207 / 244
A. PINAROLI, L. BUISSON, G. ESTOUR
206
Harvesting hamstring tendons seems to be less
risky but tendon strain is very common during
the first postoperative month and healing is
the rule when respecting a rest period during
rehabilitation. Chronical evolution with
painful fibrosis and persistant weakness is very
rare [25].
SPECIFIC COMPLICATIONS
DUE TO TUNNELS AND
MATERIALS
Most of them can be prevented peroperatively.
Efficient lavage and fluid aspiration after
reaming prevents heterotopic ossifications at the
femoral tunnel exit with a bone-tendon-bone
graft [4], controlling the correct femoral button
deployement in the same location also prevents
lateral knee pain [19]. Good positionning of
femoral tunnels, use of progressive diameter
reamers, especially in double bundle ACL
reconstruction, can avoid the occurrence of
femoral condyle fractures [13].
Lately, tibial tunnel enlargment caused by
bioarbsorbable screw resorbtion can explain
extra-articular cyst formation (fig. 2) and
facilitate a proximal tibial fracture [21].
PERSISTANT ANTERIOR
KNEE PAIN
Tear of infrapatellar nerve when harvesting
median third of patellar tendon is well known
and can probably explain superior prevalence
of anterior knee pain and discomfort while
kneeling in btb graft than in the hamstring.
Though, a mini invasive double incision [3]
and the use of PRGF in donor site [17] can
reduce this risk.
Fig. 1
Fig. 2