Analysis and prevention of intra-operative complications of TransFix fixation in anterior cruciate ligament reconstruction

We encountered some complications during the graft passage and fixation using a TransFix implant. Despite the large number of cases and publications related to the ligament surgery, few papers have reported intra-operative complications. We report our experience of such complications and prevention methods. From June 2005 to October 2007, anterior cruciate ligament reconstructions were performed in 128 patients using the TransFix devices. From the surgical records, the opinions of the assistant during the graft passage were divided into three subsets: tight, modest, and loose. The results were also analyzed according to the use of the routine procedure, vertical traction, and thigh portal. Complications during the graft passage and fixation were encountered in 13 patients. These complications occurred when the femoral tunnels were tight during the graft passage (P < 0.0001). The addition of vertical traction or a thigh portal decreased the number of complications significantly (P < 0.0001). The main cause of such complications was the lack of full proximal migration of the graft, which can cause tendon and wire breakage. This study introduces some methods to prevent such complications.