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Pain 1 week after ACL surgery

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hi there,

I am 1 week out of ACL surgery and still in a great amount of pain. I did the hamstring graft and the surgery went well, but I can barely even walk with crutches while someone holds my leg up. I had to get a wheelchair so I can get to therapy today. I take the pain medicine every 4 hours and it helps, but I feel like I am not improving yet Sad the majority of pain is coming from the posterior medial incision, as well as the hamstring incision behind my kneecap.

I've read a lot of posts where people are off their medication after the 5th day and I just don't understand how. Am I normal??

I also have a question--should I be wearing the brace when I try to crutch? I feel like the brace is so heavy and it makes my leg hurt worse. I'm a small girl (5'2" and 105lbs), so could the brace be causing me more pain?

Thank you!
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First Helper Wharfie
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replied November 4th, 2011
Especially eHealthy
Emac,

Everyone is different in how they react to pain and surgery. ACL surgery is a major orthopedic procedure and by no means as walk in the park. But, you have to do therapy, or the surgery is all for naught. Even if the surgeon did a perfect ACL surgery, if therapy is not done, the surgery will fail.

Most patients, who do well after surgery, have been in physical therapy for several months before the surgery was even performed. Those patients who have regained full range of motion, had no swelling in the joint, and were at least 75% as strong as the opposite knee, seem to do the best. Which is why many orthopedic sportsmedicine surgeons will not do an ACL reconstruction until these parameters have been met.

Doing therapy before surgery also gives the patient a idea of what therapy is going to be like after surgery. So, there are no surprises.


But, anyways, you are where you are. As to the brace, you should wear it exactly like the surgeon instructed. Most surgeons use it to protect the graft during the first few weeks, until the graft is incorporated, and can take the stresses applied to it. Most patients also feel safer and more comfortable in some type of brace, at least at first, and especially when getting up. Post-op Range of Motion braces do not weigh very much. They may top out at around a pound, maybe a little more than a full can of Coke. (I was in one of these braces for over a year. I have several of them in my closet.) You can probably take it off, or at least loosen it while resting on the couch, but when you are up, it should be on (unless the surgeon said you could go without it).

The brace may not be fitting you well and may need to be adjusted. Have the physical therapist take a look at it when you go into therapy. Short patients have more difficult time in getting the brace to fit properly.


Again, everyone is different in their pain tolerance. But, pain is also greatly modulated by attitude and perceptions of the patient. Patients who are highly motivated and have a positive attitude do much better in the whole rehab program.

Patients who incorporate alternative methods of pain control, besides opioids, also have an easier time. Though you will probably need opioids for sometime yet, you do need to start developing a program of pain management, tailored to your personal karma. Besides the usual ice and elevation (which are going to be your companions for months to come and probably off and on forever), you can start to gather techniques to calm and center you, to help control your pain, and motivate you for the long road ahead.

Some patients like to meditate, listen to music, use biofeedback or relaxation techniques. Later on, after the wounds are healed, things like whirlpool, hot tub, water therapy are great to get the tissues warmed up and pliable for therapy.

These are all things you can discuss with your physical therapist.


At the beginning of an ACL reconstruction therapy, every surgeon has his/her own protocol, pretty will outlined for the first three months or so. But, the first thing that is emphasized is for you to get the knee completely straight, right off the bat, and then to work on range of motion. This is extremely important.

So important, that if a patient is not getting his/her motion back within the first six weeks or so, many times the patient is returned to the operating room for a manipulation under anesthesia. Then the patient is usually put in continuous passive motion (CPM) machine to continually move the knee right after the surgery.

So, your first therapy sessions are going to be mostly getting your knee to move.

Also, getting your knee straight is more important at first, than bending the knee. Developing a flexion contracture can be disastrous. Be sure that when you are resting and have your knee elevated, that it is elevated in a straight line. Do not drape the knee over a pillow (even though that is the most comfortable position, it is the worst way you can elevate the knee).


Thus, you are not abnormal. Many people have significant pain after an ACL reconstruction. But, you do need to get ahead of it and on top of it. Have the therapist work with you on crutch gait training, transfers, and just generally getting around the house. Do not become depended upon the wheelchair. That leads to deconditioning and patients having more problems with the over all rehab. You need to be building up the muscles in your upper extremities. Women usually have more difficulty with this, because they usually have weaker shoulder girdles than men. But, you have proper weight on your side, so that should not be a problem. Patients often gain weight during rehab, unless they are up and about, burning off those calories.


So, again, you are not abnormal. Work hard in PT. Start developing pain management techniques. And discuss any concerns you have with your surgeon and therapist. See if the therapist can give you some things to do at home for your rehab, besides the stuff you are going to do with the therapist. Good luck, hope your knee heals well, and you get back to the activities that you like to do.


(Oh, by the way, the posterior medial incision is where the hamstring graft was taken from. The incision on the front of the knee is where they put the graft through into the knee. You may also have some wounds from an arthroscopy, if the surgery was arthroscopically assisted, as most are now days. It is very common for the harvest site to ache, especially since it gets pulled on, every time the hamstrings are fired.)


Again, good luck. You are going to do fine. Just keep an upbeat attitude and work hard in PT.
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replied July 13th, 2012
I see here you say not to elevate the knee with a pillow can you describe the best way to elevate.
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replied July 14th, 2012
The best way to elevate is to put some pillows at the heal of your foot. This way you feel a good stretch under your knee! After acl reconstruction, the most important thing to focus on is getting your knee to straighten out as soon as possible. If you don't this will cause more problems down the road. The flexing of the knee is important too, but not as important. You do not want to put the pillows under your knee as this will cause your knee to bend and make it more difficult to work on getting it straight. Good luck and I highly recommend you stick with your PT visits and home stretches they tell you to do.
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replied November 4th, 2011
Thank you, Gaelic..I really appreciate all the information. I actually was in therapy for 6 weeks before surgery to try and get my range of motion back. I wasn't able to extend or flex all the way, but did the best we could. My surgeon manipulated my knee before performing the surgery, so that's good.

I have been doing my leg raises for the past few days and have my first PT visit this afternoon. Im very motivated and ready to get the show on the road. I know it will be painful but I am ready to do the best I can. Unfortunately i dont see how i can get off the pain meds just yet, but as soon as i can i will. Thank you for the great encouragement Smile

Is my post op brace supposed to be different than my pre-op brace?? Because I'm wearing the same one. It feels like it weighs more than a can of coke. I have small legs and it does just feels bulky. When I take it off, my pain subsides some what. The brace didn't hurt me pre-op, just post op..
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replied November 4th, 2011
Oops I sent submit before I was finished. Just wanted to say thanks again for all the advice and info Smile)
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replied November 4th, 2011
Especially eHealthy
Emac,

The usual post-op range of motion brace is a long leg brace that has light weight, long, aluminum hinges on both sides, which are basically held on by light foam cuffs above and below the knee. Some have full foam pads for the whole thigh and calf, while other brands just have foam strips where the straps go around the limb. The uprights are attached to the foam with velcro. So, this type of brace is very light weight and very adjustable.

However, some surgeons just use an actual ACL sports brace, with is shorter, much stouter, more form fitting, and a bit heavier (but still not much heavier, otherwise the athlete could not use it). It's a way to save money. But, because these braces are usually fitted to the leg (both the custom made and the off the shelf ones) more closely (because it is meant to be played in, you don't want it slipping), after surgery with the dressing and swelling, it may not fit quite right.


So, of course, I do not know which brace you were put in after your injury, before the surgery. Braces really do not weigh very much, it just seems that way because your knee is hurting. Have your therapist take a look at its fit. He/she can adjust the brace as needed, so that it is more comfortable. The brace should not be causing a lot of discomfort. Be sure that you do not have the straps cinched down too tightly. Have the therapist make sure the brace is not rubbing on one of the incisions.

If the brace is just causing too many problems, you might ask the surgeon if he/she can switch to a different type of brace or a different manufacturer. There are hundreds of post-op braces out there, and there are ones specifically made for short adult female athletes. All it takes is a call to one of the brace reps.


I would not expect you to be off pain meds for a while yet. Some patients require opioid pain meds for several weeks. And in some cases, patients still need an occasional dose before a significantly intense therapy session, a couple, three months after surgery. Yes, there is the rare patient who does not need much pain medicine at all, like my spouse. Who has dental work done without any novacaine!! Not me, give me the medicines.

Most patients do not start getting into trouble with opioid dependency, until they have taken the medication regularly for about 4 to 6 weeks. Of course, everyone is different. Physical dependency usually takes that long to occur, but, psychological dependency can occur after just one dose in some people. Also, dependency and addiction are not the same thing, though they are often used interchangeably by persons who are not familiar with their definitions.

Physical dependency is a normal adaption by the body to continued administration of opioids. The use of exogenous opioids resets the body's "opioid thermostat". And as such, when the increased amount of opioids are not given to the brain, the body goes into withdrawal symptoms. This is just a physiological response, it is not addiction.

Addiction is a maladaptive behavior, in which the person continues to take opioids even when there is not need for them, takes the medicine in higher than prescribed doses, spends the majority of their time seeking ways to get the drugs, and continues to take the medicine even though they know it is harming them.

So, you can see the difference between dependency and tolerance, and between addiction and abuse. They are not interchangeable. But, you are just in the acute post-op period, so you don't need to be worrying about this stuff yet. Just a little, in terms of developing you stable of techniques for pain control down the road. Like getting all of your favorite music to listen to, obtaining candles for aroma therapy, ice and hot packs, or maybe a yoga mat. Things like that.


Work hard in PT, that is going to be your life for a while. And even though surgeons hate to admit it, therapy IS the MOST important part of a successful operation.

Your mottos are going to be things like; "Use it of Lose it" and "Motion is lotion" for many months to come.

Remember, extension, full extension of the knee is the most important first goal. Really work hard on that one thing. I have, unfortunately, seen some technically perfect ACL surgeries fail, because the patient could never quite get the extension needed. Resulting in a flexion contracture and arthrofibrosis, which caused the patients to walk on their toes, and never getting back to running or other activities.


So, have the therapist look at your brace. If it cannot be adjusted so it fits well and is comfortable, see if you can get a different one. Work hard in PT, to get full extension (flexion will come, its extension that's difficult). Start developing your pain management techniques, but don't worry too much about the medicine right now, you still very much need it.


Have fun in PT. (You do know that PT stands for pain and torture, just kidding!!) And have a great weekend. You are going to do just fine.
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replied July 10th, 2012
I had acl reconstruction with patellar graft done 10 days ago (surgery on 6/29/12 today is 7/10/12}. My surgeon is pretty anti brace/immobilizer. I actually took it off after about 3 days and have been using one crutch. I still feel pain and get stiff, especially at night time. Then I find it that actually putting my brace on at night for While helps me. Unfortunately I haven't had a good night sleep since my surgery, I will say that it's getting better. I have been going to PT 3 times a week and started just 3 days post op. I'm thinking that 4-8 weeks should do it for me with pt. I just make sure to keep doing all your pt exercises/homework at home too. I have an 18 month old which mitigates me more than anything to just get through this as quickly and safely as possible! I miss wrestling with her and so does she! Anyways, didn't mean to hi jack your post, but wanted to share my experience. Good luck to all going through this major surgery.
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replied September 4th, 2012
Acl reconstuction
Hi,

I've just had acl reconstruction with graft from my hamstring. Stopped using crutches after 3 days and now down to one painkiller a day, Only day four today and have to say self help is the best remedy. Follow all your pt exercises and go through the pain barrier.

Read read and read more about experiences as everyone's experience is different.

Good luck to everyone who is going through and going to go through Acl reconstruction
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replied September 14th, 2012
I had knee surgery (Arthroscopy) February 10th and in September I am still feeling sharp pain and stiffness in the knee. Yes, I did have physical therapy for six weeks. I was doing fine and then I began to regress. The knee began to hurt real bad, the back of my knee was very painful. That pain would go to my foot and become very painful and weak around the ankle which makes it difficult to walk.
I have had tests for blood clots and those tests proved negative. What can the problem be? I have been told that I need total knee replacement but I am afraid that my foot will become really nonfunctional then. What do you think?
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replied September 15th, 2012
Especially eHealthy
vorried,

It is not uncommon for patients to have referred pain in the extremities. If you have signficant pain in the knee, which is preventing you from continuing to keep our muscles strong, then you may develop problems in the ankle joint.

If you have severe degenerative changes within the knee joint, where you have tricompartmental destruction of the joint surface, and nonoperative treatment has not reduced your discomfort, then a total joint would be an option.


You should discuss all of your concerns with your orthopedic surgeon (as he/she knowns your case and has access to all of your studies).

Good luck.
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replied June 4th, 2013
I am now 4 days post ACL reconstruction using a donor ligament. I am so very grateful for having stumbled upon this blog as I couldn't straighten my leg before the surgery let alone after. I am now following the advise of the elevation using a straight leg. I had NO idea how I was going to accomplish this.

I am concerned about these severe electrifying shocks that hit my knee while at rest with no warning. I literally feels as though someone jams a 220 live plug into my knee. The shock runs all the down my leg and into my foot, and sometimes up my quad as well. They are so painful they cause me to scream and sometimes even cry. I'm also having random muscle spasms throughout my body. These are not painful, however, but sometimes they are hard enough it's as though I am punching or kicking someone. I stopped the use of the Nucynta on 6-2-13 at 4:30pm. I also learned that the anesthesia can cause this side effect. My surgery was 4 days ago. Wouldn't the side effects be gone by now? My main concern is the electrifying pain while at rest. Is there anything I can do for this?
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replied June 4th, 2013
Especially eHealthy
amillionpets,

Unfortunately, it is not uncommon for the random "electrical shocks" and muscle spasms to continue for some time after a major extremity surgery. It is still not known what actually causes these symptoms, but they are very common in patients undergoing orthopedic surgery. And, it often seems that they tend to get worse when the patient tries to hold the limb very still.

So, though they will start to get fewer and fewer (and less severe in nature), you can expect to have these until you are back to doing significant activity. Again, it is not known why these occur, but some thoughts are that because the limb is not being stimulated like usual, the nerves just randonly fire and the muscles contract (spasm). As a result, some patients find a light massage of the limb helps these symptoms.

Wishing you the best. Good luck with your upcoming rehab. Concentrate on getting the knee into full extension in the next couple of weeks. That is the first major goal in ACL rehab protocols.

Again, good luck.
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replied June 29th, 2013
Acl recovery
Hello everyone, I am so glad I found this active post! I had surgery last Friday. I had a cadaver ligament used for reconstruction of my acl. I also tore part of my mcl and he smoothed that out as well. I am basically off pain medicine besides maybe a dose or two a day depending on how long I wait before getting up or how long I am standing on one leg. I per say am still in a large amount of pain, but the nausea and not being able to eat much is getting to me more as I am into eating right and being healthy. I have to drink sprite and eat crackers to somewhat ease my nausea since I ran out of nausea medicine.

If anyone else is having nausea trouble, I suggest keeping a cold ice pack on your knee for your usual on and off icing of your knee as it helps keep your mind off of the nausea, I am not a fan of soda at all EVER, but I have to say as much as I hate it the sprite does work. It may just be the placebo effect, but I will take it. I can't drink water as it just makes me more nauseas. I will try drinking my usual tea tomorrow when I actually have someone at the house to help me. I have heard many different teas can help with nausea, but peppermint is the best. I will update tomorrow on that one.

Thank you all again for stressing on keeping the leg elevated at the heel or calf! My mother and girlfriend who was coherent at the end of my surgery was never told to elevate my foot this way. I have been elevating my whole leg, starting from my below my knee if not further toward my hip all the way down to my heel. At times when I am in absolute severe pain I have to put a pillow just behind my knee.

To OP: my case may be different, but I am used to living in severe pain with a condition that has lucked out to be my opponent. This acl cadaver reconstruction is very painful. I have also had labrum surgery and they fixed the head of my bicep that I tore in my shoulder. They are equally painful. The shoulder was probably more annoying being stuck for months with my arm pinned to me and not being able to move. I think the knee recovery is just more complicated in terms of for the patient as when you have to get up, move, shower, crutch around, get in and out of cars, and just about anything you are stuck on one leg while the other is being swayed, moved, jarred, needed for balance or etc and causing more pain. This surgery recovery is very awkward and causes more pain to yourself which could be avoided if you had maids. Lol. I would prefer this over shoulder any day besides the annoyance of being bed bound. Lol. I hope your surgery went well! Coming from someone who has already had a 6 month wait before being able to move my arm and having barely any movement. I done physical therapy for almost a year. I second the notion it is the more important thing of having surgery. It may sound odd, but without it we would all get reinsured and not be able to have normal ROM. They work hand in hand though and are equally important.

Sorry for the long post, I have nothing better to do. Lol. Also, I would love some tips of how to elevate my leg with just a pillow under my heel or calf. I can't leave it like that for more than 20 minutes. Which, i may just keep at 20 minutes as it causes a ton of pain and discomfort in my knee. I am worried since the surgeon didn't tell anyone to do it since I am in a special case I may be causing harm. I have just been building up in time by adding a few minutes each time.
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replied August 3rd, 2013
ACL Reconstruction Day 6
Hi, I am a 45 year old female and I had my ACL reconstruction six days ago using a graft from my own hamstring. I am a "recreational" Masters athlete and tore my ACL while training. I had physio for 7 weeks before I decided to bite the bullet and have the reconstruction. One week on and I am still on medication every 6 hours or so, including during the night. I feel the pain is decreasing each day, slowly, but my main pain is around the wound area at the front of my knee - it feels as if someone is stretching my skin around my leg, and I also get pain under my knee/thigh (from the graft I guess). I find this makes sitting on a hard chair for too long quite uncomfortable, e.g. when having dinner or out in a cafe as I tried to do yesterday for the first time. I am still regularly icing and elevating and doing the exercises given to me by the physio in hospital, 3 times per day at home. I start attending my own physio tomorrow. The hardest and most painful thing at the moment is trying to straighten my leg but I am persisting! I am getting around the house with one crutch but use 2 when I go out. I've never written a post before but I wanted to give the experiences of a middle aged woman who has undergone this operation. Hope it helps someone.
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replied August 24th, 2013
I'm a 36 female and just had surgery a week ago. Wow , I don't think anything could have prepared me for what was ahead. I also was glad this was a current post because I'm really only finding comfort in experiences of others. I started PT yesterday and am petrified that I won't be able to straighten my knee :/ anyone know how long that takes ?
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replied August 25th, 2013
Hi. I too was terrified about getting my leg straight as it had been bent for 7 weeks prior to surgery and I knew it was going to be a painful task to get it straight, but it is vital to get walking normally again, so it had to be done. Once my physio showed me how to get it straight, it took me 2 days. That was last week and I am still finding that I have to do the straightening exercise daily as I find that my leg does tend to get a slight kink in it over the day if I don't, especially after sitting for a couple of hours. Your knee may have been in better condition than mine before your operation so it may turn out to be easier for you. Apparently my knee wasn't in good condition before surgery, probably due to my injury and general unfitness, so my rehab is going to be slower than normal. Tomorrow it is 4 weeks since my operation. I am having physio 2-3 x week and am still doing home rehab exercises 3 x day. I have a bend of 100 degrees and can walk around home without crutches. Generally, I only use 1 crutch when I go out but I feel safer on 2 when I go up or down an incline as I still feel a bit unstable. Again, your rehab may proceed faster than mine. Please keep me posted as like you, I get comfort reading about other peoples experiences.
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replied September 15th, 2013
My son is 16 and just had ACL and meniscus surgery on his right knee Tuesday 9/10/13. So today we are 5 days after surgery. The doctor talked like he could go to school Monday, but he is still in a lot of pain and can't raise the leg by himself. So not sure how he can get in and out of the desks. He seems to have a hard time getting comfortable unless he is laying down. He is using the cold water/compression machine. And can only handle the elevation for very short amount of time. He has a brace locked in the straight leg position. We are having a lot of trouble in the "bathroom" department. He is having trouble getting started urinating and only having a bowel movement every couple days with the use of laxatives. He started out taking oxycodone which made him feel great(but totally loopy) but was itching, and we were thinking causing the urinating problems. Anyone else have that problem? Now he is on hydrocodone, and says that doesn't relieve the pain as well. So when do you think he will feel like going back to school, and actually feeling a little better to get up and move around more? We go for our post op app 9/20/13. Thanks so much!
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replied September 29th, 2013
acl extreem shooting pain after surgery, why?
on 9-12-13 i had acl sx with a cadaver. next day i was using the cpm machine 4hrs a day. every day i would add 5 degrees. on flexing. On the 6th day I had such piercing pain like a charlie horse starting at my knee and traveling down the back of my calf onto the arch of my foot. Screaming in pain withtears Inever experienced this ever. Also the spasms would trigger out of knowhere and be so intense my whole body shook. Ihad also lightened up my pain dosing at about the same time. I had my stitches out and was told I did'nt have to wrap my leg, but (just to keep the brace from rubbing on my skin). When I stood up Icould feel the rush of fluid expand in my leg. My foot was very swollen. I swear you could see my knee expand right befor your eyes. I went to the hospital concerned about a blood clot or infection or something gone bad because of the pain. The ultrasound showed no blood clot and I never had a fever and bw seemed to be fine. The radiologist wrapped my leg snuggly and said that would help keep the swelling under control. It felt better. dr put me on antibiotics. My hosp. experience was monday night (given pain meds and antibiotic thru iv) The sharp pain and spasms have not happened since and my leg is wrapped snuggly now. Much better. Does anyone know where or why this horrible pain came from?
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replied November 15th, 2013
Hi! I'm 28 and had ACL surgery using an allograft on 11/7/13. I had a torn ACL for 7 years and recently pinched my meniscus when I plummeted to the floor when my knee gave out! Was misdiagnosed 7 years ago (no MRI) and decided that this time I would have an MRI followed by surgery to put an end to a weak knee. Had gone to PT twice a week for a month before surgery and had pretty good range of motion and flexion.
Post surgery, I was on 1 oxycodone every 2 hours for the first 48 hours, then limited myself to only 2 or 3 per day. It is now 8 days post surgery and I have been off all oxycodone since day 6 (still taking Aspirin to thin my blood). Although I am still in a fair amount of pain when I am vertical and using crutches, it's tolerable. It does feel as though a knife or something is cutting down the medial part of my knee to my shin for a minute or so when first standing, though...
Anyone finding it extremely difficult to shower? I find that I'm pretty uncomfortable or feel very unstable when my straight brace is off, even tho I'm sitting with my legs out straight, in the tub.
Wondering when my medical tape will come off and that awful surgical/sterile smell will be gone.
Happy to know that my heel should be propped on a pillow instead of a pillow under my knee, which is what I had been doing.
My first post-op appointment isn't until Wednesday (a day short of 2 weeks after surgery) which I thought was a long time. Wondering what the next steps will be! Very anxious to get to PT again and out of this straight brace Smile
Thank you...apologies for my massive post
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