Post-Surgery Complications After ACL Injury: A Patient's Journey

Inquire about the complications following surgery for anterior cruciate ligament (ACL) injury?

Hello Doctor, I would like to inquire about the health issues of a friend abroad.
In early January of this year, he sustained injuries to his left knee and right shoulder while playing soccer.
However, the local doctors assessed that his injuries were not severe and only prescribed pain medication for one day.
His symptoms did not improve; in fact, he experienced significant pain when going up and down stairs.
It wasn't until two months later that the doctor performed X-rays and an MRI, which revealed a torn anterior cruciate ligament (ACL) in his left knee, necessitating surgery.
However, it took three months after the diagnosis to schedule the surgery, resulting in a total of six months from the time of injury to surgery.
After the operation, his left knee had a moderate recovery capacity, and he began rehabilitation therapy one month post-surgery.
However, two weeks into the rehabilitation, he started experiencing issues with his right knee.
He reported a burning sensation in his right knee, and it felt unstable while walking, as if it were dislocating.
When he consulted doctors abroad, they all responded that the right knee issues were due to compensatory strain from the left knee surgery and advised rest for one to two months.
The concerning part is that these symptoms have persisted for nearly six months.
Additionally, he has been experiencing a continuous burning sensation in his right hip joint and both shoulder joints, 24 hours a day, along with a body temperature consistently between 37.5 and 37.8 degrees Celsius.
When he asked doctors about this, the response was always "just rest." Concerned about a possible undiagnosed infection, he underwent various medical tests, which revealed the presence of two types of anti-viruses: EBV and HSV-6.
He is unsure whether these viruses are causing his burning symptoms or if they are a result of post-surgical complications.
The pain he is currently experiencing has led him to have thoughts of giving up.
Please, could you assist him? Thank you for your attention to his situation.

Alex, 20~29 year old female. Ask Date: 2012/11/18

Dr. Wang Shouji reply Orthopedics

Hello~ Surgery is unlikely to cause the aforementioned sequelae, but excessive use can lead to a burning sensation, which is commonly seen in clinical practice.
If there is a noticeable temperature difference on both sides, one can palpate both sides and feel the temperature difference; however, some may experience a subjective burning sensation while palpating both sides and finding the temperature to be the same, which could indicate a sensory abnormality due to a neurological issue.
Problems caused by viruses are often persistent and rarely localized to specific joints.
It is recommended to consult a rheumatologist to check for any autoimmune diseases that may be causing arthritis.

Reply Date: 2012/11/18

More Info

Post-surgery complications following an ACL injury can be quite complex and multifaceted, particularly when there are delays in diagnosis and treatment, as in your friend's case. The timeline of events you've described indicates a significant delay from the initial injury to the surgical intervention, which can contribute to a range of complications.

Firstly, the initial injury to the left knee, which was diagnosed as an ACL tear only after two months, suggests that there may have been underlying damage that went unaddressed during that time. ACL injuries often lead to instability in the knee joint, which can cause compensatory mechanisms in other joints, such as the right knee and even the hips and shoulders. This is particularly true if the patient is favoring one leg due to pain or instability, leading to overuse or strain on the opposite side.

The symptoms your friend is experiencing in the right knee, described as a burning sensation and a feeling of dislocation, could be indicative of several issues. One possibility is that the right knee is experiencing overuse injuries due to compensatory loading. When the left knee is unstable or painful, the right knee may take on more weight and stress, leading to conditions such as patellar tendinitis or iliotibial band syndrome. The sensation of the knee "wanting to separate" could also suggest ligamentous laxity or instability, which may require further evaluation.

The persistent burning sensation in the right hip and shoulders, along with the low-grade fever, raises additional concerns. While it is possible that these symptoms could be related to the surgical recovery process, they could also indicate an underlying inflammatory or infectious process. The presence of EBV (Epstein-Barr Virus) and HSV-6 (Human Herpesvirus 6) antibodies in the body does not necessarily mean that these viruses are causing the current symptoms, but they could be contributing to a systemic inflammatory response. Chronic infections or reactivations of these viruses can lead to fatigue, malaise, and other systemic symptoms, including fever.

Given the complexity of your friend's situation, it is crucial for him to seek a comprehensive evaluation from a healthcare provider who specializes in sports medicine or orthopedic rehabilitation. An MRI of the right knee may be warranted to assess for any structural damage, such as meniscal tears or ligament injuries, that may have developed as a result of compensatory mechanics. Additionally, a thorough examination of the hip and shoulder joints may help identify any related issues.

In terms of pain management and rehabilitation, it is essential for your friend to engage in a structured physical therapy program that addresses not only the recovery of the left knee but also the right knee and any other affected areas. This program should focus on strengthening exercises, proprioceptive training, and flexibility work to restore balance and function across all affected joints.

Lastly, if your friend's symptoms persist or worsen, particularly the fever and systemic discomfort, it is vital to rule out any potential infections or other underlying medical conditions. This may involve blood tests, imaging studies, or referrals to specialists as needed.

In summary, your friend's journey post-ACL surgery highlights the importance of timely diagnosis and comprehensive care in managing musculoskeletal injuries. The interplay between different joints and the potential for systemic issues necessitates a holistic approach to treatment and rehabilitation. Encouraging your friend to advocate for his health and seek further evaluation will be crucial in addressing his ongoing symptoms and improving his quality of life.

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