Concerns About Retained Screws After ACL Repair Surgery: Pain and Complications - Orthopedics

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After undergoing an ACL repair surgery, concerns regarding retained screws and their potential complications are quite common. In your case, it appears that you have retained screws from your previous surgery, and while your doctors initially deemed it safe to leave them in place, recent observations of one screw "floating" have raised concerns. Let's delve into the implications of this situation and what you might consider moving forward.

First, it’s important to understand that retained hardware, such as screws, can sometimes lead to complications. These complications may include pain, irritation of surrounding tissues, or even the development of conditions like post-traumatic arthritis or bone spurs (osteophytes). The floating screw you mentioned could potentially be causing irritation to the surrounding soft tissues, which might explain the pain you are experiencing in the anterior and lateral aspects of your knee.
The development of bone spurs is often a response to chronic irritation or instability in the joint. If the screw is indeed causing mechanical irritation, it could lead to changes in the joint surface and the surrounding bone, resulting in the formation of bone spurs. However, it’s also possible that other factors, such as the original injury or the surgical procedure itself, could contribute to these changes.

Regarding your question about whether you should consider surgery to remove the retained screws, this decision should be made carefully. If the screw is causing significant pain or functional impairment, removal might be warranted. However, surgery carries its own risks, including infection, nerve damage, and the potential for further complications. It’s crucial to weigh these risks against the potential benefits of removing the screw.

Before making a decision, I recommend the following steps:
1. Consultation with an Orthopedic Specialist: Seek a second opinion from an orthopedic surgeon who specializes in knee surgeries. They can provide a thorough evaluation of your current symptoms and the condition of the retained screws.

2. Imaging Studies: Consider getting updated imaging studies, such as X-rays or an MRI, to assess the position of the screws and the condition of your knee joint. This can help determine if the screw is indeed causing issues or if there are other underlying problems.

3. Conservative Management: If the pain is manageable, you might explore conservative treatment options first. Physical therapy, anti-inflammatory medications, and activity modification can sometimes alleviate symptoms without the need for surgery.

4. Monitoring: If the screw is not causing significant pain or functional limitations, your doctor may recommend monitoring the situation. Regular follow-ups can help track any changes in your symptoms or the condition of the screw.

In summary, while retained screws can lead to complications, the decision to remove them should be based on a comprehensive evaluation of your symptoms, imaging results, and a discussion with your healthcare provider. It’s essential to consider both the potential benefits and risks of surgery. If you experience worsening pain or functional limitations, it may be time to revisit the option of removal. Always prioritize open communication with your healthcare team to ensure the best possible outcome for your knee health.