Has 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.
- 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). - 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). - 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. - What % of the surgeries (for removing screws) have complications?
Answer: None the surgeon is aware of. - 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. - 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. - 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. - 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. - 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. - 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. - 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. - 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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The screws removed made ALL the difference …can’t imagine still having them
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.
How long was it until you were able to fully resume biking or running?
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?
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.
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.
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.
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
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.”
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.
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.
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
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
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? :-/
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.
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.
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.
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.
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!
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.
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.
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!!
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.