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



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.


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.


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.


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



Knee ligament reconstruction Epidemiology Economic compensation Complications Technical failures 


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.


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

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


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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

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