Pain after anterior cruciate ligament surgery 

Pain is an important issue when it comes to the anterior cruciate ligament surgery and rehabilitation. Recovery is usually not linear and is characterized by good and worse periods. Typically, the worse periods are usually accompanied by increasing pain. In the first days after surgery, pain plays a major role and it is good to think about the following questions. How much pain are you in after surgery? How long does the pain last? Is there such a thing as good and/or bad pain? In this blog, we will address the aforementioned questions and explain the effect of pain on the body and recovery.

How much pain do you have after anterior cruciate ligament surgery?

Is pain normal after anterior cruciate ligament surgery

Let us preface that pain an individual process is. Everyone has pain which is normal after knee surgery, only the degree of pain will vary from person to person. This has to do with pain perception, coping with pain and whether pain medication is properly adjusted, among other things.

What is normal and what is bad pain after anterior cruciate ligament surgery?

Pain is a normal biological response of the body. You can almost assume that any pain you feel is normal and as a result of the anterior cruciate ligament surgery. In the coming days and/or weeks, it will gradually subside. There is also such a thing as bad or unwanted pain. Here you can think of pain from straining the wounds and/or the tissue from which the tendon or graft has been won. An example of this is the knie actief buigen after hamstring tendon extraction. By normal or accepted pain, you can think of pain felt when stretching (knee hollow) or bending (front) the knee. This is often due to capsular stiffness and swelling in the knee. Quiet mobilizations of the knee usually do no harm with capsular stiffness. In general, respect the pain and adjust mobilizations and exercise material to minimize pain stimulation. Also, always consult with your physical therapist about what is best to do in your situation. For an overview of complications click here.

Hoeveel pijn heb je na een voorste kruisband operatie

How much pain are you in the first few days after anterior cruciate ligament reconstruction?

The first days and nights after anterior cruciate ligament reconstruction will be very painful. Sleeping is often difficult and finding a comfortable position during the day is also difficult. Especially the location where the tendon is extracted to make the new cruciate ligament is sensitive. It is important to take the pain medication you have been given on doctor's advice at regular intervals. The worst pain usually subsides after a few days to a week. You're usually not pain-free by then, but things are often a lot better. Of course, the degree of pain varies from person to person.

Why are some people in more pain than others?

The type of tendon or graft used in anterior cruciate ligament reconstruction affects the degree of pain experienced. The hamstring tendon is relatively the least painful, followed by the quadricepstendon. The patella tendon is the most painful and this is mainly due to the way it is extracted. The complexity and extensiveness of the surgery also plays a role. Why one person has more pain than another also depends on how a person deals with pain pain perception (pain threshold), experience, stress anxiety and dosage of pain medication. Another important issue is whether the load is adequately matched to the load capacity. In other words, are you taking enough (dosed) rest.

What is the consequence of knee and muscle pain?

Pain in itself is obviously annoying, but pain also affects sleep and stress levels. Pain also has a negative effect on the upper leg muscles. There is a good chance that Arthrogenic Muscle Inhibition (AMI) arises. The tightening and activation of the thigh muscles (quadriceps) is hampered as a result, and hip (hamstring) dominant movement often occurs. The quadriceps consists of four parts, with the vastus medialis receiving the greatest attention. The size and tension of the vastus medialis disappears first of the four parts and only comes back properly last. Regaining control of the quadriceps is important for training the muscle.


5 tips on how to deal with pain after anterior cruciate ligament surgery:

  1. Take adequate rest
  2. Practice regularly
  3. Take adequate pain medication (doctor's advice)
  4. Regularly cool the knee with ice/cool packs.
  5. Trust the process


    An anterior cruciate ligament reconstruction is most painful the first week and then usually subsides quickly. It is important to respect pain, but consult carefully with your physical therapist about what is acceptable. Dose the load well and concentrate on regaining quadriceps strength by being smart about pain stimuli. Unfortunately, pain is part of the process, but above all, have faith in the process.

The first night after surgery I slept reasonably well. The following night I was in a lot of pain and had to get used to not being able to lie down like I was used to. As a result, I barely slept, which in turn gave me a mental blow the following day. But you know the pain is temporary. Fortunately, the medication did its job and helped tremendously against the pain in my knee.


I went to the physio just three days after surgery. He massaged my leg and knee. That was not pleasant but afterwards it gave a huge relief. He also helped me with the exercises, which hurt a lot. But you know it's necessary to get back to normal eventually. The physio gives support because he has seen many operations like this before and knows what is/isn't normal.


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