The visual recovery of the knee following Anterior Cruciate Ligament (ACL) reconstruction surgery changes significantly from the immediate post-operative period to the months and years that follow. Understanding these expected visual changes helps patients monitor their healing process. The initial appearance is dominated by the body’s temporary response to trauma, which eventually gives way to the lasting visual markers of the procedure: the surgical scars. Knowing what is typical allows patients to focus on rehabilitation and recognize signs that may require urgent medical review.
Immediate Post-Surgical Appearance
The operated knee is initially encased in a substantial dressing, often including an Ace wrap and sterile padding, sometimes coupled with a rigid brace. This bulky appearance provides compression, absorbs drainage, and protects the surgical site. Beneath this protective layer, the body’s natural response to surgical trauma is immediately visible through swelling and bruising.
Swelling is an expected response, often making the operated knee appear noticeably larger than the non-surgical knee. This fluid accumulation is usually most pronounced between the second and fifth days following the operation. Managing this swelling is important because excess fluid can inhibit the quadriceps muscle, making early movement and strengthening more difficult.
Bruising results from the disruption of small blood vessels during the procedure and is typically dark blue or purple in the early days. This discoloration often tracks downward due to gravity, sometimes spreading across the shin or reaching the ankle and foot. Over the following one to two weeks, the bruise progresses through a color spectrum, fading from dark hues to green and then yellow before fully resolving.
Understanding Your Incision and Scars
Once the initial dressing is removed, typically within the first week, the visual markers of the surgery become apparent. Modern ACL reconstruction is an arthroscopically assisted procedure involving two distinct types of incisions. The most numerous are the small arthroscopic portal sites, usually two to four tiny cuts, each about half a centimeter to one centimeter long, located around the knee joint.
The second, more substantial incision is the graft harvest site, whose location and length depend on the tendon used. A hamstring autograft leaves a scar of approximately three to five centimeters on the inner side of the knee. A patellar tendon autograft typically leaves a short, straight scar at the front of the knee, just below the kneecap.
In the immediate weeks following surgery, fresh incisions are held closed with sutures, staples, or adhesive strips, appearing raised and bright red or purple. After closure materials are removed, the scar enters a maturation phase lasting 12 to 18 months. During this process, the scar tissue, initially thick and highly colored, will gradually flatten and soften. The color slowly fades from red or pink to a pale, thin line that matches the surrounding skin tone.
Visual Signs That Require Medical Attention
While swelling, bruising, and fresh incisions are normal, certain visual changes signal a potential complication and warrant immediate contact with a healthcare provider. Abnormal wound drainage differs from the small amount of clear or pink-tinged fluid typical in the first few days. Drainage that becomes thick, cloudy, foul-smelling, or appears as continuous, heavy bleeding is a sign of potential infection.
Localized signs of infection around the surgical site include rapidly spreading redness, called erythema, which extends outward from the incision and feels hot to the touch. This intense, persistent color change is concerning, particularly if it worsens instead of improves after the first week.
Visual cues for a Deep Vein Thrombosis (DVT), or blood clot, in the leg are important to recognize. The most common visual symptom is sudden, disproportionate swelling confined to one leg, typically in the calf or thigh, that does not resolve with elevation and rest. This swelling may be accompanied by a change in skin color, such as unusual redness or dusky discoloration, and increased prominence of superficial veins.