Post-Surgery Knee Displacement: Causes and Solutions

Sudden reappearance of preoperative displacement issues?

Hello, I would like to ask about my situation.
I underwent anterior cruciate ligament (ACL) reconstruction surgery in April of this year, and my recovery has been normal.
I started playing sports and basketball again in the past 2-3 months without any issues.
However, during a game yesterday, my knee suddenly felt like it dislocated.
Although the pain was less than half of what I experienced before the surgery, after resting, I was able to walk normally.
However, today the pain has become more pronounced.
This is the first time I have encountered this issue since the surgery.
Is it normal to experience this condition 8 months post-operation? What can I do to improve it?

Jingzi, 10~19 year old female. Ask Date: 2016/12/21

Dr. Yin Xinbei reply Rehabilitation

Abnormal, please return to the orthopedic outpatient clinic for consultation.

Reply Date: 2016/12/21

More Info

Post-surgery knee displacement, particularly after an anterior cruciate ligament (ACL) reconstruction, can be concerning for patients, especially when it occurs months after the procedure. Your experience of sudden knee displacement during physical activity, followed by increased pain, raises several important considerations regarding the underlying causes and potential solutions.

Understanding the Causes
1. Re-injury or Instability: The knee joint is stabilized by ligaments, including the ACL. If the reconstruction did not heal properly or if there is a re-injury, it can lead to instability. This instability may manifest as a feeling of the knee "giving way" or displacing during activities, particularly those involving pivoting or sudden changes in direction, such as basketball.

2. Muscle Weakness or Imbalance: Post-surgery rehabilitation focuses on restoring strength and stability to the knee. If the muscles surrounding the knee, particularly the quadriceps and hamstrings, are weak or imbalanced, they may not adequately support the joint during dynamic activities, leading to displacement.

3. Scar Tissue Formation: After surgery, scar tissue can form around the knee joint, potentially affecting the range of motion and stability. If the scar tissue is excessive, it may restrict movement or alter the biomechanics of the knee, contributing to feelings of instability.

4. Meniscal or Cartilage Injury: If there was an undiagnosed injury to the meniscus or cartilage during your initial injury or surgery, it could lead to pain and instability. These structures are crucial for knee stability and shock absorption.

5. Improper Rehabilitation: If the rehabilitation protocol was not followed correctly or if there was a premature return to high-impact activities, this could increase the risk of complications, including instability.

Solutions and Recommendations
1. Consult Your Surgeon or Orthopedic Specialist: Given that this is your first experience with knee displacement post-surgery, it is crucial to consult with your orthopedic surgeon. They may recommend imaging studies, such as an MRI, to assess the integrity of the ACL reconstruction and check for any additional injuries to the meniscus or cartilage.

2. Physical Therapy: Engaging with a physical therapist who specializes in post-ACL rehabilitation can be beneficial. They can assess your muscle strength, flexibility, and overall knee function. A tailored rehabilitation program focusing on strengthening the quadriceps, hamstrings, and hip muscles can help improve stability.

3. Activity Modification: Until you have a clearer understanding of the cause of your knee displacement, it may be wise to modify your activities. Avoid high-impact sports or movements that involve sudden stops or changes in direction. Instead, focus on low-impact exercises that promote strength and stability without putting undue stress on the knee.

4. Use of Bracing: Depending on the severity of your symptoms and the recommendation of your healthcare provider, using a knee brace during activities may provide additional support and stability, potentially reducing the risk of further displacement.

5. Pain Management: For managing pain, consider using ice and over-the-counter pain relievers, unless contraindicated. If you have allergies to NSAIDs, consult your doctor for alternative pain management strategies.

6. Gradual Return to Sports: Once you have addressed the underlying issues and received clearance from your healthcare provider, gradually reintroduce sports and high-impact activities. Start with lower-intensity drills and progressively increase the intensity as tolerated.

Conclusion
Experiencing knee displacement after ACL reconstruction can be alarming, but it is essential to approach this issue systematically. By consulting with your healthcare provider, engaging in targeted rehabilitation, and modifying your activities, you can work towards improving your knee stability and reducing pain. Remember, the goal is to ensure that your knee is adequately supported and strong enough to handle the demands of your chosen activities.

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