Complicationsof

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 % - 1.7 % 1 - 3 w after surgery ( JBJS Am. 2013 ;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% - 17.9% in routine arthroscopy

ACCP guideline : knee Arth. Without risk factors, just early mobilization

THANKS