How to manage swelling after ACL reconstruction surgery?

Question

Hello doctor,

I had ACL reconstruction surgery on my right knee for five years. At the same time, the medial meniscus was completely repaired and the lateral meniscus was partially repaired. After some time doctor opened my bandage and the knee healed nicely. I had been advised to do some physical exercise (such as extension, flexion, etc.) and I was doing the same correctly for up to nine days. But unfortunately, my knee started swelling, and the doctor advised me not to do any physical exercise and did some medical examination. As appeared from the report, there was no infection found from culture and sensitivity tests of fluid. Although it is found that my ESR was a little high, that is 40, and C -Reactive protein was 14.5. However, the latest medical examination revealed that ESR is 35, and C-Reactive protein is 2.5. The doctor advised me some antibiotics (Ciprofloxacin and Flucloxacillin), and I took the same. It has seven weeks have passed. Still, there is swelling in my knee, and I could not do any exercise. Now, I feel stiffness and move with the assistance of an elbow stick. My daily activities are hampering me a lot, and I am getting frustrated day by day. Therefore, I would earnestly request you to advise me on proper medications so that I can get back to daily life properly.

Answer 1

Hello,

Welcome to icliniq.com.

Firstly were you running fever three weeks post-surgery? Secondly, your first ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein) were raised, but within my comfort zone as post-surgery, they will usually be built up to six weeks to three months. The second report showed a good downtrend. Additionally, the culture was negative. I would not have started you on antibiotics unless you had.

1) Wound discharge.

2) Fever more than 101 F.

3) Redness and swelling and pain are worsening with each day.

4) Fatigue and loss of appetite.

I would have ICED the knee and put you on a gentle ROM exercise program to combat stiffness and asked you to keep the compression bandage on when not exercising to get the swelling down and kept you on anti-inflammatories till your knee subsided and then started strengthening exercises. Seven weeks down the line stiff knee and no proven infection, you have an uphill task now to combat stiffness, and at the same time, you are worried if the swelling will return. My worry here is are we sure that the repair is good and nothing is loose and floating in the joint and causing the symptoms. Also is the ACL repaired in the right place as misplaced ACL will lead to pain and swelling if it in the right place. Please upload your MRI and latest post-op AP and lateral digital X-rays of the knee to get some idea about the tunnel placement.

How to manage swelling after ACL reconstruction surgery?

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