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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
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 )
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