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RETURN TO SPORT AND PREVENTION: COMPLICATIONS - LITERATURE
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MUSCLE WEAKNESS
The underlying neuro-physiologic mechanisms
remain unclear, but asymmetry in quadriceps
strength, activation, and cortical excitability
persist in individuals with ACL reconstruction.
It can help to understand long-term reduction
in sporting activity and increase the rate of
subsequent joint injury in otherwise healthy,
active individuals afterACL reconstruction [14].
STIFFNESS AND
ARTHROFIBROSIS
Influence of the notch for cyclop syndrome is
also well known [11], as well as anterior
positionning of the graft can also explain the
occurrence of this complication.
Major stiffness is very rare and surgical
treatment is difficult [20].
Well conducted rehabilitation is necessary to
avoid stiffness and patient participation is
mandatory. Day-to-day variations in negative
mood and stress may contribute to adherence
when prescribed home exercises [5].
CARTILAGE DAMAGE AND
SECONDARY MENISCAL
TEARS
Patello-femoral arthritis, especially with btb
graft, can be prevented by adapted rehabilitation
and can also reduce poor results 3 years after
ACL reconstruction [9].
Early damaging chondrolysis has been
described after postop intraarticular continuous
pump catheter infusion of bupivacain and
epinephrin [6].
Pseudogout is a very rare complication [24].
Secondary meniscal tears are clearly correlated
to the amount of residual laxity after surgery.
GRAFT RUPTURE
Literature is controversial about the influence
of grafts on rerupture rate. Some authors
suggest that graft rupture is higher with
hamstrings [16], others find no difference when
comparing to btb graft [15], but they agree on
the fact that there is a higher rate of rereuptures
with allografts [15].
A higher rate of rerupture is also correlated
with preop grade 3 pivot shift [18], this is
influenced by hip rotation restriction (non
contact rerupture) [10] and especially concerns
young patients [16, 23].
Young patients and females are also higher at
risk to have a controlateral ACL rupture [16, 23].
Patient adapted rehabilitation protocols are
therefore important to prevent these
complications and can also help to decrease
fear of reinjury [12].