Uncommon Complications after Anterior Cruciate Ligament Reconstruction

Anteriorcruciateligamentreconstruction(ACL-R)isacommonsurgicalprocedure,with good outcome in 75 to 97% of the cases. However, different complications have been described including infection, hemarthrosis, deep vein thrombosis (DVT), and pulmonaryembolism(PE)witharaterangingfrom1to15%.Therearefewcasereportsin theliteraturedescribingrarecomplicationsafterACL-Randtheycanbedividedinto:(1) complicationsrelatedtothefixationdevice(rupture,migration);(2)fractures(tibialor femoralside);(3)infectionsduetouncommonbacteria,mycobacterium,andmycosis; (4) rare vascular injuries; (5) nerve injuries; and (6) other rare complications. In case of fixationdeviceruptureormigration,deviceremovalcanbeeasybutthediagnosismay be challenging. Patellar fracture after ACL-R may be related to harvesting and it is not uncommon. Conversely, femoral or tibial fractures are most frequently due to bone weaknessrelatedtobonetunnels.Somerareinfectionsrelatedtouncommonbacteria or mycosis are also described with potentially devastating joint damage. Popliteal artery injuries are uncommon in ACL-R but minor vessels damages are described with possible severe consequences for patients. Injuries to the infrapatellar branch of the saphenousnervearenotuncommoninACL-R.However,therearefewcasereportsalso describinginjuriestothesaphenousnerve,thecommonperonealnerveandthesciatic nerve. The aim of this paper is to review the literature describing uncommon complications after ACL-R, giving some more information about diagnosis and treatment.