Post-Surgery Symptoms: ACL Tears and Meniscus Damage - Orthopedics

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After undergoing ACL reconstruction and meniscus repair, it is not uncommon for patients to experience ongoing symptoms such as pain, swelling, and instability in the knee joint. Your description of the symptoms—specifically, the inner knee pain when squatting or lifting, the inability to fully extend the knee, and episodes of the knee giving way—suggests that there may be several factors at play.

Firstly, it is important to understand that even after surgical intervention, the knee may not return to its pre-injury state. The surgery aims to restore function and stability, but it does not guarantee a complete resolution of symptoms. The presence of pain and instability can be attributed to several potential causes:
1. Scar Tissue Formation: Post-surgical healing often involves the formation of scar tissue, which can lead to stiffness and reduced range of motion. This can contribute to the sensation of tightness and pain when attempting to squat or lift.

2. Residual Meniscal Damage: Even with repair, the meniscus may not heal perfectly, or there may be residual damage that was not addressed during surgery. This can lead to ongoing pain and mechanical symptoms such as clicking or locking.

3. Patellofemoral Pain Syndrome: After ACL surgery, some patients develop patellofemoral pain syndrome, which is characterized by pain around the kneecap. This can be exacerbated by activities that involve bending the knee, such as squatting.

4. Instability or Weakness: The knee may feel unstable or give way if the surrounding muscles, particularly the quadriceps and hamstrings, are weak. Rehabilitation focuses on strengthening these muscles, but if the program is not sufficient or if there are setbacks, instability can persist.

5. Knee Joint Arthritis: Over time, previous injuries and surgeries can lead to degenerative changes in the knee joint, resulting in osteoarthritis. This can cause pain, swelling, and stiffness.

6. Improper Rehabilitation: If the rehabilitation program is not tailored to your specific needs or if there are lapses in adherence to the program, this can hinder recovery and lead to persistent symptoms.

Given that you have been undergoing physical therapy regularly, it is crucial to communicate these ongoing issues with your physical therapist and orthopedic surgeon. They may recommend further imaging studies, such as an MRI, to assess the status of the ligaments, meniscus, and cartilage. This can help identify any underlying issues that may not be visible on X-rays.

In terms of management, here are some strategies that may help alleviate your symptoms:
- Continued Physical Therapy: Ensure that your physical therapy program includes exercises that focus on strengthening the muscles around the knee, improving flexibility, and enhancing proprioception (the sense of joint position).

- Activity Modification: Avoid activities that exacerbate your symptoms, such as deep squatting or heavy lifting, until you have consulted with your healthcare provider.

- Pain Management: Over-the-counter anti-inflammatory medications may help reduce pain and swelling. However, consult your doctor before starting any new medication.

- Knee Bracing: A knee brace may provide additional support and stability during activities, potentially reducing the sensation of the knee giving way.

- Regular Follow-ups: Keep regular appointments with your orthopedic surgeon to monitor your progress and address any new or worsening symptoms.

In conclusion, while it is frustrating to experience ongoing symptoms after surgery, it is essential to work closely with your healthcare team to identify the underlying causes and develop an effective management plan. With appropriate interventions, many patients can achieve significant improvements in their knee function and quality of life.