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: To present the technique and the results of simultaneous arthroscopic reconstruction of Bankart and SLAP lesions in patients with anterior shoulder instability.

Method: We performed shoulder arthroscopy in 95 patients aged 16–38 years (mean age:24,8) suffering anterior shoulder instability. Preoperative evaluation included clinical assessment, x-rays, MRI-arthrogram and examination under anaesthesia in comparison to the healthy shoulder. SLAP lesion was fixed using metallic suture anchors (FASTAK 2,4mm x 11,7 mm-Arthrex).The anchor was inserted in a 45° direction relative to the glenoid level. Bankart lesion was reconstructed using 2–3 bioabsorbable suture anchors (Panalok-Mitek J& J).The arthroscope was inserted through standard posterior, anterosuperior and anteroinferior portals while a posterolateral portal (portal of Whilrnington) was created for SLAP lesion repair. Patients’ average follow-up was 22 months (range, 18–30 months) and the results were evaluated using the ASES score.

Results: SLAP lesion was found in 13 patients: 6 pat.-type II (46%), 3 pat.-type I (23%), 2 pat.-type IV (15%), 1pat.-type III (7,6%) and 1 pat with a complex lesion. Of these patients 10 had also co-existed Bankart lesion. In 2 patients Hill-Sachs lesion was found while degenerative rotator cuff changes existed in 3 patients. While performing clinical evaluation anterior instability signs and symptoms were apparent with the patients complaining also for discomfort and crepitus during overhead activities. MRI preoperative sensitivity for SLAP lesion diagnosis was 59% while specificity and Positive predictive value were 90% and 76% respectively. Shoulder function and the overall ASES score improved from 44 pre-op. to 96 post-op.

Conclusion: Combined Bankart and SLAP lesions are uncommon in non-throwing patients with anterior instability. Arthroscopic suture anchors fixation ensures early and reliable rehabilitation. MRI arthrography study by a skeletal radiologist predicts to a high rate diagnosis.