What to do if you’re worried your ACL surgery just got screwed up

Posted on June 1, 2018

(Last Updated On: June 1, 2018)

One of the most common questions I get on this site and through email regarding reconstructive ACL surgery is something like this (actual email below),

“I think I may have done something to my knee Day 11; maybe bending, too much flexing or limping in the house without crutches (no pain at the time). But  I must have perhaps worked on flexion too much or something and I got swelling and I feel like my knee is buckling.

Especially when I slightly bend it feels like it gonna snap out and there’s a huge ball in there (back to square 1). I wonder if I could have aggravated the mensicus or stretched out my ACL. I rested since and today it doesn’t look as swollen but what it feels like lump around the area and it almost snaps when I bend to walk/limp – a feeling which i never had before. I got my suture out yesterday with the surgeon and saw my PT today – asked questions, but from appearance they said it looks fine.

I can also perform most of the exercises, it’s just concerningly unstable when I stand and try to limp walk which has never been the case up till Day 11. I’m afraid I did something to it internally and I was wondering if there could be anything done to prove it or help it?

I guess the only way to really find out is wait or get another MRI done (to see if I did in fact damage something) (Which I’m not sure how to approach the surgeon about since he actually apparently ‘brushed’ it off as if I was just being overly worried). I know I’m in the process of healing, but maybe you can shed some light on how I can further prevent injury or investigate. I just don’t know how to go about with that? Do you think The physio will help remove that buckling feeling?”

The short version is,

  1. Any sudden increase in swelling is almost always from suddenly doing too much. With a new knee, it takes time to learn what’s ok and what’s too much. Pushing the line too far is going to happen. It’s like a toddler bumping their head. They’re learning how to move. It happens.
  2. Weird sensations are common with this surgery. You have a tendon now where a ligament was. That tendon is going to feel out of place. You have screws in your body you didn’t have. They’re going to give odd feelings here and there. These will largely dissipate with time.
    1. Dealing with weird sensations after ACL surgery
  3. Simply check in with the surgeon. That’s what they’re there for, and they can check the graft in no time.

Long version-

First, this is very common. I vividly remember my own instance. I was within the first month, working on my extension range of motion, and when I bent my knee up just a tad I could see this little part of my knee poke out, then back in. I immediately went “WHAT THE FUCK WAS THAT?!?”

It scared the hell out of me. I immediately thought either I did something to screw up the surgery, or the surgery was screwed up itself.

I went right to my phone, called the doctor, and asked if I could bump up my next follow up. “Been having some weird sensations I’d like to get checked out.” They said sure, and got me in, I think it was two days later, when my follow up was 10 days out.

So this is our first takeaway here. If you have a good surgeon, you should be able to immediately get something like this checked out. I’ve worked with a good deal of people after they’ve had a surgery. I’m continually dumbfounded how many do not press the doctor’s office for help. You are their patient. You are their customer. If you just went to the mechanic to get work done, then not long after something seemed up with your car, you’re going to press that mechanic for information. You will call them, you will stop by the office, you will expect they see you perhaps not instantaneously, but you expect to get in sooner than some random person who has never been there before. You should expect the same from your surgeon!

If your doctor is not receptive to this, if you can’t get them on the phone, if they don’t call you back -I’ve had clients this has happened to- either make your name known, or get a new surgeon.

Making your name known does not mean leaving a second message. “Hi, blah blah blah, please call me back.” It means you call them incessantly. It means you drop by their office and demand help. You don’t go cursing and raving at them, but you tell them sternly you need their assistance. They’re on vacation? There should be an on-call doctor. You should be able to see them.

You should be having regular check ins with your doctor anyways. It should go along the lines of,

  • Within 24 hours of surgery you find out what exactly was done
    • Whoever is with you during your surgery should get a briefing after it’s done. For example, my Dad gave me the rundown he was given (from the surgeon).
    • You should get some information when you first wake up. I had a nurse and my anesthesiologist fill me in.
    • The surgeon may very well be in another surgery when you wake up. (Mine was.) I called them maybe eight hours post up. It was the day before Christmas Eve, and they answered. In fact, they were expecting my call. I was given his personal cell phone number. (I’m pretty sure they were Christmas shopping.) Again, you don’t just go performaing invasive surgery on someone then not talk to them about it for weeks afterwards. You should not be treated like a sheep or a number.
  • ~10 days post op
  • Six weeks post op
  • Three months post op
  • Six months post op
  • Nine months post op

For most, the first month or two is when this weird stuff happens. (It still happens later on. It may happen forever. But you get used to what’s normal weird and what’s not, and it lessens in frequency month by month.) You are / should be going to see your surgeon multiple times around this period. Talk to them about it. You are almost guaranteed to hear “Oh yeah, that’s completely normal.”

Furthermore, they should be assessing your graft anyways. Every appointment! That’s the whole reason for you going there. Not to have some every month check in of “So, how are you feeling?” You could do that crap on the phone.

It takes them like 15 seconds to do this. They should be doing this with their hands. Sure, they’ll likely look at some X-Rays too -to check the hardware- but their hands will tell them 99% of what they need to know. If they merely say to you “Well, I need a MRI” without using their hands at all, that’s a lazy orthopedist.

If your surgeon is not using their hands, find one who will. You can ask them to, but if they aren’t doing it on their own, who knows how well they’re going to do it when they’re asked to.

-> Unfortunately, if you’re at this point, you may very well have had the wrong person perform your surgery to begin with.

No, they don’t know everything just from a MRI or X-Ray. No, your physical therapist is not a good substitute. I have had this happen to clients as well, where the doctor deemed a MRI was all they needed. No manual assessment or anything else. I mentioned this to another surgeon and he shook his head and started laughing. “What a croc of shit.”

This client of mine had an ACL surgery ten years ago, then a recent meniscus surgery. Out of nowhere, three months into the meniscus post op, her knee is giving way on her. I personally physically assess her knee, and tell her she really needs a good ortho to check it out. I didn’t like what I felt, but she needed more trained hands than mine. Time to check in with the surgeon.

She goes back to the doctor, who doesn’t touch her, and merely orders a MRI. MRI comes back good, so  “you just need more time. Nothing’s torn. Nothing can be done surgically.”

I send her to an orthopedist I like. He can feel the laxity in her knee on a physical assessment. No, her ACL isn’t torn. No, nothing else is torn. But because of the injury history, her knee is not as stable anymore. You couldn’t see that or know that only from imaging -you could perhaps guess it, but you wouldn’t know it- yet you could feel it (know it) immediately with your hands. (Even I could feel it!)

Plus, you could know the ACL wasn’t torn based on a physical assessment anyways. The MRI wasn’t needed to begin with. (Other than for $$$.)

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