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Complications following all-inside anterior cruciate ligament reconstruction

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Abstract

Purpose

We conducted a comprehensive analysis of possible perioperative complications following all-inside anterior cruciate ligament reconstruction (ACLR). Additional techniques and tips are proposed to prevent and manage complications.

Methods

Complications following all-inside ACLR performed between December 2015 and December 2020 were retrospectively analysed. Altogether, 348 operations were performed and 275 patients were enrolled with a minimum 12-month follow-up period. Only semitendinosus autograft was utilised in most patients, and semitendinosus–gracilis autograft and allograft were used in five and 31 patients, respectively. Simultaneous meniscal repair, partial meniscectomy, and chondral surgery were performed in 29.5%, 21.1%, and 4.4% of patients, respectively. Complications were observed based on the patient’s clinical condition, plain film, and magnetic resonance imaging. Clinical outcomes were assessed pre-operatively and at 12 months post-operatively, using the International Knee Documentation Committee form, Lysholm and Tegner activity scores, and KT1000 side-to-side difference.

Results

Intraoperative and post-operative complications developed in 65 patients (23.6%). The most common complication was cortical button malposition on the femoral side (19.3%). Intra-operative breakage of the retrograde drill was found in two cases (0.73%), with three cases (1.1%) of over-drilling with destruction of the outer cortex. Post-operatively, four (1.5%), 13 (4.7%), and 16 (5.8%) cases of infection, full-thickness re-rupture, and loss of extension, respectively, were recorded. Functional outcome scales showed significant post-operative improvement.

Conclusion

Cortical button malposition was the most common but easily preventable complication. All-inside ACLR could be safe and promising after the suggested additional operative techniques and proper perioperative management which decrease complication rates and improve favourable outcomes.

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Acknowledgements

The authors wish to thank the staff members of the Orthopaedic Department at the MacKay Memorial Hospital for their expert assistance with data collection and professional advice.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Mackay Memorial Hospital, No.45, Minsheng Rd, Tamsui Dist., New Taipei City, Taiwan, Republic of China

    Tsung-Yu Lin, Cheng-Chun Chung, Wei-Cheng Chen & Yung-Chang Lu

  2. Biomechanics Research Laboratory, Department of Medical Research, Mackay Memorial Hospital, No. 45, Minsheng Rd, Tamsui Dist., New Taipei City, Taiwan, Republic of China

    Hsu-Wei Fang & Yung-Chang Lu

  3. Department of Medicine, Mackay Medical College, No. 46, Sec. 3, Zhongzheng Rd, Sanzhi Dist., New Taipei City, Taiwan, Republic of China

    Yung-Chang Lu

  4. Mackay Junior College of Medicine, Nursing and Management, No. 42, Sec. 3, Zhongzheng Rd, Sanzhi Dist., New Taipei City, Taiwan, Republic of China

    Tsung-Yu Lin

  5. Chemical Engineering and Biotechnology Department, National Taipei University of Technology, No. 1, Sec. 3, Jhongsiao E. Rd, Da’an Dist., 106344, Taipei City, Taiwan, Republic of China

    Tsung-Yu Lin & Hsu-Wei Fang

  6. Department of Radiation Oncology, Mackay Memorial Hospital, No. 92, Sec. 2, Chung-San North Rd, Zhongshan Dist., 104, Taipei City, Taiwan, Republic of China

    Che-Wei Su

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Contributions

Conceptualization: Yung-Chang Lu, Tsung-Yu Lin; methodology: Tsung-Yu Lin, Cheng-Chun Chung; formal analysis and investigation: Tsung-Yu Lin, Cheng-Chun Chung; writing—original draft preparation: Yung-Chang Lu, Tsung-Yu Lin, Cheng-Chun Chung; writing—review and editing: Tsung-Yu Lin, Cheng-Chun Chung, Wei-Cheng Chen, Che-Wei Su, Hsu-Wei Fang, Yung-Chang Lu; resources: Tsung-Yu Lin, Wei-Cheng Chen, Che-Wei Su, MD, Hsu-Wei Fang, Yung-Chang Lu; supervision: Yung-Chang Lu. All authors read and approved the final manuscript.

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Correspondence to Yung-Chang Lu.

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IRB number: 21MMHIS217e.

MacKay Memorial Hospital Institutional Review Board.

All patients provided informed consent, including for publication.

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The authors declare no competing interests.

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Lin, TY., Chung, CC., Chen, WC. et al. Complications following all-inside anterior cruciate ligament reconstruction. International Orthopaedics (SICOT) 46, 2569–2576 (2022). https://doi.org/10.1007/s00264-022-05515-w

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  • DOI: https://doi.org/10.1007/s00264-022-05515-w

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