Effective Strategies for Managing Postoperative Pain in ACL Surgery

Overview of Postoperative Pain Management Techniques

Postoperative pain management is crucial in ensuring positive surgical outcomes, particularly in anterior cruciate ligament (ACL) surgery. This complex procedure, often performed on active individuals, necessitates meticulous strategies to mitigate pain and facilitate recovery. Effective pain management includes a multimodal approach combining pharmacological and non-pharmacological interventions.

Pharmacological interventions typically involve the use of analgesics categorized into non-opioids, opioids, and adjuvant medications. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, are commonly used for their anti-inflammatory properties and minimal side effects. Opioids, while effective for severe pain, carry the risk of dependence and side effects such as constipation and respiratory depression.

The inclusion of adjuvant medications can enhance pain control. Medications such as gabapentinoids, antidepressants, and corticosteroids have shown efficacy in reducing neuropathic pain and inflammation. Moreover, local anesthetics, either through nerve blocks or infiltration at the surgical site, can significantly lower pain levels during the early postoperative period.

Non-pharmacological strategies include physical therapy, cognitive-behavioral therapy, and complementary techniques like acupuncture and massage therapy. These methods can help reduce reliance on medications, improve patient satisfaction, and enhance overall recovery outcomes (Aflatooni et al., 2025).

Comparison of Limb Occlusion Pressure and Standard Tourniquet Pressure

The use of tourniquets during ACL surgery is essential for minimizing blood loss and improving surgical visibility. However, the pressure settings of these tourniquets can significantly impact postoperative outcomes. Traditionally, standard tourniquet pressures (STP) have been set around 250-350 mm Hg, which can contribute to postoperative pain and complications.

Recent studies advocate for the use of limb occlusion pressure (LOP), a more individualized approach wherein tourniquet pressure is calibrated to the minimum required to occlude blood flow. Research indicates that using LOP can lead to reduced tourniquet site pain and overall opioid consumption post-surgery (Aflatooni et al., 2025). This individualized approach not only preserves the surgical field but also minimizes the risk of adverse effects associated with higher tourniquet pressures, such as nerve damage and prolonged recovery times.

In a randomized controlled trial, patients receiving LOP reported significantly lower pain levels and reduced opioid requirements compared to those subjected to STP. Specifically, tourniquet site pain was less in the LOP group during postoperative days 1 to 5 and averaged across the two-week postoperative period (Aflatooni et al., 2025). This approach highlights the importance of tailored pain management strategies that prioritize patient comfort and recovery.

Impact of Nerve Coaptation on Chronic Pain After Mastectomy

Chronic pain following mastectomy, often referred to as post-mastectomy pain syndrome (PMPS), is a significant concern for breast cancer survivors. PMPS can be attributed to nerve damage during surgery, leading to neuropathic pain that persists long after the initial healing phase. Recent studies have explored the potential of nerve coaptation as a strategy to mitigate this pain.

Nerve coaptation involves the surgical reattachment of transected nerves, aiming to restore nerve continuity and function. This technique has shown promise in reducing PMPS by preventing the formation of painful neuromas and promoting nerve regeneration. By establishing a route for axonal regeneration, nerve coaptation creates a biological environment conducive to healing and minimizes chronic pain (Cai et al., 2024).

Clinical trials investigating the efficacy of nerve coaptation in mastectomy patients indicate a reduction in neuropathic pain symptoms when compared to traditional surgical methods. Patients who underwent nerve coaptation reported lower scores on the Short Form McGill Pain Questionnaire (SF-MPQ) and a reduction in the incidence of chronic pain (Cai et al., 2024). These findings underscore the potential benefits of this technique in improving quality of life for breast cancer survivors.

Role of Orthobiologics in Alleviating Knee Osteoarthritis Pain

Knee osteoarthritis (OA) is a prevalent condition that often leads to significant pain and functional limitations. Traditional treatment options range from conservative management, including physical therapy and medications, to invasive procedures such as arthroplasty. However, the emergence of orthobiologics, including mesenchymal stem cells (MSCs), has revolutionized the treatment landscape for knee OA.

Orthobiologics harness the body’s natural healing processes to promote tissue regeneration and alleviate pain. MSCs, in particular, possess anti-inflammatory and regenerative properties that can effectively address the underlying pathology of knee OA. Studies have demonstrated that intra-articular injections of MSCs significantly improve pain and function in patients with knee OA, with minimal adverse effects (Wang et al., 2025).

Recent innovations in the field have led to the development of minimally manipulated products, such as microfragmented adipose tissue (MFAT), which can be injected directly into the knee joint. This approach circumvents the complexities associated with cell culture and has shown superior outcomes compared to traditional bone marrow aspirate concentrate (BMAC) injections (Wang et al., 2025). The use of orthobiologics not only enhances pain relief but also has the potential to modify the disease course, promoting cartilage repair and joint health.

Benefits of Microsurgery in Treating Gingival Recession

Microsurgery has emerged as a transformative technique in periodontal plastic surgery, particularly for the treatment of gingival recession. Traditional surgical methods, often associated with significant trauma and postoperative discomfort, are being replaced by microsurgical approaches that prioritize precision and minimally invasive techniques.

The coronally advanced flap (CAF) procedure, performed under magnification, has demonstrated superior outcomes in root coverage compared to traditional macrosurgical techniques. A systematic review revealed that microsurgery resulted in a greater reduction in recession depth and improved clinical outcomes (Raza et al., 2025). The meticulous handling of tissues and enhanced visualization afforded by microsurgical techniques contribute to better aesthetic results and reduced postoperative pain.

Clinical data supporting the efficacy of microsurgery indicate significant improvements in patient satisfaction, with reports of enhanced healing and reduced recovery times. The ability to achieve greater precision in flap design and suturing techniques minimizes tissue trauma and optimizes the healing environment, further reinforcing the benefits of microsurgical intervention in periodontal surgery (Raza et al., 2025).

Conclusion

Effective management of postoperative pain in ACL surgery and other surgical procedures is essential for optimizing patient outcomes. Integrating individualized approaches, such as limb occlusion pressure and nerve coaptation, along with the use of orthobiologics and microsurgical techniques, can significantly enhance pain relief and functional recovery. As the field of pain management continues to evolve, these strategies will play a critical role in improving the surgical experience and quality of life for patients.

References

1. Aflatooni, J., Goble, H. M., Lambert, B. P., Liberman, S. D., & McCulloch, P. C. (2025). Limb Occlusion Pressure Versus Standard Pneumatic Tourniquet Pressure in Anterior Cruciate Ligament Surgery: A Randomized Controlled Trial. J Am Acad Orthop Surg Glob Res Rev, 3541

2. Cai, W., Liu, X., Barajas, S., Xiao, S., Vemula, S., Chen, H., Yang, Y., Bochers, C., Henley, D., Liu, S., Jia, Y., Hong, M., Mays, T. M., Capitano, M. L., Liu, H., Ji, P., Gao, Z., Pasini, D., Wan, J., Yue, F., Platanias, L. C., & Liu, Y. (2024). Impact of Nerve Coaptation on Chronic Pain After Mastectomy. Polycomb group protein Mel18 inhibits hematopoietic stem cell self-renewal through repressing the transcription of self-renewal and proliferation genes. https://doi.org/10.1038/s41375-024-02462-w

3. Raza, S., K B, M., Shetti, N. A., & Dallari, D. (2025). Efficacy of microsurgery in comparison to macrosurgery for the treatment of localized gingival recession using coronally advanced flap: A systematic review and meta-analysis. J Indian Soc Periodontol, 1153

4. Wang, Y., Xu, M., & Yang, R. (2025). Role of Orthobiologics in Alleviating Knee Osteoarthritis Pain. A comprehensive review of composition, properties, clinical applications, and future perspectives of Calcium-Enriched Mixture (CEM) Cement: A Systematic Analysis. https://doi.org/10.1186/s12938-024-01290-4

5. Aflatooni, J., Goble, H. M., Lambert, B. P., Liberman, S. D., & McCulloch, P. C. (2025). Limb Occlusion Pressure Versus Standard Pneumatic Tourniquet Pressure in Anterior Cruciate Ligament Surgery: A Randomized Controlled Trial. J Am Acad Orthop Surg Glob Res Rev, 3541