PRIMARY ACL RECONSTRUCTION
Name Patient
Your answer
First Name Patient
Your answer
geslacht
Date of Birth
MM
/
DD
/
YYYY
GSM nr of telefoon nr as indicated on sticker
Your answer
Date of Surgery
MM
/
DD
/
YYYY
Surgeon
Side Of Surgery *
ACL rupture *
Lachman
Anterior Drawer
Pivot Shift
ACL Graft Type *
Tunnel Diameter Tibial *
Tunnel Diameter Femoral *
Femoral Ingrowth *
endobutton lenght *
femoral notch lenght *
Required
Femoral Offset *
Tibial Fixation *
Interferentie schroef *
Post Fixation *
Tourniquet Time (mins)
Your answer
Monoloop Procedure *
Medial Meniscus Findings
Lateral Meniscus Findings
Medial Compartment Cartilage Findings
Medial Compartment Cartilage Findings
Medial Compartment Cartilage Treatment
Lateral Compartment Cartilage Treatment
MCL
Concomitant Procedures
Remarks
Your answer
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