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J. CHOUTEAU
86
Fracture of the bone plug
Both femoral and tibial bone plugs could break,
either during graft harvesting, or while drilling
traction holes.
Fracture of the patella
Harvesting the patellar bone plug could lead to
intra-operative patellar fracture particularly in
cases of very dense bone. Chouteau
& al.
described a technique in which two holes are
drilled either side of the horizontal saw line of
the patella, to limit the risks of pre- and post-
operative patellar fracture [1].
Hamstrings Tendon graft procedures
The tibial insertion of the hamstrings tendon
(HT) is highly variable. It can be spread out to
different extents, and the tendinous portion
could start more or less distally, and could be
difficult to locate. Adhesions and septum
between the tendons could complicate their
harvesting. The vincula, combining tendons
and aponevrosis, can also present traps during
stripping. They can lead to wrong way and
insufficient graft length.
There are various intra-operative complications
that can occur while harvesting the hamstrings
tendon.
Wrong way of stripper
In most cases, this complication arises due to
an unsectioned vinculum that deviates the
stripper and yields a short harvested graft.
Tendon retraction during stripping
and subsequent graft loss
This complication occurs in case of tendon
detachment from its distal insertion and
requires use of a closed stripper. The tendon
could retract and get lost in case of stripper
blockage over an adhesion.
Inability to detach the tendon distally
over dense periosteum
This complication occurs if the surgeon uses a
retrograde harvesting technique through
postero-medial cutaneous incision. It therefore
requires an antero-medial counter-incision to
liberate the distal tendon insertion.
Absence of semitendinosus tendon
leading to use of gracillis alone
This complication could occur, and cannot be
anticipated, just as the presence of a double
gracillis tendon, that could be short and/or thin,
therefore unusable.
Insufficient size of harvested graft
This complication occurs relatively rarely, with
the possibility of performing a multibrin
transplant of the semitendinosus tendon.
Nevertheless, in such cases conversion to a
KJ procedure may be necessary.
POST-OPERATIVE
COMPLICATIONS
Post-operative complications are chiefly
related to of sensitive subcutaneous troubles.
The positioning and coverage of deficient
zones depend on the graft type (fig. 2). They
were clearly described by Dejour
(symposium
of the Société Française d’Arthroscopie in
2007)
who reported that 68% of patients
present a hypoesthesia over a mean area of
11.2 cm
2
using the KJ technique, compared to
32% over a mean area of 9 cm
2
using the
HT technique [2].
Anterior pains are difficult to characterize and
are equally frequent. Dejour [2] reported 33%
for KJ techniques, compared to 25% for HT
techniques. Zaffagnini also found significant
differences between the two techniques, 36%
using KJ compared to 12% using the HT [3]. In
this study, they are particularly frequent during