Goal : Presentation of failures and complications of ACL reconstruction

Method: We studied 356 patients (361 knees) aged 14 – 52 years who had ACL deficiency and were treated by reconstruction the period from 1-1-1997 to 31-12-2002. They have been operated by the same surgeon (S.P.) 7 days to 5 years after the initial injury by arthroscopy or/and miniarthrotomy using BPTB graft (284) and ST/G graft (77). All co-existing injuries were also treated simultaneously (72 tears of the medial meniscus, 35 tears of the lateral meniscus, 37 tears of the medial and lateral menisci, 18 traumatic lesions of the articular cartilage, 3 posterolateral instabilities) by 42 meniscal repairs, 124 meniscectomies, 2 mosaicplasty, 16 drilling of the sub-chondral bone and 3 posterolateral reconstruction.

Results: Intraoperative: 3 patella fractures during BPTB harvesting, 3 breaking of bioabsorbable femoral screw, 2 non satisfactory BPTB graft fixation at the femoral tunnel, 1 asymptomatic exit of the screw at the back of the femur. Postoperative: 3 temporary apraxies of the peroneal nerve, 10 superficial and 3 deep infections, 15 reruptures or elongations of the graft, 18 with loss of extension < 10°, 5 with loss of extension > 10°, 2 with persistent hydrarthrosis after the 2nd postoperative month, 22 with anterior knee pain after BPTB harvesting, 3 with keloid, 1 with an acute korner at the graft harvesting site at the tibia, high percentage had weekness of the quadriceps mechanism and sensory abnormalities of the anterior side of the knee.

Conclusions: ACL reconstruction is a treatment with failures and complications that require axperience, knowledge and good instrumentation

Introduction: Patellar tendon is one of the main donor sites for graft. Postoperatively, during the healing procedure there are changes, which we recorded and combined them with the clinical image respectively.

Material and Methods: During the period 1998–2001 in Sports Injury Unit, we operated for Anterior Cruciate Ligament insufficiency with autologous Bone Patellar Tendon Bone (BPTB) graft 265 patients. We used autologous BPTB graft from the middle third. We got near the two parts after taking the graft and we sewed very well the peritendon fascia. All patients, with few differentiations, followed the same rehabilitation program.

Seventy -seven of them (44 men and 33 women ranging from 17 to 44 years -mean: 24,3 years), were imaged postoperative with MRI at specific intervals from the operation between 3–36 months. In the same time we checked the patients clinically.

Results: No one study can answer which is the exact time of satisfying or complete healing. Our study shows elements of scar tissue in the middle third of patellar tendon which is decreasing given time. After the 12th month, the proportion between healthy and scar tissue changes and healthy tissue become dominant. But in some cases scar is still existing even after 36 months. The clinical problems such as anterior knee pain are not existed after the 8th postoperative month.

Conclusion: In conclusion, we can say that “regeneration” and healing of patellar tendon occurs mainly during the first postoperative year, but it doesn’t stop after this time. So, we couldn’t recommend this donor site for revision reconstruction before the completion of one year postoperatively.