AANA/SOMOS Enduring Knee Program 2025-Case Presentations: When Things Go Horribly Wrong

Video Transcription

Video Summary

The transcript captures a surgical complications panel titled “when things go horribly wrong,” featuring faculty discussing real intraoperative failures and how to manage them technically and ethically.<br /><br />Case 1: A 19-year-old Navy trainee needs a revision ACL after a new pivot injury following a prior hamstring autograft. Planned single-stage revision with a quad tendon autograft (plus possible LET and meniscus repair) is derailed when the harvested graft is accidentally contaminated after falling off the prep table. The panel debates decontamination protocols (chlorhexidine, power lavage, antibiotic soaks) versus abandoning the graft for an allograft, emphasizing that no method guarantees zero contamination. They stress prompt, honest disclosure to the patient/family, taking team responsibility, apologizing, and framing options and risks. The surgeon chose allograft; the patient initially did well but later likely re-ruptured with tunnel widening.<br /><br />Case 2: A 22-year-old polytrauma patient with a KD3L knee dislocation undergoes staged bicruciate reconstruction. An all-inside PCL graft becomes irretrievably stuck in the tibial socket, forcing graft resection and technique conversion. Post-op PACU films reveal tibial fixation failure from cortical blowout, prompting same-night revision and a return to “old school” fixation (tying over a post). The discussion highlights planning multiple bailouts, knowing graft availability, and routinely checking PACU imaging to catch fixable errors early.

Asset Caption

Case Presentations: When Things Go Horribly Wrong
Moderators: Rob E. Hunter, M.D., Jeanne C. Patzkowski, M.D., FAANA
Panel: Julie A. Dodds, M.D., Brian R. Waterman, M.D., FAANA., Andrea M. Spiker, M.D., FAANA., Robert Waltz, M.D., Andrew J. Sheean, M.D.

Keywords

surgical complications panel

revision ACL reconstruction

graft contamination management

intraoperative failure bailout strategies

ethical disclosure and informed consent

PCL all-inside reconstruction complication

tibial fixation cortical blowout revision