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

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