leg, applying ice packs for 15-20 minutes several times a day, and using compression wraps can help reduce swelling. Additionally, gentle range-of-motion exercises can promote circulation and decrease fluid accumulation. If swelling persists or worsens, it’s crucial to consult your physician, as it may indicate complications such as infection or issues with the graft.

3. Use of Crutches: The duration for which you should use crutches varies based on your recovery progress and the advice of your healthcare provider. Generally, crutches are used until you can walk without a limp and have regained sufficient strength and stability in your knee. Your physical therapist will guide you on when it is safe to transition away from crutches, typically when you can bear weight comfortably and perform basic movements without pain.

4. Healing Timeline: The healing time for the reconstructed posterior cruciate ligament (PCL) and the injured anterior cruciate ligament (ACL) can vary widely among individuals. Generally, it can take anywhere from six months to a year for the ligaments to heal sufficiently for a return to high-impact sports. However, full recovery may take longer, depending on factors such as age, overall health, and adherence to rehabilitation protocols. Regular follow-ups with your orthopedic surgeon and physical therapist will help monitor your progress.

5. Knee Pain and Patellar Health: Experiencing discomfort beneath the patella (kneecap) during rehabilitation is not uncommon, especially with increased bending and strengthening exercises. This pain can be attributed to several factors, including patellar tendinitis or irritation due to changes in biomechanics after surgery. It’s essential to communicate this discomfort to your physical therapist, who can adjust your rehabilitation program to alleviate pain while ensuring you continue to strengthen the knee. They may incorporate specific exercises to improve patellar tracking and reduce strain on the knee joint.

In conclusion, post-ACL surgery recovery is a multifaceted process that requires patience and diligence. Adhering to your rehabilitation program, managing swelling, and being mindful of your body’s signals are crucial for a successful recovery. Always consult with your healthcare team regarding any concerns or changes in your condition, as they can provide personalized guidance based on your specific situation. Remember, the goal is to regain full function and return to your desired activities safely.

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