Review Question - QID 8746

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ACL Tear Complications Graft failure due to tunnel malposition QID: 8746 (SAE07SM.84)

QID 8746 (Type "8746" in App Search)

Figure 23 shows the postoperative radiograph of a patient who underwent an anterior cruciate ligament (ACL) reconstruction (with bone-patella tendon-bone autograft) that failed. He initially had loss of flexion postoperatively. What is the most likely cause of this failure?

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Fixation in the tibial tunnel

81/1227

Fixation in the femoral tunnel

62/1227

Posterior placement of the tibial tunnel

48/1227

Anterior placement of the femoral tunnel

81%

993/1227

Size of the patellar autograft

38/1227

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The key to this question is the fact that the patient initially lost flexion postoperatively and this relates to anterior placement of the femoral tunnel, thus capturing the knee. The bone plug seen on the radiograph is actually from the tibial tunnel, but this occurred as the patient forced flexion until failure of the ACL graft and pullout of the plug from the tunnel. Although it could be argued that better tibial fixation would have prevented this failure, poor placement of the femoral tunnel led to the failure of this ACL reconstruction.