IC 305-2024: My Worst Day in the Operating Room: Navigating and Preventing Pitfalls and Complications Associated with Arthroscopic and Open Knee Surgery-IC 305: My Worst Day in the Operating Room: Navigating and Preventing Pitfalls and Complications Associated with Arthroscopic and Open Knee Surgery

Video Transcription

Video Summary

This educational panel featuring orthopedic experts from various esteemed clinics delved into complexities and complications encountered with anterior cruciate ligament (ACL) surgeries. The panel, including Travis Mack, Aaron Kritsch, Armando Vidal, and Justin Ernert, detailed methods for managing pitfalls, surgical intricacies, and patient recovery strategies. Below is a condensed summary of critical points raised during the extensive session.<br /><br /><strong>Case Summary 1: ACL Reconstruction Complication</strong><br />A 38-year-old active skier experienced a knee injury leading to an ACL tear. After initial surgery, he slipped, hyperflexed his knee, and reported significant swelling. Imaging revealed a patellar tendon rupture. Panelists debated advanced imaging's necessity with most agreeing on preoperative imaging to plan surgical reconstruction. The surgical approach involved repairing what they could and augmenting it with a hamstring autograft to ensure stability.<br /><br /><strong>Case Summary 2: Soft Tissue Graft Preferences</strong><br />Discussion emphasized graft types, particularly contrasting bone-patellar tendon-bone (BTB) vs. soft tissue grafts. Their patient, an active 49-year-old, favored a BTB for durability despite nearing 40. Post-surgery complications arose including fractures at the patellar and tibial tunnels. The need for staging and cautious planning in complex revision cases was noted.<br /><br /><strong>Case Summary 3: Patellar Fracture Case</strong><br />A patient experienced a medial patellar facet fracture following a contralateral BTB ACL reconstruction. The fracture required prompt CT scan for precise evaluation. Surgery revealed the fractured medial facet and reattachment was performed with a screw and soft tissue fixation. The case highlighted risks associated with BTB harvests and stressed patient-specific anatomical considerations.<br /><br /><strong>Case Summary 4: Peroneal Nerve Injury in Multi-ligament Reconstruction</strong><br />The panel examined a peroneal nerve injury post-multi-ligament reconstruction. Initial remedies included loosening braces and patient observation. Surgery revealed an iatrogenic traction injury to the articular branch of the peroneal nerve, emphasizing the necessity of understanding anatomical variances. A successful decompression and nerve transfer led to patient recovery.<br /><br /><strong>Conclusion</strong><br />The panel underscored the importance of meticulous surgical planning, recognizing complication signs, and exploring thorough postoperative assessments. They emphasized run-to-complication strategies, peer consulting for complex cases, and adapting surgical techniques based on outcomes to mitigate similar future issues. The cases presented provided a rich learning ground for managing ACL reconstructions, emphasizing both technical precision and comprehensive post-op care.

Keywords

orthopedic experts

ACL surgeries

surgical complications

patient recovery

imaging techniques

graft types

BTB graft

patellar fracture

peroneal nerve injury

multi-ligament reconstruction

surgical planning

postoperative assessments