Remove Screws After ACL Surgery?

remove screws acl surgeryHas anyone had their hardware removed (screws, etc) after having ACL surgery?

I’m currently scheduled to have my 2 titanium screws removed from my my incision, just below my knee. It isn’t the bioabsorbable screw, as that is not wise to remove, being deep into the bone. The surface area with the 2 screws is sensitive, but is only minor pain- probably a 2 on a 10 point scale. With my insurance deductible met, I’m tempted to have the screws removed, but I don’t want unnecessary risk.

The purpose of the screws being there is to hold your graft (replacement ACL) in place. After healing for a year, the screws are no longer necessary, as the graft has healed in its place. [see a company that makes the screws]

Below is what I have learned so far about having your ACL surgery screws removed (hardware). These responses are from an experienced arthroscopic surgeon who is the staff doctor for a professional basketball team.

  1. Do you recommend me having screws in my knee (near incision) removed?
    Answer: only remove them if you have pain in that area. Don’t remove them for other reasons, such as thinking someday in the future they may become a problem, or that you might get arthritis (not true).
  2. What are all the risks of having the screws removed?
    Answer: So, the surgery itself is not risky, but the risks are the same as for any surgery, including infection (that may lead to death), and fasciitis (damage to nerves, vessels, and tissue).
  3. What are all the risks of leaving the screws in (not having surgery)? (arthritis, pain, etc?)
    Answer:  None. There is no known risk of leaving in the hardware. In years past, it was more common to remove hardware, but is done less and less in recent years as techniques have improved. There is no risk of arthritis, despite what some people believe. Arthritis only exists near a joint, and the screws are not at the knee joint, but below at the place of incision.
  4. What % of the surgeries (for removing screws) have complications?
    Answer: None the surgeon is aware of.
  5. Of all the ACL surgeries you have performed, what % have had their screws removed?
    About 1% to 5% have their screws removed due to pain it causes- from doing about 100 ACL surgeries per year for many years.
  6. Of all ACL surgery patients who have had their screws removed, what % noticed improvement (less pain) and were satisfied?
    Answer: Most all who had pain in that area had reduced or no more pain in that region.
  7. How long is the procedure to remove screws?
    Answer: Short, only about 15-20 minutes, but additional time for preparation, such as anesthesia, prepping the leg (shaving hair, cleaning, sterilizing, etc), and recovery. The surgery is a relatively simple procedure, as its near the surface. The only thing covering the heads of the screws are skin and a little fatty tissue, including nerves and vessels. That part is cut and the titanium screws (and washers) are removed using a regular hand-held screw driver (not a drill). Then the incision is sewn back together and its done. There is no endoscopy or any other procedure needed.
  8. Does the procedure require anesthesia and will the patient be asleep?
    Yes. The initial unscrewing of the screw from the bone would be painful without anesthesia. You need to be completely asleep for it. It’s also possible to have partial anesthesia so you’re not 100% asleep.
  9. Will the screws being removed make the fixation any weaker?
    No. After a year goes by, the graft has fused into the bone where it should not be weaker without the screws.
  10. What is the typical recovery time after the screws are removed?
    You can walk the same day, but crutches are recommended for the first day or two. You will be sore in that area. No pain medication is needed post surgery. After 1 week, you should be able to resume normal athletic activities.
  11. Is there any advantage (timeliness) in having screws removed sooner vs later? (such as years into the future?)
    No, there is no advantage at all. Your body will respond in the same way, whether 1 year after surgery or 10, or 20 years. If there’s no pain causing you to need to take out the screws, don’t take them out. Simply wait and see if it becomes a problem and is painful and if so, then take them out down the road, since there’s no disadvantage in waiting.
  12. What are the exact billing codes used for this? (codes you may give your insurance company to determine whether your plan covers it or not)
    20680 – hardware removal
    plus billing codes for the surgeon’s fee, the anesthesiologist, any assistants

An additional questions that would be nice to ask:
What % of ACL patients have a problem with their screws unscrewing on their own?

So, has anyone had their hardware removed (screws, etc) after having ACL surgery and what was your experience (do you recommend it)?

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48 thoughts on “Remove Screws After ACL Surgery?

  1. The screws removed made ALL the difference …can’t imagine still having them

    1. I had minimal pain in tibia,no doctor had any concerns…i ditched my OS and went with a young hotshot OS asked him to remove hardware from ACL 5 years prior..no problem he removed large cheap screws with high Nickel content..those cheap screws had caused a local and systemic reaction…a giant hole in my tibia had to be filled with bone cells as a result of cheap metal screws…plus my headaches and fatigue went away within days of removal. So glad I had hardware removed. Metal is toxic to body micro particles absorbs into bone marrow.

  2. rehab queen says:

    I work for a sports rehab center and I tore my ACL a couple years ago, then opted to have the screws removed later because of pain around that area- I’m so glad I did. I don’t have any knee pain now and was able to walk around just fine the same day of surgery.

    1. How long was it until you were able to fully resume biking or running?

  3. I’m 2.5 years out of a Patella graft replacement. In the last 6 months I’ve started getting pain around my tibial screw. Nothing that is earth shattering, but it’s enough that I notice it – especially after doing things like lunges. It’s both sore to the touch (pushing on the screw) and doing something like twisting on my knee

    I went to the surgeon who did my surgery. The X-ray didn’t show that the screw was backing out, but he thought it may just not show it or that the skin over the screw was just irritated. He suggested we remove it.

    I’m a triathlete and being down and out during my ACL recovery nearly drove me insane. The surgeon scheduled the surgery but I freaked out like 2 hours before and didn’t show up. I’m terrified of being on my back for an entire month again (my recovery was pretty rough). He (the surgeon) says that it’s only a couple days, but I just don’t trust Drs.

    Can anyone give me a an example of the activities they were able to do, say 3, 5,10, and 14 days after screw removal?

    1. Easy recovery,few days rest. Many people walk with in days.but take easy to give body chance to heal. When you think how toxic metal is to body,it makes sense to remove while your young and healthy

  4. I went ahead and bit the bullet and had my screws removed on Tuesday (2 days ago).

    I was able to walk out after surgery. I’m in a bit of pain and limping around. But I think I’ll be back in action in a week or so. I will continue to post my progress.

    1. Hey Chris how are you doing?? I had the same surgery and am now having pain. Called my Dr. today about it. I’m nervous to get the screws removed but if I keep hurting like this I am going to have to do something.

      1. i had 5 screws removed from my left ankle 25 years ago and was glad i did. now i have my right ankle broken with 7 screws and cant wait to have them out as well. i felt much better after i did. dont be afraid.

    2. zubersabugar says:

      dear chris,
      can i removed my screw after surgery?

  5. I’ve had 2 ACL recon (one on each knee) Its been 8 years since surgery on one and 6 years on the other. I have Never had any pain post 1 year after surgery, The pain you may feel may actually be SCAR TISSUE!! And anyone who gets the screws removed and feels relief after its probably not because of the screws being removed but that while your doctor was in there he removed some built up scar tissue he or she may have seen…..My doctor warned me and told me to be aggressive in your rehab to break that scar tissue up which also affects Extension and flexibility !!!! 8 years and never have had a problem, they both feel great

    1. I had my big screws removed after 5 years. So glad I did. The medical profession is lying when they say are harmless. Toxic metal over time release ions into blood. Many patients are duped and implantation of cheap metal. I was told I had titanium,until it was removed. And got a surprise

  6. I had ACL surgery along with meniscus repair almost two years ago. One of my screws under my vertical incision started backing out a few weeks ago. The first day this started happening the area below my knee right over the incision was very red, swollen, and almost bruised looking. About 24-48 hours later with ice,ibuprofen and reduced activity, the area looked perfectly normal again. Once the swelling went down I could actually see the screw poking out and can distinctly feel the head of the screw.

    I haven’t limited my activities since my screw started backing out. I train for triathlons and teach fitness classes, so I’m not inactive. The only thing I can’t do is kneel on that leg, even on a soft surface such as a bed. I’ve decided to wait and see if the screw causes any complications or pain, but so far I just have a “screw loose.”

  7. Operated for ACL in 2003. 2 screws inside and no pain till today and playing games. The spinal anasthesia causing a lot of trouble till today. Do i need spinal anasthesia again to remove the screws, if so i all never go for removing them, even if it hurts my leg. I need help from a doctor about spinal anasthesia troubles. It still hurts (tickles – something moves from the point of the injection towards outside) breathing problems, headache, backbone going stiff after i sit for a while. I need help to get out of this spinal problem.

  8. aclsurgery says:

    I didn’t have spinal anesthesia, but just through the vein in my arm when I had my regular ACL surgery. For removing the screws, I understand it could be very painful without any anesthetic, as its screwed into the bone, and they literally use a screw driver to back it out. My surgeon said he doesn’t use a power drill screw driver, but just a hand tool. You’d want at least local anesthesia or regular to minimize pain.

  9. thanks aclsurgery, actually my request for anasthesia in the arm vein was denied during my regular ACL surgery. Around 4 men bent me down to put the spinal anasthesia twice despite the failure on the first attempt, My bad luck or fate i think, i now need some treatment to get rid of the pain and suffering that i am going thru for the past 8 years. someone or anyone plz help

  10. Stephanie says:

    I have had 2 ACL reconstructions. Right ACL in 2007, and left ACL in 2011 (3 days ago). While I was out for the second one, my doc removed the 2 screws in my tibia (yes, I had an extra screw…long story) from the first reconstruction. The screws were not much trouble, but I could feel the top of the screws through my skin and when I kneeled, I could feel a little pinch so he offered to remove them. He won’t remove the one in my femur though. That will be with me for life and beyond :-)

  11. I had a ACL Reconstruction while in the military, thanks to bad info from the forward observer in our landing zone, I hit a stump tearing my ACL and fracturing my knee in three places. I had the surgery in the late 90’s. Almost 5 years ago I was told by the VA surgeon that I needed to have the hardeware removed since it was causing me pain. However, not only am I having pain, but my knee still feels weak and does give out on me. I told the doctors this and they have not told me what could be the cause of the weak feeling and giving out. I am going back to the VA the end of this week to see a new surgeon for a consult to remove the screw…Is there anyone that can give me information as to the way my knee feels this long after the original surgery? :-/

    1. Brian, it sounds like you have failure of your ACL graft and may need to have it redone. The “giving out” is the ACL not fully intact and doing its job”. The weakness is likely due to muscle weakness because due to the pain you likely do not use the leg in the same way as you do the other one and you may have some muscle atrophy. See another doctor and get this evaluated.

  12. I’ve had a total of 5 surgeries on my left knee, 4 were minor meniscus repair, however, the major ACL reconstruction with iso-graft was July 2010. It was December that same year on my last day of physio that I noticed the hard bump below the knee where the inscision was. At my 6 month check up with the ortho surgeon, I was advised that this was a screw backing out and if I wanted it removed, I had to wait a year post surgery (which would have been July 2011). I still haven’t had it removed as it’s not causing me any discomfort or pain. You can visably see it protruding from my skin and touch it, however, it only pains when I kneel on it….or my 4 year old acidentally kicks it….LOL. Recently, however, in the last few days actually, it has been making a cracking sound (like cracking your knuckles) with every step that I take. Again, no pain or discomfort, just an awful cracking sound. I wonder if it’s the screw rubbing against the bone? Is this even possible? Any comments or suggestions are welcome. Thanks.

  13. aclsurgery says:

    Hi, are you sure the cracking sound if from the screw? Doctors usually say knees/joints that crack are normal and aren’t harmful. My screws protrude from the skin a bit too. It feels only slightly uncomfortable sometimes. But if I ignore it – get my mind off it- I feel normal.

  14. Angle powers says:

    After my last acl surgery with a patellar tendon graph I have noticed that my tibia screw is protruding. If I am not paying close attention when I shave my legs, I always shave the top of where the screw is coming out. It bleeds and I have to put a band-aid on my leg. I know, sounds yuck. Anyway, I am thinking about having the screw removed. This will be the 5 th surgery on knee. What would you do? Really am getting tired of the scars.

  15. I just had my screw removed a week or so ago..but mine was biodegradable so they only removed some since it was already fusing to the bone..but it already feels soo much better!

  16. I got my knee surgery about 3 minths ago it feels fine. But i want to join the MARINE CORP so any metal is a no no. So its cool to just get them out.

    1. Jonathan Mullins says:

      Jeremy,

      This all depends on the amount and extent of the damage to the area as I myself am Ex-Military(U.S. ARMY) 19kilo(Armor Crewman)/ 96Zulu. I had a major meniscul tear and ACL removal(my graft failed) and the result of my Fixation Screw was a serious Staph infection that kept me in the infectious disease ward for well over 3 months not to mention my Physical therapy. They may accept you making you sign a waiver but if the damage is too extensive you will not be able to enlist. Sorry but I will not lie to you.

  17. Wow! I thinK I have one metal and one bioabsorbale…NEVER want another surgery although my surgeon was fantastic and I had/have no complications thus far, 4.5 months post-op. Need to be more aggressive with physical-therapy though.

  18. hi, im in the army and just had ACL Reconstruction and had one screw put in place, came out of surgury on thursday 9th feb. and still on crutches, stitches out, not i done this playing rugby and was very painful trying to strighten my leg,

    any advice on when you think it’ll start healing … ie. running and things>?? be very grateful!!

  19. I had ACL reconstruction from a rugby injury November 30th. I was able to resume running 12 weeks post up. Returning to the pitch will be about a year from the surgery. I do ok with my running but still have weakness walking up and down stairs.

  20. I had an acl reconstruction in July 2011 after tearing my acl in a canoeing accident. Had a great surgeon and recovered very quickly. About a month ago I started having intermittent pain at my tibia incision that sometimes made it hard to walk. My doctor told me it is the screw and he could take it out. But since I would have to resatisfy my deductible and out of pocket I am going to wait until it bothers me a lot more. I had a long nerve block (36 hours plus) and general anesthia with my acl surgery and didn’t have any pain nor did I take pain killers. From research it appears that the nerve block made all the difference.

  21. Solid snake says:

    How much would it cost to remove a screw from my ankle? I live in El paso, Tx. I have no insurance.

  22. Really interesting reading all of the above. Wonder if anyone has been in my situation and can offer any advice? Had acl op after skiing accident – just over a year later, having not felt my knee was stable, the acl went again and then it was discovered tunnels had been drilled FAR too posterior (was only a matter of time before it failed). Then had to have bone graft op to fill in wrongly placed tunnels and seven months later another go at the acl. This time (over a year now) pleased to say knee stable but I have a constant deep ache, increases during lots of weight bearing exercises. Want to have screw removed but surgeon not willing to do it as scans show no sign of inflammation. What do I do, can’t do sports as used to because of discomfort. Four years now since this started and rather at the end of my tether!

  23. I had two screws removed two weeks ago (tore ACL in 2001) along with a meniscus repair and a small 5mm microfracture procedure. I am getting my ACL revised using patellar tendon mid December. The reason for the staged surgeries is because the doctor said he needed the tunnels/holes to fill back in with bone so he could start from a clean slate. Has anyone experienced the staged surgeries?

  24. I had 2nd of 2 ACL recons in 2001, on the same knee. Has been great stability wise, ROM etc. However for the past decade, the tibia screw has been backing out. It doesn’t pain me day to day, but protrudes significantly now and I sometimes ding or pinch it on something, which does hurt. Since I went to an OS for another problem, I’ve asked him about removing the screw after the more important issue is understood. Any thoughts on leaving it alone or going for removal? I do not want to affect my knee stability, but the screw is not comfortable either…

  25. Just wanted to contribute because I’ve been reading a lot over the internet. Had my ACL surgery, meniscus repair on Oct-12th-2011 at Univ Hospital Miami. Painful ACL surgery but the progress was good,I was undergoing PT, stopped going to a therapist after 6 months of surgery(insurance restrictions), I still had pain near the incision, visited the doctor again in Feb-2013 and he told me that I need to get the screw removed, had it removed on Feb-17th 2013, I did have pain for a week but compared to ACL pain, this was nothing, I would say, it was a 5 on a scale of 10. I am not planning to play sports at least for a month to be safe. Since I still have pain from the incision, can’t say for sure that the pain no longer exists, just being hopeful..just as you mentioned in your article above, if there is pain because of the screw, just get it removed…

  26. David Guetta and Sia’s song “Titanium” is my official jam. I have screws in my right knee for an ACL reconstruction (2010) and a fixation screw in my finger holding the DIP joint together for a fusion. All are doing their jobs flawlessly, and with strength. I had a titanium suture anchor in the finger originally (a little devil about the size of an adolescent ant) that was holding a tendon in place, but the total fusion with the big-boy screw wound up being a better option after arthritis set in… this was an injury, not arthritis, btw. These contraptions have not only given me my life back, but they have caused no trouble whatsoever, in my case at any rate. In a strange way, it is reassuring to know they are there. After all, titanium is… well, titanium. It’s like science fiction-strong. Six Million Dollar Man strong. And how cool it is to show girls your scars! In my opinion, if they aren’t causing bother, leave them be. The only reason I will ever have mine out is if they can be replaced by new models that can shoot lasers or have rhinestones or something. Aside from that, (and I sing here…) “I am ti-tan-i-uum!!!”

  27. I had ACL reconstruction August, 2012 and repair of crushed/torn miniscus. Used my hamstring tendon to reconstruct the ACL. Slow rehabilitation, 4 months to run again ‘normally.’
    My issue is I am at 8 months out, and my front tibia screw is slowly unscrewing itself!! The pain is worse than the injured ACL, and the screw doesn’t show up on X rays, so I have to wait for a MRI. Has anyone else encountered their leg slowly undoing the screw?!
    I read the above comments, and am quite glad to hear that if I do have to have another surgery, it is only a few weeks, compared to a good 6 months of recooperation for ACL surgery. Google does not have much on this topic, so I am glad to have found this website!!

  28. I had a fractured knee a broken femur and my ankle fractured in three places. From a motorcycle accident. Happened 7 years ago. Five screws in my knee four screws to hold the femur rod in and three screws in my ankle. I have been in pain after sergery the whole seven years and I have done nothing to take care of the pain. I have been dealing with the pain the whole time. I need to do something soon because the pain is so bad now I have a dificuty in walking my pain is a 10. Will a total knee replacement do the trick.Please respond.

  29. Panzer Treat says:

    I can’t find anything on removing screws for ankles so I’ll just post here… I had an ankle reconstruction a year ago, I’ve still got pain where the screw is. I can’t remember if it is a dissolvable one or not but my surgeon said I can have it removed later. I’m going to book another appoint with him. Mine hurts sometimes when it’s cold, if I touch it or just randomly like today. I did all my physical therapy and more, did everything I could and still have pain (different type of pain to what I had pre-surgery), so I assume it’s the screw.

  30. my knee has been giving me problems lately .. i had surgery about 20 years ago .. never really had problems till recently. can or should i get my screws removed .. any suggestions ? i surf 3-4 times a week .. ive had acl patella reconstruction .. dont know how to go about doing something like this…

  31. I had ACL surgery back in 2006 and then again on the same knee in 2007 after tearing it for a second time. There are two titanium screws holding the new ACL in place. After reading this post I learned that you don’t need the screws any more after a year. I have always felt mine protruding a bit on the front of my knee just below my knee cap, and you can see it as well. The interesting thing is that I have been seeing a holistic doctor who found large amount of chromium coming out of my skin over my face and knee that the screws are in, and it is causing problems to my health. I talked to my surgeons team, and they informed me that the screws are made out of titanium so they said the screws shouldn’t be the issue for where the chromium is coming from. Since talking with them, I learned that most screws are actually titanium alloys which are made up of multiple different metals. I am wondering if anyone knows what metals are in these titanium alloy screws they put in your knee for ACL reconstruction, and if chromium is one of those metals?

    1. They lied and put cheap nickle in my ACL repair. Yes,I found out years later when I had them removed. Not healthy to have metal in human body. The metal had eaten a large hole in my tibia and made me suffer headache and fatigue for years.this all resolved quickly after removing hardware

  32. hi,

    I was at ACL surgery 5 years ago. Yesterday I was at screw removal, but it wasn’t successful, as screw is overgrown with my bone, so it was impossible to catch it. I don’t have now problems with screw, but i want to ask you if there is need to extract the screw. I should notice, that screw isn’t made of titanium. I’m not sure about material, but probably its some kind of steel.

    To extract the screw i have to be in full anesthesia, so I’m a bit afraid of this. I’m 28 years old, and need to know if there is need to extract it, or can i live with that screw without any complications, or problems in my future live.

    thanks

    1. Get hardware removed while your young and healthy. Don’t wait for toxic side effects. Medical professionals mislead by saying hardware inert. Metal is toxic to human body. I felt so much better after removing

  33. I had acl surgery 13 feb 2014.I am so depressed becuase before surgery ,i was about 90 % fine .I had no pain swelling and even unstability.only problem was ,whenever i tried a agressive zig zag motion ,i feel unstability and fell down .MY SURGEON didinot guide me with the procedure of acl reconstruction .Now i ma tottlay woried about titanium screw.
    Can some one guide me

    1. Adel, don’t worry,once your a year out ask to have screws removed,give body time to heal

  34. I just had my 2 screws removed from a surgery in 2011 with hamstring graft. Everything I read said it would be little pain afterwards. I had 2 huge golfball sized bumps from swelling by both incisions and pain was tolerable but definitely there first few days. It’s been 2 weeks since and still can’t bend the knee fully but better every day, I had mine removed though because they were affecting a nerve and sadly still have the numbness.. Hoping as weeks go by it gets better. Just disappointed, I thought I’d be back running in the next few weeks but I doubt it right now

  35. I had ACL surgery on my right knee in 1992, in 2000 I had the hardware removed due to pain and swelling I was experiencing. My surgeon removed everything sucessfully except, when he attempted to remove the screw in my tibia, it broke off. He tried to dig it out and could not remove it. An outpatient procedure then become an overnight stay in the hospital to manage the extreme plan I was experiencing. I have had pain and swelling in that area for 14 years off and on. For past week, I have been in alot of pain. The swelling around the site is unbelievable and I feel piercing with every step. Has anyone ever experienced this?

  36. Chad Hill says:

    My name is Chad Hill , I had ACL reconstruction surgery March 28th of this past year. I used my patellar tendon for the graft.

    Anyway, it has been about 14 weeks post operation and I have been running for about two weeks. The screw is beginning to hurt especially when doing one legged squats and running. It is not excruciating pain but enough to remind me that it is there.

    I will be leaving for bootcamp next June and I will need my knee to be good to go as of December because I must get cleared by military doctors by then otherwise I will be medically disqualified. Anyway, my concern is if I get the screws removed now, will my new graft be any weaker? I know you said to wait a year or so before the screws are removed, unfortunately, I do not have the luxury of waiting to get the surgery (if I am going to get it at all). If there is any chance that my knee will be weaker because I got the screws out early I will not get the surgery and just deal with the pain and get the surgery after bootcamp or something. Please let me know what you think.

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