​Hi everyone, ​I’m currently 5 days post-op from an ACL reconstruction and a partial meniscus resection. I'm a 30-year-old female, plus-size, and I also have a bit of a medical background, so I understand pharmacology reasonably well. Honestly, being even "a bit of a medic" while being the patient is a total curse - instead of just resting, I keep overthinking and analyzing the pathophysiology of my own recovery. ​This morning, the pain was absolutely excruciating easily a 9/10. It has eased up a bit tonight, but my knee is still a constant, deeply exhausting ache. ​Graft Selection Twist & My Hospital Stay ​Initially, my doctor was planning to use a BTB (Bone-Patellar Tendon-Bone) autograft. However, right before the surgery, he informed me that he had changed his mind and chosen a different method - a 4-strand STG (hamstring) graft - stating it would be much better suited for my specific body and recovery. ​I spent just one night in the hospital. Immediately after surgery, I was given intravenous antibiotics for infection prophylaxis. The baseline analgesia in the ward was heavy-duty: they had me on Oxycodone (both a prolonged-release form to maintain a baseline and an immediate-release version for breakthrough pain), along with the standard cocktail of Paracetamol and Ibuprofen. Thanks to that heavy narcotic coverage, the first 24 hours were relatively bearable. But as soon as I was discharged home on a stepped-down regimen, the real challenge began.

​Live-Streamed Arthroscopy & Finnish Medical Culture Shock

​I’m an expat, and the local approach to surgery and rehabilitation here in Finland completely caught me off guard. ​To start, the pre-op process blew my mind. Back home, I would have had to collect a massive, exhausting folder of medical clearances, blood panels, and specialist sign-offs just to step foot in an operating room. Here in Finland? Absolutely zero pre-op lab tests or medical screenings were required. The only instructions I received were a strict fasting order after midnight and a rule to stop taking Omega-3 supplements a couple of weeks before the procedure. That was it. ​At my request, the surgery itself was performed under spinal anesthesia (plus benzos for sedation). They placed the monitor right in front of my eyes, so I literally watched the entire procedure inside my joint in real-time! The damaged part of my meniscus was literally frayed like fringe, and the surgeon was incredibly meticulous, clearing out the joint using biters and a shaver.

​However, what happens after surgery would be considered madness in my home medical culture: ​No compression garments: Absolutely none. No stockings or wraps after discharge. ​No immobilization: No braces, rigid knee immobilizers, or casts. The leg is completely free right out of the OR. ​Extension and 90° flexion from day one: Doctors demand getting the leg into near-full extension immediately. Reaching 90 degrees of flexion is also a goal for the very first days- no one waits weeks for things to "heal first." ​Aggressive, immediate physical therapy: They actually tried to start my physical therapy on the exact day of the surgery, while I was still in the recovery room (PACU). However, it was completely impossible due to the excruciating pain. All I managed to do was hobble to the toilet, and thankfully, they stopped torturing me for the night. The next morning at 9:00 AM, they were right back at it. They taught me how to navigate stairs on crutches, evaluated how I performed the basic exercises, gave me a highly detailed instruction booklet, and thoroughly explained the long-term plan. ​At first, while in the hospital, I could only lift and lower my leg off the bed or move it on and off the pillows with the help of the nurses, or by looping a compression bandage around my foot - which I had luckily packed with me just in case - to use as a strap. ​Since coming home, I barely did any of the exercises because the pain has been so intense. Despite that, I can already hold my leg up in the air almost completely straight on my own now, which feels like a tiny victory.

​Visuals & Anatomy

​My knee is massively swollen, and I’ve developed huge, sprawling yellow-green bruises all along the anteromedial aspect of my shin and calf. Anatomically, it’s text-book classic: ​The Graft Site: The hematoma perfectly maps over the pes anserinus (goose's foot) where the STG tendons were harvested. ​Bone Tunnels: Blood from the drilled tibial tunnel is naturally pooling downward into the subcutaneous layers of my shin due to gravity. ​Anticoagulants: I am on daily low-molecular-weight heparin injections (Innohep) for DVT prophylaxis. Because of the hypocoagulation, the bruising looks incredibly dramatic and widespread. ​Yesterday, I had to rip off an airtight, clear waterproof dressing. The edges were pulling and cutting into my skin so hard with any micro-movement that it was causing an intense, burning secondary pain. Switching to a loose, breathable non-woven dressing gave immediate cutaneous relief.

​My At-Home Pain Management (The Pharma Dilemma)

​Because I have a history of asthma and a massive personal fear of opioid dependency, I initially tried to avoid the prescribed heavy pills. I even tried to self-prescribe Gabapentin 300mg to modulate any neurological aspect of the pain. However, against the acute, nociceptive pain of a drilled bone, it was practically useless. ​To survive this first-week peak, I’ve set up a strict, timed multimodal protocol: ​Morning: Panacod x2 (1000mg Paracetamol / 60mg Codeine total) + Ibuprofen 600mg ​Afternoon: Gabapentin 300mg + Panacod x1 + Ibuprofen 600mg ​Evening: Panacod x1 + Ibuprofen 600mg ​Physical Decompression: Strict R.I.C.E. protocol - keeping the leg stacked on pillows strictly above heart level and applying ice for 20 minutes every few hours. ​Also I have been using small, controlled doses of cannabis between my medication windows. It helps immensely with the protective muscle guarding around the joint and changes the brain's perception of the pain. But knowing a bit about pharma, I am incredibly careful with the timing: cannabinoids temporarily inhibit the liver enzyme CYP2D6. Codeine (the prodrug in Panacod) requires this exact enzyme to metabolize into active morphine to actually work. To keep the cannabis from blocking my prescription painkillers, I strictly separate them by at least a 2-hour window. I’ve also completely cut out Gabapentin for the night to avoid any cumulative respiratory depression while sleeping with asthma.

​Questions for the Sub:

​Did anyone else experience a total lack of pre-op testing before surgery? Is this standard in European healthcare systems or just a Finnish thing? ​Also, did anyone else have a last-minute change in their graft selection right before rolling into the OR? For those with a 4-strand hamstring graft, are you happy with how it turned out compared to what you originally expected? Did anyone else find their home regimen incredibly weak after leaving the hospital's Oxycodone? Who else went through a "free-leg" rehab protocol (no brace, no compression socks, immediate flexion)? ​I'm especially eager to hear from fellow plus-size women: did you hit a massive pain wall right around day 5? How many days did it take for that deep, bone-aching pressure in the tibia to finally start dialing down?