Advertisement

Complications and technical failures are rare in knee ligament reconstruction: analyses based on 31,326 reconstructions during 10 years in Denmark

  • Daniel Rayan Kalakech Munch
  • Thomas Irgens Hansen
  • Kim Lyngby Mikkelsen
  • Michael Rindom KrogsgaardEmail author
KNEE
  • 33 Downloads

Abstract

Purpose

Knowledge about treatment injuries (technical failures and complications) in relation to knee ligament reconstructions is sparse. Our purpose was to describe treatment injuries to knee ligament reconstruction in Denmark during a 10-year period and to suggest initiatives to reduce the risk for treatment injuries.

Methods

Treatment injuries after knee ligament reconstructions reported to the Danish Patient Compensation Association (DPCA) 2005–2014 were analyzed and compared to information from the Danish Kneeligament Reconstruction Register and Danish National Patient Register.

Results

The number of knee ligament reconstructions in Denmark 2005–2014, including revisions, was 31,326. Of the 704 cases claimed to DPCA, 371 were approved as treatment injuries (1.42% of all operations). Tunnel malpositioning (135 = 0.43% of all operations), deep infection (0.27%), nerve injury (0.17%), pain (0.12%) and unrecognized combined instability (0.11%) were the most common. Patients operated with anteromedial technique for femoral tunnel placement had a lower incidence (p < 0.0001) of tunnel malpositioning compared to other techniques. Public and private hospitals had the same risk of treatment injures. Hospitals that performed the largest number of reconstructions/year had the smallest risk of a treatment injury (p < 0.001). The total compensation was 7.6 m EURO, which equals 243 EURO/performed knee ligament reconstruction.

Conclusion

Treatment injuries as defined in this study were rare, with tunnel malpositioning being the most common. Analyses of the results indicate that it may be clinically relevant to reduce the number of treatment injures that knee ligament reconstructions are concentrated in clinics with high volume. Also, malpositioning might be reduced by routine documentation of K-wire position before tunnels are drilled.

Level of evidence

III.

Keywords

Knee ligament reconstruction Epidemiology Economic compensation Complications Technical failures 

Notes

Author contributions

The study was designed by MRK and KLM. Data were collected by TIH, DM and KLM. Statistical analyses were performed by KLM, and data were interpreted by MRK and KLM.

Funding

This study was funded by Bispebjerg-Frederiksberg Hospital's research fund.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This article does no contain any studies with human participants performed by any of the authors. It is a registry study which does not need ethical approval.

Supplementary material

167_2018_5297_MOESM1_ESM.docx (13 kb)
Supplementary material 1 (DOCX 12 KB)
167_2018_5297_MOESM2_ESM.docx (25 kb)
Supplementary material 2 (DOCX 24 KB)

References

  1. 1.
    Lind M, Nissen N, Lund B, Jakobsen BW, Rosenbeck J, Kristensen G, Maagaard N, Nafei A, Kraemer O, Konradsen L, Barfod G, Pedersen AB, Madsen M et al (2016) Dansk Korsbånd Rekonstruktions Register Årsrapport 2016. Danish National Board of Health, https://www.sundhed.dk/content/cms/0/4700_dkrr_aarsrapport_2016.pdf
  2. 2.
    Jameson SS, Dowen D, James P, Serrano-Pedraza I, Reed MR, Deehan D (2012) Complications following anterior cruciate ligament reconstruction in the English NHS. Knee 19(1):14–19CrossRefGoogle Scholar
  3. 3.
    Wang C, Ao Y, Wang J, Hu Y, Cui G, Yu J (2009) Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: a retrospective analysis of incidence, presentation, treatment, and cause. Arthroscopy 25(3):243–249CrossRefGoogle Scholar
  4. 4.
    Lind M, Lund B, Faunø P, Faunø P, Said S, Miller LL, Christiansen SE (2012) Medium to long-term follow-up after ACL revision. Knee Surg Sports Traumatol Arthroscop 20(1):166–172CrossRefGoogle Scholar
  5. 5.
    Lyman S, Koulouvaris P, Sherman S, Do H, Mandl LA, Marx RG (2009) Epidemiology of anterior cruciate ligament reconstruction: trends, readmissions, and subsequent knee surgery. J Bone Jt Surg Am 91(10):2321–2328CrossRefGoogle Scholar
  6. 6.
    Figueroa D, Calvo R, Vaisman A, Campero M, Moraga C (2008) Injury to the infrapatellar branch of the saphenous nerve in ACL reconstruction with the hamstrings technique: clinical and electrophysiological study. Knee 15(5):360–363CrossRefGoogle Scholar
  7. 7.
    Rahr-Wagner L, Thillemann TM, Pedersen AB, Lind MC (2013) Increased risk of revision after anteromedial compared with transtibial drilling of the femoral tunnel during primary anterior cruciate ligament reconstruction: results from the Danish Knee Ligament Reconstruction Register. Arthroscopy 29(1):98–105CrossRefGoogle Scholar
  8. 8.
    Sonnery-Cottet B, Archbold P, Zayni R, Bortolletto J, Thaunat M, Prost T, Padua VB, Chambat P (2011) Prevalence of septic arthritis after anterior cruciate ligament reconstruction among professional athletes. Am J Sports Med 39(11):2371–2376CrossRefGoogle Scholar
  9. 9.
    Barker JU, Drakos MC, Maak TG, Warren RF, Williams RJ III, Allen AA (2010) Effect of graft selection on the incidence of postoperative infection in anterior cruciate ligament reconstruction. Am J Sports Med 38(2):281–286CrossRefGoogle Scholar
  10. 10.
    Judd D, Bottoni C, Kim D, Burke M, Hooker S (2006) Infections following arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 22(4):375–384CrossRefGoogle Scholar
  11. 11.
    Wolf BR, Ramme AJ, Britton CL, Amendola A, MOON Knee Group (2014) Anterior cruciate ligament tunnel placement. J Knee Surg 27(4):309–317CrossRefGoogle Scholar
  12. 12.
    McConkey MO, Amendola A, Ramme AJ et al (2012) Arthroscopic agreement among surgeons on anterior cruciate ligament tunnel placement. Am J Sports Med 40(12):2737–2746CrossRefGoogle Scholar
  13. 13.
    Morgan JA, Dahm D, Levy B, Stuart MJ, MARS Study Group (2012) Femoral tunnel malposition in ACL revision reconstruction. J Knee Surg 25(5):361–368CrossRefGoogle Scholar
  14. 14.
    Waterman BR, Arroyo W, Cotter EJ, Zacchilli MA, Garcia EJ, Owens BD (2018) Septic arthritis after anterior cruciate ligament reconstruction: clinical and functional outcomes based on graft retention or removal. Orthop J Sports Med 1 6(3):2325967118758626.  https://doi.org/10.1177/2325967118758626 CrossRefGoogle Scholar
  15. 15.
    Dong JT, Wang X, Men XQ, Wang XF, Zheng XZ, Gao SJ (2015) Incidence of deep venous thrombosis in Chinese patients undergoing arthroscopic knee surgery for cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 23(12):3540–3544CrossRefGoogle Scholar
  16. 16.
    Hardy A, Casabianca L, Andrieu K, Baverel L, Noailles T, Junior French Arthroscopy Society (2017) Complications following harvesting of patellar tendon or hamstring tendon grafts for anterior cruciate ligament reconstruction: Systematic review of literature. Orthop Traumatol Surg Res 103(8S):S245–S248CrossRefGoogle Scholar
  17. 17.
    Sanders B, Rolf R, McClelland W, Xerogeanes J (2007) Prevalence of saphenous nerve injury after autogenous hamstring harvest: an anatomic and clinical study of sartorial branch injury. Arthroscopy 23(9):956–963CrossRefGoogle Scholar
  18. 18.
    Widmer B, Lustig S, Scholes CJ, Molloy A, Leo SP, Coolican MR, Parker DA (2013) Incidence and severity of complications due to femoral nerve blocks performed for knee surgery. Knee 20(3):181–185CrossRefGoogle Scholar
  19. 19.
    Zhu W, Lu W, Han Y, Hui S, Ou Y, Peng L, Fen W, Wang D, Zhang L, Zeng Y (2013) Application of a computerised navigation technique to assist arthroscopic anterior cruciate ligament reconstruction. Int Orthop 37(2):233–238CrossRefGoogle Scholar
  20. 20.
    Luo H, Yu JK, Ao YF, Yu CL, Peng LB, Lin CY, Zhang JY, Fu X (2007) Relationship between different skin incisions and the injury of the infrapatellar branch of the saphenous nerve during anterior cruciate ligament reconstruction. Chin Med J 120(13):1127–1130PubMedGoogle Scholar
  21. 21.
    Kjaergaard J, Faunø LZ, Faunø P (2008) Sensibility loss after ACL reconstruction with hamstring graft. Intern J Sports Med 29(6):507–511CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  • Daniel Rayan Kalakech Munch
    • 1
  • Thomas Irgens Hansen
    • 1
  • Kim Lyngby Mikkelsen
    • 2
  • Michael Rindom Krogsgaard
    • 1
    • 2
    Email author
  1. 1.Section for Sports Traumatology M51Bispebjerg-Frederiksberg HospitalCopenhagen NVDenmark
  2. 2.Danish Patient Compensation AssociationCopenhagen KDenmark

Personalised recommendations