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Complication &ACL revision - PowerPoint PPT Presentation


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Complication &ACL revision. Time . Intraop . complications. Surgical tech. errors. Tunnel placement Inadequate notchplasty Graft selection& size

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Presentation Transcript
surgical tech errors
Surgical tech. errors

Tunnel placement

Inadequate notchplasty

Graft selection& size

Tensioning

Fix failure:

Poor bone quality,screwbreakage,screw divergence & graft damage

tunnel malposition
Tunnel malposition

Femur

Ant. Position & post. Position & vertical

Tibial

ant. & post position

graft tensioning
Graft tensioning

Inadequate tensioning

Overtensioning

Stiffnes

Graft stretching

Stress on cartilage

Poor vascularity

fixation
Fixation

Screw

Transfix

endobutton

graft impingement
Graft impingement

Notchplasty

Postop pain

Bleeding

Swelling

regrowth

postop problems
Postop problems

Persistent Ant Knee Pain 0 34%

Motion deficits 1 13%

Arthrofibrosis

Graft failure

Osteoarthritis

DVT Infection

ant knee pain
Ant Knee pain

Flex contracture>10

Q weakness

BPTB G

short imobilization,early &proper PT

loss of motion
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
Graft specific complications

BPTBG: Ant knee pain,kneelingpain,flexcontracture,patellarfx,tunnelmismatch,graftfx,suturelaceration,post cortex fx

Hamstring :

Short graft

Saphen n. injury H. Weakness

Tunnel widening

Allograft :

acl recon failure
ACL recon. failure

Retearing & instability

Loss of motion

Persistent pain

revision of acl
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
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 89 30 11 91
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
complication

Hemarthrosis 10

Endo pain 4

Infection 2

Retearing 27

No allograft( 33) no female(12)