Intraoperative incidents and complications in primary arthroscopic anterior cruciate ligament reconstruction.
OBJECTIVE
To analyze intraoperative incidents and complications in primary arthroscopic anterior cruciate ligament reconstruction (ACLR) with bone-patellar tendon-bone (BPTB) and quadruple hamstring semitendinosus and gracilis (STG) grafts.


METHODS
From January 1999 to June 2004, we performed 330 BPTB and 96 STG procedures. Intraoperative incidents and complications were recorded for each case.


RESULTS
Our overall intraoperative incident and complication rate was 9.6% and was higher in the STG group (13.5%) than in the BPTB group (8.7%). In the BPTB group, combined incidents and complications according to stage of the procedure consisted of graft harvesting, 4 cases (1.21%); tunnel placement, 9 cases (2.7%); and graft fixation, 15 cases (4.5%). In the STG group, combined incidents and complications included graft harvesting, 8 cases (8.3%); tunnel placement, 1 case (1%); graft fixation, 3 cases (3.1%); and others, 1 case (1%). In 4 patients (0.9%), we had to change the technique from BPTB to STG and vice versa. In 2 STG cases, conversion of the technique was required because of graft-related problems; in the third case, it was necessary because of fixation. One BPTB was converted to STG because the graft was completely transected as a result of improper screw fixation technique.


CONCLUSIONS
None of the encountered incidents and complications had an adverse effect on final stability or on range of motion in operated knees. All incidents and complications were due to technical errors that occurred during graft harvesting, tunnel placement, or graft fixation. It is known that technical errors are preventable if careful surgical technique is followed. The surgeon must be well versed in various reconstruction techniques to be able to detect and resolve forthcoming incidents or complications. Backup implants are mandatory.


METHODS
IV, therapeutic case series.
Almazán
Arturo
A
Arthroscopy and Sports Medicine Department, National Institute of Rehabilitation, Mexico City, Mexico. arturo@mirodilla.com <arturo@mirodilla.com>
Miguel
Antonio
A
Odor
Alberto
A
Ibarra
José-Clemente
JC
D016118:Anterior Cruciate Ligament / Q000601:surgery*; D001182:Arthroscopy / Q000009:adverse effects*; D001863:Bone Screws / Q000009:adverse effects; D050376:Bone-Patellar Tendon-Bone Grafting / Q000009:adverse effects; D004868:Equipment Failure; D005269:Femur / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D013710:Tendons / Q000637:transplantation; D016378:Tissue Transplantation / Q000009:adverse effects; D020858:Tissue and Organ Harvesting / Q000009:adverse effects