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

Purpose: The purpose of our study is to record the composition and the viability of the cells from reaming products during intramedullary nailing of tibia or femur.

Material and Methods: We studied 21 fractures (13 tibia and 8 femur). The patients had mean age 27 years {1 9–67) and they didn’t face any systemic disease. The operation was done during the first 3 days from the injury and there was pro-operative x-ray check for measuring the medullar cavity. For 16 fractures we used reamers with diameter smaller or equal to the medullar cavity and for the rest 5 for biomechanical reasons we used bigger reamer. We take the products in aseptic condition in the operating room and after the proper elaboration they were been analyzed histo logically. The patients were followed up until the complete healing of the fractures.

Results: Our first observation was that in the very small reamers, which didn’t “touch” the endosteum there were non-viable marrow cells. After that with reamers till 1mm less than the intramedullary diameter there was viable bone mass 35–70% more than the non-viable. When the reaming exceeded this border microscopic analysis showed pieces (1–1, 5mm) of bone mass with few viable elements in the center of them and more compressed dead cells in the perimeter. From the p.o. follow-up it was remarkable that the patients whose bone was reamed didn’t exceed the intramedullary diameter showed primary callus formation in x-rays after 4–5 weeks, but the others after 5–7 weeks.

Conclusions: In conclusion, although our sample is not big enough, we can say that there are sighs that the reaming products cells are more viable when the reaming does not exceed the intramedullary diameter. This fact seems to have positive influence in the callus formation procedure.