Technical Complications of ACL Reconstruction.

Abstract

The main goal of ACL reconstruction is to reproduce native knee kinematics in order to allow the patient to return to high-level activities. Orthopaedic surgeons achieve this objective in the overwhelming majority of cases, but complications can ensue. A rare technical complication is highlighted in the July 24 edition of Case Connector . A twenty-one-year-old male college football player presented with gross instability of the knee after moving laterally during practice. The ACL in the affected knee had already been treated twice surgically. Three years before presentation, the patient had undergone a transtibial reconstruction with use of a hamstring autograft. Following a reinjury six months after that, he underwent a revision that involved inside-out femoral tunnel drilling and a posterior tibialis allograft. The graft was fixed on the femoral side with an Arthrex RetroButton, while tibial side fixation employed an interference screw with a screw-washer reinforcement. During intraoperative stability testing, the RetroButton popped loose, presumably because the lateral cortex had been breached. The graft was taken down and was refastened with a 17-mm polyethylene button on the femoral side and with a reinforced interference screw on …