Table 2.
Complications related to graft harvest
| Complication | Clinical effect | Prevention | Detection | Remedy |
|---|---|---|---|---|
| Graft dropped during surgery [5] | Contaminated graft and risk of infection | Careful intraoperative technique with suture fixation and clamps to secure grafts to field | Easily detected during surgery | Sterilize the graft with chlorhexidine 2%; harvest contralateral graft (BTB versus hamstring); use allograft if available and patient amenable |
| Patellar graft or quadriceps tendon graft: bone cuts not beveled during harvest [8] | Patella fracture can occur after harvest | Trapezoidal cut can help to minimize a steep cut angle and prevent a stress riser at the harvest site | Examine the cut edge of the graft and the harvest site | Bevel the remaining cut edge of the patella; bone graft the donor site with plug trimmings if a large defect is present; protected weightbearing |
| Hamstring graft: tendons not adequately released [21] | Can lead to proximal transection of the tendon and inadequate length of the graft for reconstruction | The tendons should be released from the sartorial fascia and all gastrocnemius attachments should be transected; the stripper should be seated and constant pressure, in line with the harvested tendon, should be applied | The graft is examined after muscle removal and the length checked. Minimal length is typically 18 cm (9 cm when double looped); the surgeon can detect an impending inadequate release if she or he cannot deliver at least 3 cm of tendon through the skin wound with traction and knee flexion before stripping | Augment with allograft; harvest ipsilateral patellar tendon or contralateral hamstrings (if consented); abort procedure |
| Hamstring graft: excessive removal of muscle tissue [27] | Knee flexion weakness, particularly at high flexion angles. | Avoid plunging at time of harvest; avoid hamstring graft in athletes who require maximal power at high flexion angles (ie, hurdlers) | Excessive muscle tissue noted when graft is prepared for insertion | Physical therapy directed at hamstring strengthening |
| Saphenous nerve injury [25] | Injury to either the sartorial (terminal) or infrapatellar branch of the saphenous nerve during harvest or skin incision | Careful intraoperative technique, blunt retraction | Hyperesthesia and numbness on medial aspect of the knee | Observation, patient counseling, or desensitization therapy. |
BTB = bone-tendon-bone.