Orthopedics & Sports Medicine Expert Forum
Was a mistake made by my surgeon?
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Questions in the Orthopedics & Sports Medicine forum are answered by Michael L. Gross, MD the CEO of Active Orthopedics & Sports Medicine.

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Was a mistake made by my surgeon?

I had reconstructive (allograft) surgery on my left knee. When I was four weeks post op I had continuing and it kept getting worse. In addition, I had an incident where my knee became extremely swollen and the subsequent pain was unbearable. I was unable to put any weight on my leg at all. I went to the emergency room where they took x-rays.

When comparing the x-rays for my left knee to the right knee (which had the same surgery in May, 2010 & healed-up, nicely), I noticed a glaring difference. The right knee had two metal screws visible on the x-ray - one on top and one on the bottom. However, the x-ray of my left knee (which has caused much grief & discomfort) only showed one metal screw. While I understand that dissolvable screws are an option and don’t show up on x-rays, I have been curious and perplexed as to why the procedures were performed differently. That combined with all the difficulty and swelling that I have had with my left knee has given me pause and enough concern to ask more questions.

I have asked my original surgeon and my physical therapist about this situation. However, I was not comforted by the vague answers that I received. In addition, I have sought a second opinion from another surgeon, who has indicated that my left knee is a complete re-do. Based on the x-rays the Dr. has taken, he’s indicated that I am experiencing bone-on-bone contact in my left knee which is causing the pain I am having and that the allograft “didn’t take”. The Dr. has recommended I have additional surgery to correct these issues. Specifically, he would like to proceed with a Proxcitimal Tibial Realignment and new ACL reconstruction (allograft).

My questions are:

• Is my first surgeon at fault because he forgot to put a metal, stronger screw on the bottom of my knee?
• Should I get a MRI to truly see what the problem is?
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Most surgeons who do a lot of ACL reconstructions, myself included, have gotten away from using metal screws and have started using either synthetics or bio-composites.  There really is no clinically significant difference and certainly no disadvantage in the use of non-metal screws.  From what you are indicating, it really doesn't sound as if the choice of screws has anything at all to do with the problems you are experiencing
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