tunnel placement

Timing of Surgery

Issue

- reported higher incidence with immediate reconstruction in acute phase

- reduced by settling inflammation / effusion and obtaining FROM

- always best to delay if not professional athlete

- problematic if patient has locked bucket handle mensical tear

Results

Bottoni et al Am J Sports Med 2008

- RCT of early (average 9 days) v late reconstruction (average 85 days)

Incidence

Up to 8% patients with ACL reconstruction will have recurrent instability and graft failure

- increased with surgical inexperience

Graft can

1.  Be inadequate from the start

- inadequate tension

- poor tunnel placement