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POTENTIAL COMPLICATIONS OF ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

SPECIFIC COMPLICATIONS

PATELLAR FRACTURE

Use of the bone-patellar tendon-bone graft may result in patellar fracture. This can occur at the time of harvest or later during rehabilitation. Patellar fracture may require operative reduction and internal fixation. It may result in chronic patello-femoral pain.

PATELLAR TENDON RUPTURE

This rare complication has been reported in the medical literature but has never occurred at our institution.

PATELLAR TEND0NITIS & CALCIFICATION

Patellar tendinitis may occur during the rehabilitation period. Symptoms usually resolve with rest, anti-inflammatories and physiotherapy. Local calcification may occur within the patellar tendon at the site of graft harvest and may produce local irritation.

GRAFT FIXATION SCREWS

Local irritation from the screws used to secure and tension the graft may necessitate screw removal.

GRAFT FAILURE

Bone-Patellar Tendon-Bone graft reconstructions have excellent initial fixation and stability. In the long term however the graft relies on revascularisation to allow permanent bone growth and new-ligament formation. This takes approximately 6 months but can continue for up to 2 years after surgery. Failure of revascularisation can lead the graft to weaken, possibly leading to recurrent symptoms of instability.

STIFFNESS

Stiffness (loss of motion) may result from many causes including prolonged immobilisation, reflex sympathetic dystrophy, infection and pain. Technical problems related to graft placement might lead to loss of flexion or extension. Contracture of the anterior soft tissues of the knee following harvest of Bone-Patellar Tendon-Bone graft can limit motion. Excess fibrous (scar) tissue formation, or new bone (osteophyte) formation, around the graft can produce a mechanical block to extension.

GENERAL COMPLICATIONS

INFECTION

Despite surgery under sterile conditions, infection is still a potential complication of all operations. Post-operative infection maybe:

Superficial - Wounds only and usually settles with antibiotics.

Deep - Involving the joint. Requires further surgery to washout the joint and intravenous antibiotics. May lead to joint stiffness and early degeneration.

DEEP VENOUS THROMBOSIS & PULMONARY EMBOLUS

A blood clot in the deep veins of the calf or thigh is a complication of any lower limb surgery. The treatment is anti-coagulation for 3-6 months.

A blood clot that breaks-off and travels to the lungs is called a Pulmonary Embolus. This is a rare but life threatening complication. The treatment is anti-coagulation for 3-6 months.

HAEMARTHROSIS

Bleeding within the knee joint can complicate any surgical procedure. A haemarthrosis will usually respond to ice, rest and physiotherapy but can lead to delayed recovery and joint stiffness.

NERVE INJURY

Small areas of numbness may be associated with the operative incisions. The numbness is usually temporary. Occasionally wounds can become painfully sensitive, although this normally settles with time.

REFLEX SYMPATHETIC DYSTROHY

Reflex Sympathetic dystrophy is a little understood condition, which can complicate any operation. It consists of regional pain, swelling, sweating and stiffness due to local overactivity of the sympathetic nerves triggered by surgery, however minor.

COMPARTMENT SYNDROME

A rare complication where fluid used to dilate and irrigate the knee joint tracks into the muscle compartments of the calf. Increased pressure within the calf can compromise the nerve and blood supply of the lower leg and requires emergency surgery to decompress the leg.

Potential complications of arthoscopic anterior cruciate ligament reconstruction