Managing Knee Pain and ACL Injury After Fracture: A Patient's Guide

Anterior cruciate ligament (ACL) tear, knee swelling and pain?

Hello Dr.
Shi,
Last October, I fell off my motorcycle and fractured the neck of my left femur.
When I was taken to the hospital, my thigh injury was more severe, and my knee appeared to be fine, so it wasn't given much attention.
In January of this year, due to malalignment and poor healing of the femur, I underwent surgery again to have a steel rod inserted.
After the surgery, knee issues gradually surfaced.
At its worst, my knee was very swollen and painful, making any movement excruciating.
In February, after undergoing arthroscopy, the pus and blood inside were drained, and I felt much better.
However, just a few days later, it swelled up again, though it was not as painful as before.
I also had an MRI, and after a thorough examination, the doctor diagnosed me with a torn anterior cruciate ligament and wrote "pyogenic arthritis" in the diagnosis report.
Currently, my thigh is nearing healing, but my knee remains swollen and painful.
I can only bend it to a maximum of 150 degrees, and it feels very tight.
Sometimes it feels warmer than my other leg, and I experience pain behind the knee when bending.
I would like to ask you:
1.
Should I apply ice or heat to my knee? Is massage advisable?
2.
Is it better to keep my knee straight?
3.
During my recovery, my left leg has been very inactive, leading to noticeable atrophy in my left buttock, and I even have swelling in my foot.
I want to start some rehabilitation exercises, but any attempt worsens my knee issues.
If I don't exercise, I'm concerned about muscle atrophy.
What should I do?
Thank you very much.

Wú jìn yì, 40~49 year old female. Ask Date: 2006/03/11

Dr. Shi Guozheng reply Orthopedics

If the stability of the anterior cruciate ligament (ACL) tear in the knee joint is sufficient, there may not be an urgent need for surgical intervention.
Typically, rehabilitation therapy can be initiated to strengthen muscle power and enhance the stability of other tendons around the knee joint.
Surgery should only be considered if these measures are insufficient.
Additionally, you have septic arthritis, which complicates the situation; it is essential to treat it with antibiotics to completely eliminate the bacteria for any improvement to occur.
If there is currently warmth in the joint, cold compresses or ice packs should be applied.
The lack of movement in the left thigh will inevitably lead to muscle atrophy, so it is crucial to begin rehabilitation as soon as possible for improvement.
Please consult your attending physician for clarification on the treatment direction.

Reply Date: 2006/03/11

More Info

Managing knee pain and addressing an ACL injury after a fracture can be quite challenging, especially following a significant trauma like a motorcycle accident. Your situation involves multiple complexities, including a previous thigh fracture, subsequent surgery, and now the development of knee issues, including a suspected ACL tear and possibly septic arthritis. Here’s a comprehensive guide to help you navigate your recovery.

1. Cold vs. Heat Therapy
For your current condition, ice therapy (cryotherapy) is generally recommended, especially in the acute phase of injury or when experiencing swelling. Ice can help reduce inflammation and numb the area, providing pain relief. Apply ice packs for 15-20 minutes every couple of hours, ensuring you have a cloth barrier to protect your skin.

Heat therapy, on the other hand, can be beneficial once the initial swelling has subsided. It helps to relax and loosen tissues and stimulates blood flow to the area. However, since you are still experiencing significant swelling and pain, it’s best to stick with ice for now.

2. Knee Positioning
Keeping your knee in a straight position can be beneficial, particularly if you are experiencing swelling. Elevating your leg while resting can help reduce swelling. However, it is also important to gently move your knee through its range of motion to prevent stiffness. If you find that keeping it straight exacerbates your pain, you may need to find a balance that allows for some gentle flexion without causing significant discomfort.

3. Physical Activity and Rehabilitation
Given your concerns about muscle atrophy and the swelling in your knee, it’s crucial to engage in rehabilitation exercises that are appropriate for your condition. Here are some steps to consider:
- Consult with a Physical Therapist: A physical therapist can design a tailored rehabilitation program that considers your knee's current state and your overall recovery goals. They can guide you through exercises that strengthen the muscles around your knee without exacerbating your pain.

- Gentle Range of Motion Exercises: Start with gentle range-of-motion exercises to maintain flexibility. These can include heel slides or ankle pumps, which can be done while sitting or lying down.

- Isometric Exercises: These exercises involve contracting the muscles without moving the joint. For example, you can try tightening your quadriceps while keeping your knee straight. This can help maintain muscle strength without putting undue stress on your knee.

- Avoid High-Impact Activities: Activities that put stress on your knee, such as running or jumping, should be avoided until your knee has healed sufficiently.

4. Monitoring Symptoms
Pay close attention to your symptoms. If you notice increased swelling, redness, or warmth in your knee, or if the pain worsens significantly after activity, it may indicate that you are overdoing it or that there is an underlying issue that needs to be addressed. In such cases, it’s essential to consult your healthcare provider.

5. Medication Management
If you are experiencing significant pain, over-the-counter pain relievers like NSAIDs (e.g., ibuprofen) can help manage discomfort and reduce inflammation. However, always consult with your doctor before starting any medication, especially if you have other health conditions or are taking other medications.

6. Long-Term Considerations
Given your diagnosis of septic arthritis, it’s crucial to follow up with your orthopedic surgeon or rheumatologist. They may recommend further imaging or interventions, such as aspiration of the joint or additional surgical procedures, depending on the severity of the infection and the state of your ACL.

Conclusion
Your recovery from a knee injury, especially following a complex fracture and surgery, requires a multifaceted approach. Focus on managing pain and swelling, engage in appropriate rehabilitation exercises, and maintain open communication with your healthcare team. With patience and proper care, you can work towards regaining strength and function in your knee. Always prioritize your safety and comfort during this process, and don’t hesitate to seek help when needed.

Similar Q&A

Effective Strategies for Managing Persistent Knee Pain: A Comprehensive Guide

Dear Dr. Lee, I have been experiencing knee pain for the past two years, which has caused significant inconvenience in my daily life, especially since I used to enjoy walking and hiking as forms of exercise. I have sought medical attention multiple times, but the opinions have v...

Dr. Li Wenlin reply Orthopedics
Hello: In response to your question, based on your description, possible diagnoses include patellar chondromalacia or subluxation, avascular necrosis of the femoral condyle, and degenerative arthritis. The diagnostic tools should be utilized in the following order: 1. Standing kn...

Effective Strategies to Alleviate Knee Pain from Sports Injuries

Hello Doctor: My brother is currently studying, but he is under a significant physical burden with a fixed training schedule every day. Recently, for more than a week, he has frequently reported experiencing pain in his knee. In the past few days, the pain has been so severe that...

Dr. Yang Nanping reply Orthopedics
Hello: Based on the description, it may be quadriceps tendonitis. If there is also tenderness at the knee joint interface, there may be associated cartilage damage. Rest is the most important principle in treating this type of sports injury. Other measures, such as wearing a knee...

Managing Post-Surgery Knee Pain: Effective Strategies and Next Steps

On August 15, 2023, the patient underwent arthroscopic surgery on the left knee, including chondroplasty, drilling, and high tibial osteotomy with internal fixation using a plate. Postoperatively, the patient has experienced persistent pain on the medial side of the knee (difficu...

Dr. Chen Yongxue reply Orthopedics
Cold compress, elevation, elastic bandage, and analgesics.

Managing ACL Injury: Tips to Delay Further Knee Damage

Hello, I recently suffered a torn anterior cruciate ligament (ACL) while playing basketball. The doctor recommended surgery, but due to work commitments, I cannot take time off for at least six months. However, I have recently noticed discomfort in my knee even while standing, an...

Dr. Hong Ximing reply Orthopedics
Hello: For a complete tear of the anterior cruciate ligament (ACL), it is essential to confirm the diagnosis first. If it is a complete tear, surgery will be necessary to reconstruct the ligament using a graft from other ligaments. In the meantime, it is important to use a knee b...