Anterior Cruciate Ligament (ACL) surgery is a common orthopedic procedure performed to repair or reconstruct a torn ACL, a band of tissue that stabilizes the knee joint. Understanding what to expect regarding pain is helpful for individuals undergoing this procedure.
Expected Pain Levels and Timeline
Immediately following ACL surgery, the pain is most intense during the first 24 to 72 hours. This acute pain is manageable with prescribed medications. Patients often experience significant pain reduction over the first two weeks post-surgery, with very little discomfort by the end of this period. Swelling and bruising are also common during this initial phase.
As the weeks progress, the pain shifts from sharp surgical pain to a more generalized discomfort associated with healing and rehabilitation exercises. By three months, pain reduces, often described as annoying and occasionally more noticeable. This improvement continues, with pain significantly reducing by six months post-surgery.
A year after surgery, mild pain may still be present for some, though it continues to improve over time. Residual aches or stiffness can persist for several months, particularly during physical activity or in response to weather changes. Individual pain experiences can vary considerably.
Managing Post-Surgery Pain
Effective pain management is important for recovery following ACL reconstruction. Pharmacological options include prescribed opioid pain relievers for short-term, severe pain, which are tapered off as discomfort lessens. Over-the-counter medications like nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and acetaminophen can also help manage milder discomfort and inflammation. Nerve blocks and regional anesthesia are used immediately after surgery to reduce acute pain and opioid use.
Beyond medication, non-pharmacological strategies are also beneficial. The RICE method—Rest, Ice, Compression, and Elevation—is recommended. Applying ice packs for 15-20 minutes several times a day helps reduce swelling and alleviate pain. Elevating the affected leg above heart level minimizes swelling and discomfort, while compression bandages provide support.
Physical therapy plays an important role in pain reduction by guiding early, gentle movements to prevent stiffness and improve circulation. Controlled exercises help regain range of motion and strengthen muscles around the knee joint. Distraction techniques and adequate rest also contribute to overall comfort during the recovery period.
Factors Affecting Pain Levels
Several factors can influence an individual’s pain experience after ACL surgery. Personal pain tolerance varies. The type of graft used can also affect pain; autografts, which use the patient’s own tissue (e.g., patellar or hamstring tendon), may cause more donor site pain than allografts, which use donor tissue.
The specific surgical technique employed, such as minimally invasive procedures, can result in less tissue damage and a more comfortable recovery. The presence of other injuries, such as meniscus tears or cartilage damage, alongside the ACL tear can lead to increased pain. Adherence to post-operative instructions and consistent participation in physical therapy are also important in managing pain and promoting healing. Psychological factors, including anxiety or fear about the recovery process, can also influence perceived pain levels.
When to Seek Medical Advice
While some pain is expected after ACL surgery, certain symptoms require medical attention. Uncontrolled or worsening pain despite medication could indicate a complication. Signs of infection, such as fever above 101°F (38°C), excessive redness, warmth, or pus draining from the incision site, require evaluation.
New or worsening numbness or tingling in the foot or calf should be reported, as this could signal nerve injury or a blood clot. Excessive or sudden swelling that does not subside, or persistent calf pain, can indicate a deep vein thrombosis (DVT). Any feeling of instability in the knee or a decrease in the ability to fully extend or flex the knee are also concerning symptoms.