Complications in anterior cruciate ligament reconstruction Articular cartilage reconstruction: Review of concepts, techniques, complications, risk factors, and Bail out/salvage strategies

Abstract

Chondral lesions are difficult and challenging depending on their size, location, and chronicity. In cartilage reconstruction, our aim is to employ techniques to help save the joint, regenerate lost or diseased cartilage, and hopefully prevent or delay the progression of osteoarthritis and the need for arthroplasty. As patient and lesion characteristics differ from case to case, there is no single surgical strategy ideal to treat all chondral lesions. With the advancement of our knowledge and comprehensive research efforts, marrow-stimulating techniques like microfracture and microdrilling, as well as cartilage regeneration methods such as autologous chondrocyte implantation, autologous matrix-induced chondrogenesis, and the application of hyaluronic acid-based scaffolds with MSCs, have become fundamental approaches in confronting this growing challenge. Emphasizing the importance of patient selection is vital, given that compliance with rehabilitation and return-to-play protocols, along with adherence to established timelines, is essential. Furthermore, it is necessary to select patients who are free from biomechanical malalignment and do not present with concomitant meniscal or ligamentous issues that must be addressed prior to surgery. However, despite all our attempts to ensure the best outcomes for our patients, complications are sometimes unavoidable. Thus, being able to recognize possible complications, utilize strategies to prevent these complications, and knowing how to manage complications when encountered are important for any orthopaedic surgeon.