Complications in brief: Anterior cruciate ligament reconstruction

Abstract

When performing reconstruction of the ACL, the major complications that can arise include missed concomitant injuries, tunnel malposition, patellar fracture, knee stiffness, and infection. We review the complications that can occur as a result of errors made before, during, and after surgery.

Fig. 1

The posterior horn and root attachment of the medial meniscus are seen with the arthroscope positioned under the posteromedial bundle of the PCL, along the lateral aspect of the medial femoral condyle in this Gillquist view [10]. Meniscal root tears and far posterior horn tears can be missed if a detailed arthroscopic examination is not performed. (MFC = medial femoral condyle; MM = posterior horn attachment of medial meniscus).

Fig. 2

An arthroscopic view shows the intercondylar notch during an ACL reconstruction with the knee positioned in full extension. An intercondylar notch is evident after a tunnel dilator (unseen) is placed in the tibial tunnel. Because the dilator is in the position of the ACL graft, a frontal view such as this one can be used to determine if the tunnel is well placed. Positioned correctly, the dilator (and therefore the graft) is not seen when the knee is in full extension. In this view, only the tibia and femur are seen with the knee in full extension; the tunnel dilator (position marked by *) is obscured by the distal femur, indicating proper tibial tunnel placement and absence of graft impingement. (F = femoral trochlea; ACL = ACL stump).

Fig. 3

An arthroscopic view shows the intercondylar notch during a left ACL reconstruction with the knee positioned in flexion. The arthroscope is in the anterolateral portal. The femoral tunnel in this left knee was drilled via a medial portal and is in the correct 2 o’clock position. By contrast, the point selected by a transtibial guide would orient the graft too vertically. (T = femoral tunnel; TT = transtibial guide).