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Complications Form
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Complications Form
Patient First Name
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Patient Surname
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Patient ID
Surgeon First Name
Surgeon Surname
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Date of Review
Follow Up Period
Date of Review
Weeks
Months
Years
Early Postoperative Complications
Date of occurrence
Excessive bleeding/haematoma formation
Nerve injury (other than minor infrapatellar branch involvement)
Infection: Superficial
Infection: Deep
DVT
PE
Early failure of fixation, graft loosening
Other
Please Specify:
Late Postoperative Complications
Date of occurrence
Arthrofibrosis (extension <0o; flexion >10o less than other side)
Graft rupture/recurrent instability:
Secondary meniscal tear
Other
Please describe
Specify Type
Traumatic
Atraumatic
Consequence
Readmission required
Reoperation required
Other
Please describe
Complication Description
Please describe
Name
This field is for validation purposes and should be left unchanged.
