What medication is given after ACL reconstruction? A Comprehensive Guide

October 10, 2025 •

4 min read

Following ACL reconstruction, effective pain and symptom management is critical for a smooth recovery and physical therapy progression. In recent years, the standard approach has evolved from heavy opioid reliance to a multi-faceted strategy that combines various medications and techniques. This article explores what medication is given after ACL reconstruction to help patients manage pain, prevent complications, and optimize healing.

Quick Summary

An overview of medications prescribed after ACL reconstruction, detailing the multimodal approach for pain, swelling, and complication prevention. It covers various pain relievers, blood thinners, and drugs to combat side effects like nausea and constipation.

Key Points

Multimodal Pain Management: The current standard of care uses a combination of medications to effectively control pain and reduce dependence on a single drug, such as opioids.
Early Pain Relief Options: Patients may receive a regional nerve block or local anesthetic injections during surgery to provide immediate post-operative pain relief for several hours.
Limited Opioid Use: Oral opioids are prescribed for a short period to manage severe, breakthrough pain, but providers aim to minimize usage due to addiction risks.
Consideration for NSAIDs: While NSAIDs like ibuprofen and naproxen treat pain and inflammation, they may be delayed for the first 2-6 weeks to prevent potential interference with tissue and graft healing.
Blood Clot Prevention: Many patients are prescribed daily aspirin for a couple of weeks to reduce the risk of deep vein thrombosis (DVT).
Managing Side Effects: Patients are often given medications for common side effects of surgery and pain medication, such as anti-nausea drugs (Zofran) and stool softeners (Colace).
Individualized Treatment Plan: Medication regimens can vary based on individual health, surgical specifics, and patient tolerance, so it is crucial to follow the surgeon's specific instructions.

The recovery following an anterior cruciate ligament (ACL) reconstruction can involve a significant amount of pain, swelling, and discomfort. To address this, healthcare providers use a comprehensive, multimodal pain management approach that leverages a combination of medications to target pain and reduce reliance on strong narcotics. The strategy typically involves medications for pain, inflammation, and blood clot prevention, along with treatments for common side effects.

Pain Management: A Multimodal Approach

Modern medicine favors using a combination of drugs with different mechanisms of action to achieve better pain control with fewer side effects. This begins during surgery and continues throughout the initial recovery phase.

Local and Regional Anesthetics

Pain management starts in the operating room. Anesthesia providers often administer local and regional nerve blocks to numb the surgical area for an extended period.

Regional Nerve Blocks: An adductor canal block is a common regional anesthesia technique that numbs the pain receptors around the knee. It can provide significant pain relief for 8-24 hours after the procedure, allowing patients to delay the start of oral pain medication.
Local Anesthetic Infiltration: A local anesthetic, such as bupivacaine, is injected directly into the knee joint and surrounding tissues during the surgery. This provides immediate, short-term pain relief at the surgical site.

Oral Pain Relievers

As the initial nerve blocks wear off, patients transition to oral medications to manage pain at home.

Opioid Analgesics: For the first few days, a short course of opioids like oxycodone (Percocet) or hydrocodone (Norco) may be prescribed for severe or “breakthrough” pain. Given the risk of dependence, the goal is to use these for a limited time and at the lowest effective dose.
Acetaminophen: Acetaminophen (Tylenol) is a non-opioid pain reliever frequently used in conjunction with other medications. It is important not to exceed the maximum daily dose, especially if taking combination pills containing acetaminophen, such as Norco or Percocet.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs like ibuprofen (Advil, Motrin) or naproxen (Aleve) target both pain and inflammation. However, many surgeons advise delaying the use of NSAIDs for at least a couple of weeks to avoid potential interference with graft healing. Some providers may use COX-2 specific inhibitors like celecoxib.

Preventing Complications: Blood Clot and Infection Prophylaxis

Beyond pain, two of the primary concerns after major surgery are blood clots and infection. Medications are used to address both risks.

Blood Clot Prevention

Limited mobility after knee surgery increases the risk of deep vein thrombosis (DVT), or blood clots in the leg.

Aspirin: Many patients are instructed to take a daily low-dose aspirin (e.g., 325 mg) for a couple of weeks post-surgery.
Prescription Anticoagulants: For patients with a higher risk of blood clots, stronger prescription anticoagulants, such as rivaroxaban (Xarelto) or apixaban (Eliquis), may be prescribed. These are used cautiously due to their bleeding risk.

Infection Prevention

While infection is a rare complication, it is a serious one. An antibiotic is typically administered intravenously during the surgery to prevent it from occurring. For outpatient procedures, patients are not usually sent home with an antibiotic prescription.

Managing Side Effects of Medication

Post-operative medication, especially narcotics, can cause unwanted side effects that must be managed to maintain patient comfort.

Constipation: A very common side effect of opioid use. A stool softener (e.g., docusate, Colace) or a mild laxative (e.g., Senokot, Miralax) is often recommended proactively.
Nausea and Vomiting: Can result from the effects of anesthesia and/or narcotics. An anti-nausea medication like ondansetron (Zofran) is commonly prescribed for use as needed.
Itching: Some patients experience itching as a side effect of narcotic pain medication. An over-the-counter antihistamine like diphenhydramine (Benadryl) can often help.
Muscle Spasms: Occasionally, a muscle relaxant like cyclobenzaprine (Flexeril) may be prescribed for patients experiencing muscle spasms.

Comparison of Medications After ACL Reconstruction


Medication Type	Examples	Primary Purpose	Key Considerations
Opioid Analgesics	Oxycodone, Hydrocodone, Tramadol	Moderate-to-severe pain relief	Short-term use only; high potential for dependence; common side effects include nausea, constipation, and drowsiness.
Acetaminophen	Tylenol	Pain relief	Non-narcotic; does not treat inflammation; safe to take with most other pain meds, but watch for maximum daily dose.
NSAIDs	Ibuprofen, Naproxen, Celecoxib	Pain and inflammation reduction	May delay soft tissue healing; many surgeons avoid use for the first 2-6 weeks; take with food to prevent stomach upset.
Anticoagulants	Aspirin, Rivaroxaban (Xarelto)	Blood clot prevention	Risk varies by patient; consult surgeon on specific regimen; watch for signs of bleeding.
Stool Softeners	Docusate (Colace), Senokot	Prevent/treat constipation	Recommended while taking opioid pain medication due to common side effect.
Anti-Nausea	Ondansetron (Zofran)	Treat/prevent nausea	Used as needed for nausea from anesthesia or opioids.

Conclusion

Medication following an ACL reconstruction is a critical component of a successful recovery, but it is part of a larger, multimodal strategy designed to manage pain while minimizing risks. The standard of care has shifted away from relying heavily on opioids in favor of a combination approach, which may include regional nerve blocks, acetaminophen, and deferred NSAID use. Blood clot prevention is addressed with medications like aspirin, and patients are also given prescriptions to manage common side effects such as nausea and constipation. Patients should always follow their specific surgeon's instructions and communicate openly about their pain levels and side effects to ensure a safe and comfortable recovery. For the best outcomes, medication should be used in conjunction with other non-pharmacological interventions like icing, elevation, and physical therapy, and never taken without a doctor's recommendation.

For more information on ACL surgery and recovery, the American Academy of Orthopaedic Surgeons (AAOS) offers reliable resources.

Frequently Asked Questions

The need for pain medication varies, but most patients require a short course of stronger medication, such as opioids, for the first few days (typically 2-5 days). They then transition to over-the-counter options like acetaminophen and eventually manage pain without medication as recovery progresses.

Not usually. Many surgeons recommend avoiding NSAIDs for the first several weeks after ACL reconstruction, as they can potentially inhibit the healing of the tendon or bone graft. Always follow your surgeon's specific instructions on when it is safe to start taking them.

A nerve block is a regional anesthetic injected before the surgery that numbs the nerves around the knee. This provides significant pain relief immediately following the procedure and can last for several hours, reducing the need for oral pain medication right away.

Constipation is a common side effect of opioid pain relievers. To combat this, surgeons often recommend taking an over-the-counter stool softener, such as Colace, starting the day of surgery. Increasing your fluid intake and eating fiber-rich foods also helps.

Following knee surgery, limited mobility increases the risk of deep vein thrombosis (DVT), a type of blood clot. Medications like aspirin or prescription anticoagulants are used for a few weeks to minimize this risk.

If you experience nausea, it is often due to the effects of anesthesia or opioids. Many doctors prescribe an anti-nausea medication like ondansetron (Zofran) for you to take as needed.

It is best to start taking oral pain medication as soon as you feel the nerve block starting to wear off, rather than waiting for the pain to become severe. Taking medication with food can also help prevent nausea.