After ACL reconstruction

After ACL reconstruction, complications can occur in several ways. Early recognition and management is important to optimize patient outcome. In this summary the most prevalent complications that are important for a physical therapist are presented. 

Loss of motion after ACL reconstruction can be caused by scar tissue that attaches within the intercondylar notch on the tibial side (los of extension) and scar within the gutters and suprapatellar pouch region (los of flexion). Incorrect tunnel placement can also result in a limited range of motion. Other causes of extension problems can be caused by a tightened capsule (after a meniscal repair), MCL scarring, hamstring tightness or posterior capsular scarring. Full extension and 90 degrees of flexion should be achieved after 2 weeks. When a patient complains about instability, graft failure should be considered. Graft failure could be caused by surgical technical errors, graft incorporation failure and trauma. Infections after ACL reconstruction do not occur often (about 1%). However one should be alert for symptoms like increased pain and swelling and erythema and drainage from the surgical incisions. 

A physical therapist plays an important role in signaling complications. Therefore the status and function of the knee should be examined continuously during rehabilitation. > From: Heard et al., Sports Med Arthrosc Rev 21 (2013) 106-112. All rights reserved to Lippincott Williams & Wilkins.