Complication &ACL revision

Time Minimal or no swellingLeg controlFull ROM

Intraop. complications Tunnel malpositionImproper tensioningFix. ProblemGraft 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 Stiffnes Graft stretching Stress on cartilage Poor vascularity

Fixation Screw Transfix endobutton

Graft impingement Notchplasty Postop pain Bleeding Swelling regrowth

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 surgery PT, 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. Weakness Tunnel widening Allograft :

ACL recon. failure Retearing & instability Loss of motion Persistent pain

Revision of ACL Cause of failure Patient selection Motivation & expectation Time of surgery Surgical tech Graft selection G incorporation Secondary restraint(medial & posterolat) Meniscal& cartilage condition Rehabilitation Second trauma Motion loss flex cont>10 & end of flex>20 Lower extrimity alignment

Preop. Planning of instability Cause of failure History & 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 stage Loss of ext>5 limited flex >20 Widening>15mm

21/7/ /11/ 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 27 No allograft( 33) no female(12)