7 months post-op, stuck at a 30° extension block and 110° flexion. Surgeon ignored a displaced tibial spine fracture, did an ACL repair + MUA, and now wants to do a 3rd surgery (ORIF). Local surgeons refuse a second opinion. Need advice
Had an e-bike accident 7 months ago resulting in a displaced tibial spine fracture, grade 3 ACL tear, and bucket-handle meniscus tear. The surgeon repaired the ACL and trimmed the meniscus, but ignored the displaced bone. When the knee locked, he performed a Lysis of Adhesions (LOA) + Manipulation Under Anesthesia (MUA), which gave just enough motion to move from crutches to a cane, but left me plateaued at a persistent 30° extension deficit and 110° flexion.
An outside X-ray just confirmed the displaced tibial spine never healed (nonunion) and is acting like a physical doorstop. The surgeon is now recommending a 3rd surgery (ORIF), but local private practices refuse to evaluate me for a second opinion because they "don't touch another doctor's recent surgery."
The Initial Injury (March 2026) Mechanism: Severe e-bike crash. Initial Imaging (March 8, 2026): Emergency X-rays documented displaced fracture fragments of the tibial spines extending into the medial and lateral plateaus, along with nondisplaced fractures of the lateral tibial plateau and lateral femoral condyle.
Surgeon's Assessment: The doctor said the tibial spine displacement was minimal with no surgery needed. Pre-Op MRI (April 3, 2026): Confirmed a ruptured ACL, a bucket-handle lateral meniscus tear, grade 2 MCL sprain, extensive bone contusions, and noted an avulsion fracture healing with "nonosseous union" (fibrous scar tissue rather than bone).
Surgery #1: ACL Reconstruction & Meniscus Trim (Late April 2026) Roughly 5 weeks post-injury, the surgeon performed a grade 3 ACL repair and trimmed the bucket-handle lateral meniscus. The displaced tibial spine fracture was left completely unaddressed and unreduced. The high-tension ACL graft was anchored over/near an unstable, elevated bone fragment. Post-operative imaging was performed, but no complications were communicated.
Post-Op Complications & Surgery #2: LOA + MUA (August 2026) Recovery stalled immediately. Despite aggressive physical therapy, my knee developed a persistent, rigid 30-degree extension block. Walking caused sharp bone-on-bone pain, and the joint capsule remained chronically swollen. Right before scheduling a second procedure, an X-ray was taken, and the surgeon verbally acknowledged that the tibial spine fracture "might be coming back to bite us." Despite noting the bone issue, he proceeded with a soft-tissue clean-out: Lysis of Adhesions (LOA) and Manipulation Under Anesthesia (MUA).
Outcome: The procedure provided minor gains in extension and flexion—just enough to transition from crutches to a cane—but quickly hit a hard mechanical stop. At 7 months post-injury, I remain stuck at a 30° extension deficit and capped at 110° flexion.
The Revelation & Proposed Surgery #3 (Present Day) An outside chiropractor ordered new X-rays, which clearly captured a prominent, elevated bony fragment sitting directly in the joint notch. I brought those films back to my orthopedic surgeon. He finally admitted that the tibial spine fragment broke off and never achieved bony union over the last 7 months.
Current Recommendation: The surgeon is now scheduling a 3rd surgery: Open Reduction and Internal Fixation (ORIF) of the left tibial spine.
Major Concerns: Reducing that fragment flat after 7 months will likely alter the tension of the existing ACL graft, leaving it loose or non-functional. 6+ months of forced movement against a mechanical block has likely caused roof impingement, graft fraying, and femoral cartilage erosion. I do not feel comfortable having the original surgeon perform a 3rd procedure after missing/minimizing this twice.
The Roadblock: Getting a Second Opinion I have been trying to secure an independent second opinion before consenting to this 3rd surgery. The "Liability Wall": Local private orthopedic practices are outright refusing to book an appointment. Schedulers explicitly state they "do not touch or evaluate another surgeon’s recent post-op cases."
Insurance Constraint: I have an HMO plan (Florida Blue myBlue), which requires formal physician-to-physician electronic referrals and prior authorizations to see any specialist. Next Steps in Progress: Working with my Primary Care Physician to bypass private practice gatekeepers and send a direct, urgent referral to an academic tertiary referral / Level 1 trauma center (USF Health / Tampa General Hospital) to see a complex revision and adult reconstruction specialist.
Questions:
Has anyone had an unhealed tibial spine avulsion fracture successfully fixed (ORIF) months after an ACL reconstruction?
Was your existing graft salvageable, or did you need a full revision ACL reconstruction?
Did prolonged mechanical impingement cause lasting damage to your femoral notch cartilage?
Did you ever regain a normal gait with full extension and flexion after clearing a long-standing mechanical block?
For those who faced the "no other surgeon will touch another doctor's recent work" barrier, what was the most effective way you got into an academic or trauma revision specialist's office?