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· DOS Abstracts
Tunnel malpositioning in knee ligament reconstruc-
tions Denmark 2005-12
Thomas Hansen, Kim Lyngby Mikkelsen, Michael Rindom Krogsgaard
Section for Sportstraumatology M51, Bispebjerg Hospital; , The Patient
Compensation Association
Background:
Suboptimal positioning of tunnels is stated as the reason for
cruciate ligament revision in 27 % of 1.866 operations reported to the Danish
Kneeligament Reconstruction Register (DKRR) 2005-13. It is also the most
common reason for compensation from The Patient Compensation Association
(PCA) to patients after knee ligament reconstruction.
Purpose / Aim of Study:
To describe the characteristics of tunnel malposi-
tioning in knee ligament reconstruction reported to PCA and to evaluate causes
and possible means of prevention.
Materials and Methods:
From PCA patients with a reported complication
2005-2013 after knee ligament reconstruction were identified, and details in
cases of tunnel malpositioning were studied. This was combined with informa-
tion about the number of operations/year for each clinic (< 10, 10-50 and
>50), if it was a public or private clinic and technique for femoral tunnel posi-
tioning.
Findings / Results:
92 malpositions were accepted for compensation. Of 52
malpositions in femur, 38 were anterior and 12 were vertical. Of 29 malposi-
tions in tibia, 9 were anterior, 7 posterior and 13 medial, some perforating the
medial tibial plateau. Combined malposition in femur and tibia was seen in 11.
The incidence of tunnel malpositioning was highest in clinics with < 10 recon-
structions/year (2,26 %), medium in clinics with 10-50 reconstructions/year
(0,69 %), and lowest in clinics with > 50/year (0,28 %) (p < 0,05). 73 femoral
tunnels were placed by transtibial (TT) technique and 11 by anteromedial (AM)
technique – about 1/3 of all operations were done with AM technique and 2/3
with TT.
Conclusions:
If 27 % of revisions were caused by tunnel malpositioning, less
than 21 % of these had been reported to PCA. AM technique was less fre-
quently connected to malpositions than TT technique. Routine seemed to be the
best prevention against tunnel malpositioning.
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