CLINICAL FAILURE OF TIBIAL INTERFERENCE SCREW FIXATION AFTER ANTERIORCRUCIATE LIGAMENT RECONSTRUCTION - A REPORT OF 2 CASES

Accelerated rehabilitation after ACL surgery was initially advocated b y Shelbourne and Nitz.(11) Since that time, it has become standard pra ctice to accelerate the rehabilitation after ACL surgery because compl ications of flexion contracture, quadriceps weakness, and arthrofibros is are seen less frequently after an accelerated rehabilitation progra m than after more traditional ACL rehabilitation protocols. In clinica l practice, however, some physicians and therapists are employing a mo re unbridled, aggressive approach to rehabilitation than was originall y advocated. The early initiation of closed kinetic chain exercises an d efforts to maintain full extension are standard practice among most surgeons performing ACL reconstructions. Most surgeons have found that restoration of a functional gait leads to improved early range of mot ion and lessens the complications of thigh atrophy and quadriceps musc le weakness. During the first 3 to 4 weeks after surgery, however, gra ft fixation is the weakest link in the reconstruction and may fail if excessive loads are encountered. To date, there have been no reports o f postoperative clinical failure of tibial interference screw fixation that was previously determined to be acceptable at the time of surger y. We are reporting two cases of failure of tibial interference screw fixation after ACL surgery. Both patients were involved in an accelera ted rehabilitation program that was more aggressive than the one publi shed by Shelbourne and Nitz, and one of the patients was noncompliant with the parameters established for his rehabilitation.