Download PDF
J Knee Surg 2015; 28(02): 165-174
DOI: 10.1055/s-0034-1373739
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Management of Intraoperative Complications in Arthroscopic Primary Anterior Cruciate Ligament Reconstruction

Charalambos P. Charalambous
1   Department of Trauma and Orthopaedics, Victoria Hospital, Blackpool, United Kingdom
,
Farhan Alvi
2   Department of Trauma and Orthopaedics, North West Deanery, Manchester, United Kingdom
,
Paul M. Sutton
3   Department of Trauma and Orthopaedics, Northern General Hospital, Sheffield, United Kingdom
› Author Affiliations
Further Information

Publication History

07 October 2013

11 February 2014

Publication Date:
21 April 2014 (online)

    Permissions and Reprints

Abstract

Arthroscopic anterior cruciate ligament reconstruction is a commonly performed procedure which is technically demanding and involves multiple surgical steps with the potential for a wide range of intraoperative complications. In this article, we review these potential complications and give algorithms for dealing with them based on our experience and published evidence. We discuss the use of both bone-patellar tendon-bone and hamstring grafts and examine complications associated with suspensory button and interference screw fixation.

Keywords

knee - reconstruction - ACL - complications
 

  • References

  • 1 Ahldén M, Samuelsson K, Sernert N, Forssblad M, Karlsson J, Kartus J. The Swedish National Anterior Cruciate Ligament Register: a report on baseline variables and outcomes of surgery for almost 18,000 patients. Am J Sports Med 2012; 40 (10) 2230-2235
    CrossrefPubMedGoogle Scholar
  • 2 Maletis GB, Granan LP, Inacio MC, Funahashi TT, Engebretsen L. Comparison of community-based ACL reconstruction registries in the U.S. and Norway. J Bone Joint Surg Am 2011; 93 (Suppl. 03) 31-36
    CrossrefPubMedGoogle Scholar
  • 3 Lind M, Menhert F, Pedersen AB. The first results from the Danish ACL reconstruction registry: epidemiologic and 2 year follow-up results from 5,818 knee ligament reconstructions. Knee Surg Sports Traumatol Arthrosc 2009; 17 (2) 117-124
    CrossrefPubMedGoogle Scholar
  • 4 Chechik O, Amar E, Khashan M, Lador R, Eyal G, Gold A. An international survey on anterior cruciate ligament reconstruction practices. Int Orthop 2013; 37 (2) 201-206
    Google Scholar
  • 5 Ali MS, Kumar A, Adnaan Ali S, Hislop T. Anterior cruciate ligament reconstruction using hamstring tendon graft without detachment of the tibial insertion. Arch Orthop Trauma Surg 2006; 126 (9) 644-648
    CrossrefPubMedGoogle Scholar
  • 6 Izquierdo Jr R, Cadet ER, Bauer R, Stanwood W, Levine WN, Ahmad CS. A survey of sports medicine specialists investigating the preferred management of contaminated anterior cruciate ligament grafts. Arthroscopy 2005; 21 (11) 1348-1353
    CrossrefPubMedGoogle Scholar
  • 7 Cooper DE, Arnoczky SP, Warren RF. Contaminated patellar tendon grafts: incidence of positive cultures and efficacy of an antibiotic solution soak—an in vitro study. Arthroscopy 1991; 7 (3) 272-274
    CrossrefPubMedGoogle Scholar
  • 8 Goebel ME, Drez Jr D, Heck SB, Stoma MK. Contaminated rabbit patellar tendon grafts. In vivo analysis of disinfecting methods. Am J Sports Med 1994; 22 (3) 387-391
    CrossrefPubMedGoogle Scholar
  • 9 Molina ME, Nonweiller DE, Evans JA, Delee JC. Contaminated anterior cruciate ligament grafts: the efficacy of 3 sterilization agents. Arthroscopy 2000; 16 (4) 373-378
    CrossrefPubMedGoogle Scholar
  • 10 Plante MJ, Li X, Scully G, Brown MA, Busconi BD, DeAngelis NA. Evaluation of sterilization methods following contamination of hamstring autograft during anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2013; 21 (3) 696-701
    CrossrefPubMedGoogle Scholar
  • 11 Pasque CB, Geib TM. Intraoperative anterior cruciate ligament graft contamination. Arthroscopy 2007; 23 (3) 329-331
    CrossrefPubMedGoogle Scholar
  • 12 Hantes ME, Basdekis GK, Varitimidis SE, Giotikas D, Petinaki E, Malizos KN. Autograft contamination during preparation for anterior cruciate ligament reconstruction. J Bone Joint Surg Am 2008; 90 (4) 760-764
    CrossrefPubMedGoogle Scholar
  • 13 Nakayama H, Yagi M, Yoshiya S, Takesue Y. Micro-organism colonization and intraoperative contamination in patients undergoing arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 2012; 28 (5) 667-671
    CrossrefPubMedGoogle Scholar
  • 14 Lee GH, McCulloch P, Cole BJ, Bush-Joseph CA, Bach Jr BR. The incidence of acute patellar tendon harvest complications for anterior cruciate ligament reconstruction. Arthroscopy 2008; 24 (2) 162-166
    CrossrefPubMedGoogle Scholar
  • 15 Papageorgiou CD, Kostopoulos VK, Moebius UG, Petropoulou KA, Georgoulis AD, Soucacos PN. Patellar fractures associated with medial-third bone-patellar tendon-bone autograft ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2001; 9 (3) 151-154
    CrossrefPubMedGoogle Scholar
  • 16 Salvi AE, Metelli GP, Musella G. Intraoperative fracture of patellar bone plug during anterior cruciate ligament reconstruction with bone-patellar tendon-bone: clinical case. Knee Surg Sports Traumatol Arthrosc 2007; 15 (1) 58-60
    CrossrefPubMedGoogle Scholar
  • 17 Kurzweil PR. Formula to calculate the length of the tibial tunnel with endoscopic ACL reconstruction to avoid graft-tunnel mismatch. Arthroscopy 1999; 15 (1) 115-117
    PubMedGoogle Scholar
  • 18 Kenna B, Simon TM, Jackson DW, Kurzweil PR. Endoscopic ACL reconstruction: a technical note on tunnel length for interference fixation. Arthroscopy 1993; 9 (2) 228-230
    CrossrefPubMedGoogle Scholar
  • 19 Shaffer B, Gow W, Tibone JE. Graft-tunnel mismatch in endoscopic anterior cruciate ligament reconstruction: a new technique of intraarticular measurement and modified graft harvesting. Arthroscopy 1993; 9 (6) 633-646
    CrossrefPubMedGoogle Scholar
  • 20 Yasin MN, Charalambous CP, Mills SP, Phaltankar PM. Accessory bands of the hamstring tendons: a clinical anatomical study. Clin Anat 2010; 23 (7) 862-865
    CrossrefPubMedGoogle Scholar
  • 21 Charalambous CP, Alvi F, Phaltankar P, Gagey O. Hamstring tendon harvesting—effect of harvester on tendon characteristics and soft tissue disruption; cadaver study. Knee 2009; 16 (3) 183-186
    CrossrefPubMedGoogle Scholar
  • 22 Charalambous CP, Kwaees TA. Anatomical considerations in hamstring tendon harvesting for anterior cruciate ligament reconstruction. Muscles Ligaments Tendons J 2012; 2 (4) 253-257
    PubMedGoogle Scholar
  • 23 Hamido F, Misfer AK, Al Harran H , et al. The use of the LARS artificial ligament to augment a short or undersized ACL hamstrings tendon graft. Knee 2011; 18 (6) 373-378
    CrossrefPubMedGoogle Scholar
  • 24 Jepsen CF, Lundberg-Jensen AK, Faunoe P. Does the position of the femoral tunnel affect the laxity or clinical outcome of the anterior cruciate ligament-reconstructed knee? A clinical, prospective, randomized, double-blind study. Arthroscopy 2007; 23 (12) 1326-1333
    CrossrefPubMedGoogle Scholar
  • 25 Loh JC, Fukuda Y, Tsuda E, Steadman RJ, Fu FH, Woo SL. Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o'clock and 10 o'clock femoral tunnel placement. 2002 Richard O'Connor Award paper. Arthroscopy 2003; 19 (3) 297-304
    CrossrefPubMedGoogle Scholar
  • 26 Iriuchishima T, Shirakura K, Fu FH. Graft impingement in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2013; 21 (3) 664-670
    CrossrefPubMedGoogle Scholar
  • 27 Park JK, Song EK, Seon JK. Comparison of intraoperative stability in ACL reconstruction based on femoral tunnel positions. Orthopedics 2010; 33 (10, Suppl): 94-97
    CrossrefPubMedGoogle Scholar
  • 28 Bedi A, Altchek DW. The “footprint” anterior cruciate ligament technique: an anatomic approach to anterior cruciate ligament reconstruction. Arthroscopy 2009; 25 (10) 1128-1138
    CrossrefPubMedGoogle Scholar
  • 29 Lubowitz JH, Akhavan S, Waterman BR, Aalami-Harandi A, Konicek J. Technique for creating the anterior cruciate ligament femoral socket: optimizing femoral footprint anatomic restoration using outside-in drilling. Arthroscopy 2013; 29 (3) 522-528
    CrossrefPubMedGoogle Scholar
  • 30 Petersen W, Forkel P, Achtnich A, Metzlaff S, Zantop T. Anatomic reconstruction of the anterior cruciate ligament in single bundle technique [in German]. Oper Orthop Traumatol 2013; 25 (2) 185-204
    CrossrefPubMedGoogle Scholar
  • 31 Shino K, Suzuki T, Iwahashi T , et al. The resident's ridge as an arthroscopic landmark for anatomical femoral tunnel drilling in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2010; 18 (9) 1164-1168
    CrossrefPubMedGoogle Scholar
  • 32 Hutchinson MR, Ash SA. Resident's ridge: assessing the cortical thickness of the lateral wall and roof of the intercondylar notch. Arthroscopy 2003; 19 (9) 931-935
    CrossrefPubMedGoogle Scholar
  • 33 Gelber PE, Erquicia J, Abat F , et al. Effectiveness of a footprint guide to establish an anatomic femoral tunnel in anterior cruciate ligament reconstruction: computed tomography evaluation in a cadaveric model. Arthroscopy 2011; 27 (6) 817-824
    CrossrefPubMedGoogle Scholar
  • 34 Gavriilidis I, Motsis EK, Pakos EE, Georgoulis AD, Mitsionis G, Xenakis TA. Transtibial versus anteromedial portal of the femoral tunnel in ACL reconstruction: a cadaveric study. Knee 2008; 15 (5) 364-367
    CrossrefPubMedGoogle Scholar
  • 35 Chang CB, Choi JY, Koh IJ, Lee KJ, Lee KH, Kim TK. Comparisons of femoral tunnel position and length in anterior cruciate ligament reconstruction: modified transtibial versus anteromedial portal techniques. Arthroscopy 2011; 27 (10) 1389-1394
    CrossrefPubMedGoogle Scholar
  • 36 Golish SR, Baumfeld JA, Schoderbek RJ, Miller MD. The effect of femoral tunnel starting position on tunnel length in anterior cruciate ligament reconstruction: a cadaveric study. Arthroscopy 2007; 23 (11) 1187-1192
    CrossrefPubMedGoogle Scholar
  • 37 Yamazaki S, Yasuda K, Tomita F, Minami A, Tohyama H. The effect of intraosseous graft length on tendon-bone healing in anterior cruciate ligament reconstruction using flexor tendon. Knee Surg Sports Traumatol Arthrosc 2006; 14 (11) 1086-1093
    CrossrefPubMedGoogle Scholar
  • 38 Hamilton SC, Jackson II ER, Karas SG. Anterior cruciate ligament femoral tunnel drilling through anteromedial portal: axial plane drill angle affects tunnel length. Arthroscopy 2011; 27 (4) 522-525
    CrossrefPubMedGoogle Scholar
  • 39 Rue JP, Busam ML, Detterline AJ, Bach Jr BR. Posterior wall blowout in anterior cruciate ligament reconstruction: avoidance, recognition, and salvage. J Knee Surg 2008; 21 (3) 235-240
    Article in Thieme ConnectPubMedGoogle Scholar
  • 40 Dave LY, Nyland J, Caborn DN. Knee flexion angle is more important than guidewire type in preventing posterior femoral cortex blowout: a cadaveric study. Arthroscopy 2012; 28 (10) 1381-1387
    CrossrefPubMedGoogle Scholar
  • 41 Hammond KE, Dierckman BD, Potini VC, Xerogeanes JW, Labib SA, Hutton WC. Lateral femoral cortical breach during anterior cruciate ligament reconstruction: a biomechanical analysis. Arthroscopy 2012; 28 (3) 365-371
    CrossrefPubMedGoogle Scholar
  • 42 Avadhani A, Rao PS, Rao SK. Effect of tibial tunnel position on arthroscopically assisted anterior cruciate ligament reconstruction using bone-patellar tendon-bone grafts: a prospective study. Singapore Med J 2010; 51 (5) 413-417
    PubMedGoogle Scholar
  • 43 Pinczewski LA, Salmon LJ, Jackson WF, von Bormann RB, Haslam PG, Tashiro S. Radiological landmarks for placement of the tunnels in single-bundle reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br 2008; 90 (2) 172-179
    CrossrefPubMedGoogle Scholar
  • 44 Kongcharoensombat W, Ochi M, Abouheif M , et al. The transverse ligament as a landmark for tibial sagittal insertions of the anterior cruciate ligament: a cadaveric study. Arthroscopy 2011; 27 (10) 1395-1399
    CrossrefPubMedGoogle Scholar
  • 45 Ferretti M, Doca D, Ingham SM, Cohen M, Fu FH. Bony and soft tissue landmarks of the ACL tibial insertion site: an anatomical study. Knee Surg Sports Traumatol Arthrosc 2012; 20 (1) 62-68
    CrossrefPubMedGoogle Scholar
  • 46 Kopf S, Musahl V, Tashman S, Szczodry M, Shen W, Fu FH. A systematic review of the femoral origin and tibial insertion morphology of the ACL. Knee Surg Sports Traumatol Arthrosc 2009; 17 (3) 213-219
    CrossrefPubMedGoogle Scholar
  • 47 Tállay A, Lim MH, Bartlett J. Anatomical study of the human anterior cruciate ligament stump's tibial insertion footprint. Knee Surg Sports Traumatol Arthrosc 2008; 16 (8) 741-746
    CrossrefPubMedGoogle Scholar
  • 48 Barrett GR, Papendick L, Miller C. Endobutton button endoscopic fixation technique in anterior cruciate ligament reconstruction. Arthroscopy 1995; 11 (3) 340-343
    CrossrefPubMedGoogle Scholar
  • 49 Petre BM, Smith SD, Jansson KS , et al. Femoral cortical suspension devices for soft tissue anterior cruciate ligament reconstruction: a comparative biomechanical study. Am J Sports Med 2013; 41 (2) 416-422
    CrossrefPubMedGoogle Scholar
  • 50 Mae T, Kuroda S, Matsumoto N , et al. Migration of EndoButton after anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy 2011; 27 (11) 1528-1535
    CrossrefPubMedGoogle Scholar
  • 51 Yanmiş I, Tunay S, Oğuz E, Yildiz C, Ozkan H, Kirdemir V. Dropping of an EndoButton into the knee joint 2 years after anterior cruciate ligament repair using proximal fixation methods. Arthroscopy 2004; 20 (6) 641-643
    CrossrefPubMedGoogle Scholar
  • 52 Karaoglu S, Halici M, Baktir A. An unidentified pitfall of Endobutton use: case report. Knee Surg Sports Traumatol Arthrosc 2002; 10 (4) 247-249
    CrossrefPubMedGoogle Scholar
  • 53 Muneta T, Yagishita K, Kurihara Y, Sekiya I. Intra-articular detachment of the Endobutton more than 18 months after anterior cruciate ligament reconstruction. Arthroscopy 1999; 15 (7) 775-778
    CrossrefPubMedGoogle Scholar
  • 54 Smith CA, Tennent TD, Pearson SE, Beach WR. Fracture of Bilok interference screws on insertion during anterior cruciate ligament reconstruction. Arthroscopy 2003; 19 (9) E115-E117
    CrossrefPubMedGoogle Scholar
  • 55 Konan S, Haddad FS. A clinical review of bioabsorbable interference screws and their adverse effects in anterior cruciate ligament reconstruction surgery. Knee 2009; 16 (1) 6-13
    CrossrefPubMedGoogle Scholar
  • 56 Macdonald P, Arneja S. Biodegradable screw presents as a loose intra-articular body after anterior cruciate ligament reconstruction. Arthroscopy 2003; 19 (6) E22-E24
    CrossrefPubMedGoogle Scholar
  • 57 Werner A, Wild A, Ilg A, Krauspe R. Secondary intra-articular dislocation of a broken bioabsorbable interference screw after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2002; 10 (1) 30-32
    CrossrefPubMedGoogle Scholar
  • 58 Hall MP, Hergan DM, Sherman OH. Early fracture of a bioabsorbable tibial interference screw after ACL reconstruction with subsequent chondral injury. Orthopedics 2009; 32 (3) 208
    PubMedGoogle Scholar
  • 59 Resinger C, Vécsei V, Heinz T, Nau T. The removal of a dislocated femoral interference screw through a posteromedial portal. Arthroscopy 2005; 21 (11) 1398
    PubMedGoogle Scholar
  • 60 Lee JJ, Otarodifard K, Jun BJ, McGarry MH, Hatch III GF, Lee TQ. Is supplementary fixation necessary in anterior cruciate ligament reconstructions?. Am J Sports Med 2011; 39 (2) 360-365
    CrossrefPubMedGoogle Scholar