Complications of ACL Rec. Dr a. Bagherifard,MD Knee surgeon SHAFA orthopedic hospital, IUMS

Complications of ACL rec.  intraoperative  postoperative

Intraoperative complications : tunnels malposition impingement improper tensioning inadequate fixation

Tunnels malposition :  Fem. T : Ant loss of flexion ( captured knee ) Pos blowing out Vertical rotational stability A.P stability

Tunnels malposition :  Tib. T : Ant impingement ( flx cont. ) Pos loss of flexion ( captured knee) Med or Lat impingement synovitis

Impingement : Non anatomic tunnel placement Oversized graft Notch stenosis

over tensioning : Loss of flexion Chondrolysis ( stress on the cartilage ) Poor vascularity ( graft degeneration ) Amount of standard tension is unknown ( 10 N ??? )

Ligamentization :  Necrosis ( 1 m )  Revascularization & cellular proliferation ( 1 – 3 m )  Remodeling ( 6 m )

postoperative complications :  Stiffness  Infection  Graft failure  Osteoarthritis

Stiffness : The most common complication. causes : Tunnel malposition ( fem ) Prolonged immobilization Poor patient compliance Notch scaring, capsulitis, RSD

Infection : Rare but devastating complication. 0/14 % % w after surgery ( JBJS Am ;95:843-9 ) Graft can often be maintained

Infection : Risk factors: Previous surgery Duration of surgery > 1.5 h Small portal Flash sterilization Autograft > allograft

Graft failure :  Mechanical : Tunnel malposition Overtensioning Impingement  Biological : Infection Graft insufficiency Premature return to sport Allograft > autograft ???

Osteoarthritis :  OA is a common complication.  50 % after ACL tear.  70% associated with a meniscal inj.  ACL reconstruction can not alter the natural history ( JBJS Am, 2014 Feb 19;96(4): 292 – 300 )

Medical complication :  DVT : potentially life threatening 0.6% % in routine arthroscopy ACCP guideline : knee Arth. Without risk factors, just early mobilization

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