Guide to Knee Surgery Recovery

Torn ACL

The anterior cruciate ligament, or ACL, is a band of tissue that connects the tibia to the femur through the center of the knee joint. As one of the most common knee injuries, the ACL can become damaged or torn when the body rotates while the foot stays planted. The injury does not necessarily require contact and, in fact, can happen simply by pivoting or planting the foot in the wrong way.¹

Because the ACL is such an important component of knee stabilization, surgery is often necessary, especially for athletes who want to continue playing sports. 

Torn MCL

The medial collateral ligament, or MCL, is another one of the four ligaments that create stability in the knee. This connective tissue runs along the inner side of the knee joint and, therefore, is most frequently damaged by a blow from the side. MCL tears can also result from a poor landing or bending at certain angles.²

Torn Meniscus

The menisci are cartilaginous tissues that disperse friction and provide cushioning between the tibia and femur. There are actually two menisci in the knee joint that work together to disperse body weight and reduce friction as the knee straightens and bends.³

Trauma or rotation can tear the meniscus. The tear can be repaired, or in some cases, the torn portion of the meniscus can be removed.^{4 5}

For athletes, the damaging of all three of these important tissues in a single injury is not uncommon. The treatments for these injuries vary depending on factors such as severity, the patient’s age, activity levels, and so on. When a doctor recommends surgery, the procedure may include:^{4 5}

• Repairing damaged tissue
• Replacing damaged tissue
• Removing torn cartilage
• Arthroscopic procedures (a minimally invasive surgery technique) 

Regardless of the reasons for knee surgery and the procedures used, the recovery pathway is similar. 

Rest

Your body requires energy to heal, so the more you can rest, the better it is for your recovery. Rest also decreases the risk of a secondary injury. Resting your injured leg as much as possible is important, even as range of motion returns. Follow recommendations from your doctor and physical therapist regarding how much activity you can sustain during the various phases of recovery. Your health team may recommend gentle stretching exercises beginning as early as a day after surgery.⁷

In addition to resting during waking hours, getting enough sleep plays an important role in the recovery process.⁸ If pain or difficulty finding a comfortable sleeping position makes sleep difficult, talk to your doctor about pain management strategies. 

Cryotherapy

Cryotherapy is the application of cold to an injury to help reduce pain, swelling, and the accumulation of excess fluid, or edema.⁹ Cooling damaged tissue slows down cellular metabolism and decreases the demand for oxygen. This helps slow the inflammatory process to help the tissue heal faster and can result in a quicker recovery.¹⁰

Although traditional ice packs are effective, other methods can deliver targeted, consistent cold temperatures after knee surgery. 

Compression 

The accumulation of excess fluid in or around the knee joint after surgery can slow the healing process. Compression helps reduce this fluid buildup and helps reduce inflammation.¹¹

Active compression, which provides a natural pumping effect, can be even more beneficial. In addition to reducing edema, active compression also brings freshly oxygenated blood to the damaged tissue in the knee, helping move along the healing process.¹⁶

Healthy Living

Proper healing depends on healthy habits such as regular sleep and good nutrition. Your body uses more energy while it is recovering, so be sure to give it everything it needs to repair itself as fast as possible. 

Having someone to help you during your recovery can also be important. So, before undergoing surgery, talk to your partner, family, and friends about how they can best support you while you recover. 

Some research has also found a link between mental health and recovery. One study, for example, found that a sense of purpose in life could improve recovery.¹³ This suggests that strategies such as therapy and other forms of mental health self-care may affect recovery. 

Pain Management

Unfortunately, one of the side effects of knee surgery is some pain. Your doctor can help you manage any pain immediately after surgery and may prescribe medication if you have ongoing discomfort.

Cold therapy, including active compression, may also help improve pain in a non-opioid setting.¹⁸

Physical Therapy

As your body heals after surgery, you should start to regain range of motion and flexibility in the joint. For the duration of your recovery, finding the right balance between activity and rest is important. Work with a physical therapist to learn appropriate exercises for each stage of your recovery.⁷

Although each of these factors plays a role in knee surgery recovery, each case is different, which is why working closely with your healthcare providers every step of the way is so important.

How Cryotherapy Can Help the Healing Process

Cryotherapy is proven to produce therapeutic effects in the following ways¹⁴:

• Blood flow: Cold causes the blood vessels to constrict, which restricts blood flow. The body’s natural response to this constriction is to allow the blood vessels to dilate, thus bringing fresh, new blood to the surgical site. The cycle continues as cellular waste is removed and oxygen-rich blood delivers healing nutrients to the knee joint. Constricting the blood vessels can also reduce painful inflammation and swelling initially. 
• Cellular metabolism: The cells in your body act like little machines. They constantly work to perform their designated functions. This requires energy, and when cells do not receive enough energy, they die and are replenished with new cells. When cold is applied, it enables the surrounding cells to work at a slower pace, thus requiring less energy and limiting the amount of cell death that occurs during the healing process.
• Pain: Cold helps reduce the activity of nerve fibers, thereby reducing the amount of pain you may feel. Cryotherapy can often be used in place of or in combination with pharmaceutical painkillers, many of which come with unwanted side effects.
  
  

  All these factors combine to help you recover from knee surgery as quickly as possible by reducing the body’s natural inflammatory response. However, ice alone has its drawbacks. When ice packs are applied, heat from your body is transferred to the ice, quickly warming the ice. This means that the temperature of the therapeutic cold gradually increases over time, becoming less effective throughout the therapy session.

  
  

  How Active Compression Can Help the Healing Process

  Just as technology has improved cryotherapy, so, too, can it enhance traditional static compression. Active compression may provide the following benefits for patients recovering from knee surgery:¹⁵

  • Edema removal: Excess fluid generated during the body’s natural inflammatory response after surgery may contribute to greater swelling and discomfort. Active compression mimics and enhances the body’s natural pumping effect to draw fluid away from the knee joint.
  • Blood flow: The pumping effect of active compression helps the blood vessels expand and contract, thus refreshing the oxygen-rich blood that tissues in the knee need to repair themselves.
  • Targeted cryotherapy: Compression provides better contact with the cold source so that the benefits of cryotherapy can be achieved more thoroughly and quickly. Compression allows the therapeutic cold to penetrate deeper and last longer.
  
  

  Active compression works well alone, but it provides additional benefits when combined with cryotherapy. 

 

Day 1: 

The first day following surgery is often one of the most difficult. Within a few hours, your doctor will likely instruct you to begin walking with assistance. You may need help to move. You’ll need someone to drive you home. Your doctor or PT will tell you which activities to perform and encourage you to move and walk to the extent that it is safe to do so. You may need to wear a knee brace and may be on crutches for a couple of weeks.

 

Day 2:

You may have a little less pain and stiffness on this day and may begin gentle stretching. 

 

The early weeks:

You may not be able to drive or walk long distances. Exercise will focus on building strength and mobility, and your physical therapist will help you build a more progressive and safe routine. 

 

Six weeks:

Most people are able to begin driving, walking longer distances and engaging in regular activities (such as cleaning and working) by week six. Athletes and non-athletes alike should not return to their sport or work, even part time, until a doctor gives them the go-ahead. 

 

12 weeks:

Most people who have had knee surgery need 3-6 months to recover. You might still continue with physical therapy to ensure a lifetime of knee health, but your doctor will likely give you the go-ahead to return to all of your normal activities. If you experience pain, weakness, or a change in knee function, immediately tell your doctor.