ABSTRACT
To evaluate, out of the possible causes, the risk factors arid complications of arthroscopic anterior cruciate ligaments [ACL] reconstruction using PT arid STG [four strands] in patients with chronic torn ACL. Al Razi Orthopedic Hospital, Kuwait. A total of 245 patients with chronic ACL deficient knee underwent arthroscopically-assisted reconstruction with either autologous patellar tendon graft or gracilis arid semitendinosus [four strands]. Preoperatively, no significant difference between the two groups was noted with respect to age, or level of activity. A standardized rehabilitation program was used for all the patients after surgery. The patients were evaluated at a minimum of three years postoperatively [range 37-48 months]. No significant differences between the two groups [chi square analysis] with respect to subjective complaints, functional level of activity or objective laxity evaluation, including KT 1000 measurement, were found. Patello femoral pain arid crepitus developed in 25% arid 8% in PT arid STG groups, respectively. Fracture of the patella, patellar tendinitis cyclops lesion and loss of movement were common complications noticed in the PT group, while premature amputation of the hamstring tendon, infection and injury to the saphenous nerve was noted in the STG graft. Late patellar fractures, extensor mechanism rupture, failure of graft fixation and reflex sympathetic dystrophy are rare complications and were not seen in our patients. Details of our complications, possible causes, risk factors and the management of these factors are presented. Familiarity with the regional anatomy arid its variation, proper surgical technique, proper placement of the tibial and femoral tunnels, adequate notchplasty, rigid fixation of the graft, early mobilization with extension of the knee, gradual flexion and rehabilitation with routine use of prophylactic antibiotics are key to avoid or decrease these complications in arthroscopic ACL reconstruction. It was noticed that isolated tear of ACL is a common injury. It is also clear that most of ACL injuries, if not all, occur in males, as there are not many female sports players in Kuwait. However, we have operated on two female athletes [one Judo arid one basketball player] recently. These two females were not involved in the study