ACL Post Op Bruising
ACL Surgery: Understanding Post-Op Bruising
Bruising after ACL (anterior cruciate ligament) reconstruction is a common concern. One of the most frequently observed patterns is bruising and discoloration that appears not around the knee itself, but further down the leg; typically on the shin, ankle, or even foot.
Why Does Bruising Happen Below the Knee?
Post-operative bruising in the lower leg is primarily the result of gravity. Blood from internal bleeding near the surgical site, whether from incisions, graft harvest, or tissue manipulation, can migrate downward through soft tissue. This phenomenon is particularly noticeable in the presence of swelling, tourniquet use, or when hamstring or patellar tendon grafts are involved.
Common Causes of Bruising After ACL Surgery:
- Post-operative bleeding: Minor bleeding from the surgical site or incisions is expected.
- Tourniquet use: Pressure applied during surgery can cause microscopic blood vessel trauma, leading to leakage once the tourniquet is released.
- Tissue trauma from graft harvesting: Whether your graft came from the patellar tendon, hamstring, or quadriceps, harvesting involves tissue disruption that can lead to local bleeding.
- Swelling and fluid drainage: Accumulated fluid from inflammation or irrigation during surgery may seep through tissue planes.
- Gravity: Once upright and walking or standing, the effects of gravity guide residual fluid and blood down the leg, where it pools and settles in dependent areas.
What You Can Do About It
Most of the time, bruising is self-limiting and resolves within 1 to 3 weeks. However, proper post-op care can minimize both the extent and duration of discoloration:
- Elevate the leg above heart level, especially in the first several days. This helps reduce blood pooling and encourages venous return.
- Ice regularly (as directed) to reduce inflammation and capillary leakage, which limits new bruising.
- Use compression (if recommended by your surgical team) to reduce swelling and improve lymphatic drainage.
- Ankle pumps and gentle foot movements help maintain circulation and prevent stagnation of blood and fluids.
- Monitor the area closely. Call your surgeon if you experience:
- Worsening pain
- Expanding or hard bruising
- Redness or warmth
- Drainage or pus
- Fever or chills
When to Be Concerned
While bruising is typically benign, some warning signs may indicate a more serious issue, such as infection, hematoma, (a lot of bleeding under the skin; probably a deep bruise), or a vascular complication. If you notice symptoms such as increasing tenderness, firmness under the skin, foul-smelling discharge, or difficulty moving your foot or toes, seek prompt medical attention.
Bottom Line:
Bruising below the knee after ACL surgery can look alarming, but it’s often a normal part of healing. With proper elevation, icing, and movement, the discoloration typically fades within a few weeks. As always, stay in touch with your orthopedic team if anything doesn’t feel right.