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Why have I developed a lump after ACL?

Saturday, 30 October 2010
Answered by: Dr Mathew Varghese
Head, Department of Orthopaedics, St. Stephens Hospital, New Delhi
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Q. I am a 25 years old male who underwent ACL reconstruction surgery for my right knee. I was under a rehabilitation programme for three weeks. I have found a soft lump formed on the incision area just below the knee and it has also started bleeding. I am concerned as I haven't seen any of my friends having faced such an issue after an ACL surgery. Why have I developed such a lump?

A.  From what you are describing it seems to be a small haematoma at the site of the lower incision. This is the site where the graft is attached to the bone. I am not sure which technique has been used in your case. Some surgeons use screws (known as interfering screws) to hold the graft in place. This screw is usually buried and does not present as a bump though haematoma can still happen. Some surgeons on the other hand use special sutures to tie the graft in place. This is more likely to present with the bump and this may also present a haematoma. Usually this is a minor problem and should settle with time. However, if there is infection at the site from which blood has come out that could be bad. If you are developing infection the surrounding can become warm, red and your pain which should have subsided by now may increase. You may also have fever. If that is the case you may have to consult your surgeon for an aggressive treatment. Otherwise, use a wash-proof sterile dressing on the discharging area and continue with your rehab programme.

A.  From what you are describing it seems to be a small haematoma at the site of the lower incision. This is the site where the graft is attached to the bone. I am not sure which technique has been used in your case. Some surgeons use screws (known as interfering screws) to hold the graft in place. This screw is usually buried and does not present as a bump though haematoma can still happen. Some surgeons on the other hand use special sutures to tie the graft in place. This is more likely to present with the bump and this may also present a haematoma. Usually this is a minor problem and should settle with time. However, if there is infection at the site from which blood has come out that could be bad. If you are developing infection the surrounding can become warm, red and your pain which should have subsided by now may increase. You may also have fever. If that is the case you may have to consult your surgeon for an aggressive treatment. Otherwise, use a wash-proof sterile dressing on the discharging area and continue with your rehab programme.

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