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

2. Complications of ACL rec.  intraoperative  postoperative

3. Intraoperative complications : tunnels malposition impingement improper tensioning inadequate fixation

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

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

6. Impingement : Non anatomic tunnel placement Oversized graft Notch stenosis

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

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

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

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

11. Infection : Rare but devastating complication. 0/14 % - 1.7 % 1 - 3 w after surgery ( JBJS Am. 2013 ;95:843-9 ) Graft can often be maintained

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

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

14. 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 )

15. Medical complication :  DVT : potentially life threatening 0.6% - 17.9% in routine arthroscopy ACCP guideline : knee Arth. Without risk factors, just early mobilization

16. THANKS