Patients and friends will encounter a lot of problems and disturbances in the process of post-surgical recovery. In the outpatient review and postoperative patients’ telephone consultation, I found a lot of problems, and now we summarize such problems and put forward precautions for reference. I. Postoperative common symptoms 1, posterior pain Now the mainstream technology of ACL reconstruction is to use autologous N cord tendon. This kind of postoperative pain is usually caused by the damage of subcutaneous tissue and deep fascia caused by the tendon extractor, which is manifested as pain in the posterior thigh or posterior knee joint. This pain usually lasts for about 1 week after the surgery, but some patients do not have such pain at all. Sometimes a small amount of bleeding may seep under the skin and cause irritation and pain. It is normal to see bruising under the skin on the back of the thigh or behind the knee, mild tenderness, and no obvious swelling. This kind of pain is mild or only pressure pain, usually about 1 week after the operation, will last for 3-4 weeks. 2, elevated body temperature Mildly elevated body temperature after surgery, within 38 ℃, lasting but 4 days, generally for postoperative absorption of heat, is normal. If the body temperature exceeds 38℃ or lasts for more than 4 days despite being around 37.5℃, we should be alert to postoperative infection or respiratory tract infection, and need to consult a doctor as soon as possible. Swelling of the joints After ACL reconstruction, the knee joints are usually swollen, and the degree of swelling varies depending on the degree of damage to the cartilage and other parts of the knee. In less severe cases, the swelling will improve in 4-6 weeks after the surgery, and the swelling can be reduced within 3 months after the surgery. If the cartilage damage is more severe, there are patients with knee swelling in 6-8 months after the surgery. It is generally recommended that patients with no swelling in the knee joint for more than 3 months should seek medical attention. Knee swelling is usually caused by fluid accumulation. If the knee swelling is felt to be very obvious and tense (sometimes accompanied by elevated body temperature), the patient should see an outpatient, and the surgeon will decide whether to puncture and draw fluid and put pressure bandage according to the situation, etc. Mild swelling within 3 months can be strengthened with ice packs if rehabilitation of the knee flexion and other angles is being carried out (see the later section for more details). If the knee mobility has been restored, anti-inflammatory drugs such as topical joint wash and oral fuchsin can be used, while strengthening the knee muscle strength exercises (see later for details). 4, inner ankle bruise Reconstruction of the anterior cruciate ligament to take the tendon or the bone channel opening will have a small amount of bleeding, if the amount of bleeding is more than 20-30 ml, it can not be absorbed in the vicinity of it. The unabsorbable bleeding will flow down the gap between the subcutaneous and deep fascia and stay at the inner ankle, slowly oozing out, forming bruises and other bruises in the subcutaneous manifestations, and there is mild pain when pressed. This phenomenon usually occurs 7-10 days after surgery, lasting 3-4 weeks. 5, skin numbness This special area of numbness is to take the tendon incision before the lower outer or inner calf, other areas of numbness need to consult a doctor. The reason for this kind of skin numbness is the saphenous nerve injury when taking the N cord tendon, some clinical studies think that the oblique incision can reduce the saphenous nerve injury when taking the tendon, but still can not be effectively avoided. This type of numbness does not affect the patient’s life, but can cause mild discomfort or panic. Most of the numbness in the postoperative 3 months -6 months recovery, some to continue to about 1 year after surgery. The so-called walking is unfavorable, that is, walking with a “limp” phenomenon. Generally seen in the postoperative knee extension is limited, some patients tend to focus on the early postoperative knee flexion exercises, straightening is often worse than 3-5 °, so that the patient in walking the affected knee will be “dragging the hind legs”, resulting in the phenomenon of limp. In this case, the patient should go to the outpatient clinic to see the surgeon, and the surgeon should strengthen the straightening exercises in time, except for other causes of limited knee straightening. There are two other cases: one is muscle atrophy around the affected knee, the solution is to strengthen the strength exercises. The second is the combination of cartilage repair, meniscus suture and other surgeries, weight-bearing walking is delayed compared with the general reconstructive surgery, the solution is to increase the walking time to find the feeling of balance of both lower limbs. Another common phenomenon of unfavorable walking is the lack of flexibility in knee flexion and extension, which is especially obvious after the knee mobility is fully restored about 2 months after the surgery, and is related to the high expectation of the patients at this time. Normal inflexibility usually improves after activity, and knee flexibility usually returns to normal at about 5 months after surgery. Common problems and precautions in rehabilitation 1. Support wear The support wear after ACL surgery is commonly known as “curved splint”. The use of the splint should be in strict accordance with the requirements of rehabilitation. In the first month, the splint should be worn 24 hours a day, in the second month, it can be removed at night when sleeping, and in the third month, it should be worn when going out and walking. Some patients with good muscle strength in the knee should have their doctor decide whether to end the use of the splint earlier. The main purpose of the splint is to maintain the stability of the knee joint and to protect the reconstructed ligaments from excessive pulling; of course, if the protection is overdone, the knee muscles will atrophy, and the trade-off between the two should be discussed with the doctor. A common problem with braces is “sagging”. The solution comes from patient experience: wrap a folded towel around the top of the inner ankle for one week, then wrap the bottom Velcro around the towel tightly, and tighten the Velcro from the bottom to the top in turn. 2. Flexion Exercises Flexion can be painful and varies from person to person. Patients who strictly follow the rehabilitation program will generally have no problems. Patients who have undergone surgery to repair other stabilizing structures of the knee, such as meniscal sutures and medial collateral ligaments, will have some difficulty in bending the knee, and the pain will be a little heavier, so they need to have perseverance. It is important to note that the knee flexion exercises should not be performed too quickly from straightening to the established angle of knee flexion, and are usually performed for 10-20 minutes, and when you get to the established angle, you should stay for 10 minutes, and when you do, you can start icing the knee. After straightening, you can use your hands to knead the upper, inner and outer muscles of the knee joint to sense the degree of stiffness and compare it with the opposite side, if there is any stiffness, you can massage yourself to make it relax. The most important thing is to relax, some patients are very good at relaxation, the knee will be very smooth, the pain is slight when bending the knee, and the pain will stop when the bending of the knee is completed. Some patients are more tense, mainly because they are afraid of pain, and will have difficulty in bending the knee. The latter group of patients who have not been able to learn to relax for a longer period of time, resulting in a slow process of knee flexion, mainly manifested in every time the knee is flexed, “very painful”, after flexion of the knee pain for more than 5 minutes, need to seek timely help from the surgeon. The former group of patients should not be rushed, the process of knee flexion is too fast, especially about 6 weeks after surgery, easy to make the reconstruction ligament laxity. It should be noted that 6 weeks after surgery, some patients feel very good about themselves, able to wear a brace or not wear a brace for jogging or fast running, etc., is very dangerous. 3, learn to ice Ice is closely related to the process of knee flexion. Bend the knee when and after bending the knee to ice. Prepare ice bag: supermarket shopping large plastic bag, filled with water 600ml-800ml, placed in the ice, ice and water ratio of about 1:1, the amount of ice and water mixture can be adjusted according to the size of the knee joint itself. Tie the mouth of the bag tightly, try to exclude the air inside the pocket, so that the ice bag is easy to fit. Ice application site: the front, inner and outer side of the knee joint. Areas that are painful during knee bending exercises must be included in the ice pack. Precautions: use a towel to separate the ice bag from the skin; each ice pack lasts about 20 minutes, the first ice pack may last 25-30 minutes, so that you will feel the entire inside of the joint are “cool”; skin ice pain lasts for 5 minutes to stop the ice pack, to prevent frostbite; the two ice packs between 40-60 minutes, a knee bends! Ice 6 times after practice; according to the degree of knee swelling the next day to adjust the number of ice packs, and gradually master the number of ice packs to adapt to their own, bending the knee during the exercise to the knee is mildly swollen (can be reviewed to let the doctor to assist in judging) as appropriate. 4, static squatting exercises squatting can not only practice the muscle strength around the knee joint, the correct static squatting posture and long on the lumbar spine, cervical spine and other benefits. Correct static squatting posture rehabilitation program, here is to emphasize: 1. static squatting before the general experience of a period of time straight leg raising exercises, pay attention to increase the time and load of the straight leg raising (in the calf on the weight), generally recommended to straight leg raising will be affected by the knee muscle strength to reach more than 80% of the normal static squatting exercises. 2. static squatting, back can not be leaning on the wall, can not let the wall share the weight! The angle of knee flexion should not be too large, except for a small number of patients with strong muscle strength, the general knee flexion should not exceed 60 °. 4. When squatting, the waist is straight, the head is stretched back, and the rest of the body must be relaxed, except for the knee muscles are tense. 5. After the exercise, the pain in the anterior and medial muscles of the knee joints is a valid evidence of the correct exercise posture. Please note that the increased pain in the knee joint after static squatting is an abnormal performance, which will cause damage to the knee joint and aggravate the chondromalacia of the patellofemoral joint. Where this occurs, attention should be paid to changing the way: first, the affected knee muscle strength has not improved enough, to strengthen the straight leg raising exercises. Secondly, squatting without avoiding the pain point. 6. squatting time must be improved section by section, not stagnant, so that the muscle strength will grow smoothly. 7. practice can be used in a variety of entertainment methods to transfer fatigue, such as watching TV, movies, listening to music, listening to audiobooks, etc.. 5, intra-articular ringing knee mobility exercises smooth late, began to walk normally. Some patients will find that there will be ringing in the knee joint, some ringing is small, can only be felt, some patients ringing is larger, for a clear popping sound. There are many causes of rattling; meniscectomy, scarring of the fat pad area, and muscle atrophy are all common causes of popping after ACL reconstruction. These can be corrected with muscle strength exercises and adaptive joint mobility training. Most patients notice the popping around 1 month after surgery, and it gradually disappears around 6 months after surgery. It should be noted that patellofemoral cartilage injury is a pathologic clinical condition that leads to knee popping. This can be seen in the operative record and is usually accompanied by pain and tenderness in the anterior knee region, especially when walking up and down stairs. It is important that patients with these clinical signs communicate regularly with their physicians to obtain timely information about the treatment of chondromalacia patella. Surgical patients in sports medicine basically go through a rehabilitation process after surgery. My experience is that timely, comprehensive, and effective communication between the patient and the physician is of utmost importance. A patient who fails to provide timely information or a physician who obtains incomplete information can have a bad effect on the recovery process. Doctors are not patients, and of course they can’t appreciate every aspect of the recovery process, so effective communication is a complementary and mutually enhancing process.