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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
DD slash MM slash YYYY
Weeks
Months
Years
Early Postoperative Complications
Date of occurrence
DD slash MM slash YYYY
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
DD slash MM slash YYYY
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
Comments
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