My ACL graft feels loose again two years after surgery. What is happening?

What a loose graft feels like

Patients often describe the knee shifting when they turn quickly, a lack of trust on uneven ground, or one clear episode of giving way followed by swelling. Some notice nothing dramatic, only a gradual sense that the knee is not as solid as it was in the first year after surgery.

Not every loose feeling is the graft. Quadriceps weakness, a meniscus tear or an injury to the collateral ligaments can all make a knee feel unreliable.

Why a graft can loosen over time

• A new twisting injury, often in football, padel or basketball
• Bone tunnels that did not match the position of the original ligament
• Gradual stretching of the graft under repeated load
• An untreated injury to another ligament, such as the posterolateral corner
• A steep slope at the top of the shin bone, which increases strain on the graft

What to do now

Avoid pivoting sport until the knee has been examined, because repeated giving way can damage the meniscus and cartilage. Keep up strengthening work that does not involve twisting, and control any swelling with rest, ice and elevation.

Book an assessment if the knee gives way more than once, swells after activity, or locks or catches. Seek prompt care if the knee is suddenly very swollen or you cannot put weight on it.

What the assessment at Aman Hospital involves

Dr. Gelber examines all the knee ligaments and compares the knee with the other side. An MRI shows the graft, meniscus and cartilage, and a CT scan may be added to look at the old tunnels if revision surgery is being considered. Bringing your previous operation notes, including those from abroad, makes the assessment much more useful.