COMPLICATIONS IN ARTIFICIAL LIGAMENTS REPAIR
J P.Laboureau MD France
There has been so many complications that i feel sorry to talk about what we have gone through and in
the mean time quite proud some of us have been able to resist and participate in some improvements .
CLASSICAL COMPLICATIONS SYNOVITIS :
acute ,they were due to the releasing of toxic lubricating substances used during the manufacturing of
the fibers . Nobody, including the FDA was awared of that .
But now with the cleaning processes ;this complication has been totally eliminated
During the « adaptation post operativ period », it happens sometimes(5%),but is cured by NSAI and
do not last more than 3 month .
Late, it means debris due to pre-rupture ,most of the time related to a technical mistake such as hyper
tension , abrasion against the notch, wrong placement or direction of tunels .
RUPTURES : they went down from about 50% in the early 80’s to 7% in ACL (acutes and chronics
together) and 15% in PCL 5( acutes and chronics together )
Spontaneous and early ,they are for sure the consequence of a technical mistake
Later they have probably the same origin but they occur also for unprecise reasons, specially in case
of « naked ligament »in chronic cases due to the fatigue of the material . And this is why it is not a
good indication . In these cases the synthetic fibers have to be surronded by autologous tissue .
But the other techniques have also the same rates of failures, back to instability . The only difference
is that it is not called a rupture and nobody blames anybody as it is admitted to be part of the mysteries
of human nature .
Nevertheless technical mistakes are done in all techniques and it is surprising when looking to post-op
xrays to discover that estimated right placements are in fact wrong ( femoral tunel too psterior) and led
to failures.
EARLY OA : is mainly due to over tightening or no respect of isometry that results in the same hyper
pressure on the cartilage .
LOOSENING OF FIXATION : can be avoided by careful procedure but can also be caused by a
new trauma . Then it is easy to repair , easier than to perform a new autogenous reconstruction
SPECIFIC COMPLICATION OF THE ORIGINAL LARS TECHNIQUE : the lateral femoral
haematoma . A good solution seems to be the inside –out femoral fixation , at the condition of a
perfect technique( divergence of ligament and screw )
There are less stiffness of the knee, less DVT, less infections with the use of synthetic ligaments
(purely arthroscpic procedure , immediate weight bearing and full motion )
The results of our series show that the global outcome of synthetic ligaments in knees is favourably
comparable to other procedures , with less immediate inconveniences for the patient. The same was
proven by other autors with prospective randomized studies versus BTB . It shows also that late
complications can be widely avoided if the repair is done acutely . Do we wait to fix a tibial fracture ?
Is it just because everybody,including the patient can see it on the xray and we would be blamed to
delay the treatment ?Let us think about it .
In other indications such as acomio clavicular dislocation, rotator cuff repair, achiles or patelar tendon
ruptutes etc, the use of synthetic fibers is very useful and did not demonstrate particular complications