Complication &ACL revision

Time

Minimal or no swelling

Leg control

Full ROM

Intraop. complications

Tunnel malposition

Improper tensioning

Fix. Problem

Graft impingement

Surgical tech. errors• Tunnel placement

• Inadequate notchplasty

• Graft selection& size

• Tensioning

• Fix failure:

Poor bone quality,screw breakage,screw divergence & graft damage

Tunnel malposition

• Femur Ant. Position & post. Position & vertical• Tibial ant. & post position

Blumensaat,s line

Graft tensioning

• Inadequate tensioning• Overtensioning StiffnesGraft stretchingStress on cartilagePoor vascularity

Fixation

• Screw• Transfix• endobutton

Graft impingement

• NotchplastyPostop painBleedingSwellingregrowth

Postop problems• Persistent Ant Knee

Pain 0 34%• Motion deficits

1 13%

• Arthrofibrosis

• Graft failure

• Osteoarthritis

• DVT Infection

Ant Knee pain

• Flex contracture>10• Q weakness • BPTB G short imobilization,early &proper PT

Loss of motion

• Tunnel malposition• Prolonged immobilization• Poor patient compliance• RSD• Too early recons.• Inadequate notchplasty• Concomitant surgeryPT, steroid, manipulation,arthroscopy & revision

Graft specific complications

• BPTBG: Ant knee pain,kneeling pain,flex contracture,patellar fx,tunnel mismatch,graft fx,suture laceration,post cortex fx

• Hamstring : Short graft Saphen n. injury H. WeaknessTunnel widening Allograft :

ACL recon. failure

• Retearing & instability• Loss of motion• Persistent pain

Revision of ACLCause of failurePatient selectionMotivation & expectationTime of surgerySurgical techGraft selectionG incorporationSecondary restraint(medial & posterolat)Meniscal& cartilage conditionRehabilitationSecond traumaMotion loss flex cont>10 & end of flex>20Lower extrimity alignment

Preop. Planning of instability

• Cause of failureHistory & ph. Exam.& imaging(AP,lat,MRI,CT,Long standing alignment view)• Good ROM• Low swelling• Good mucle strength• Graft selection• Tunnel place & widening& previos device• One stage or two stageLoss of ext>5 limited flex >20Widening>15mm

21/7/89---30/11/91

• 564 ACLtearing 407recon.• 25 retearing 2 reretearing

6.63%• 19 revision• Tech. error 4 21%• Recurent trauma 15 79%

complication• Hemarthrosis 10• Endo pain 4• Infection 2• Retearing 27No allograft( 33) no female(12)