REVISION ANTERIOR CRUCIATE LIGAMENT SURGERY
Section snippets
Loss of Motion
Loss of motion is one of the most common complications following knee ligament surgery.‡ The incidence of loss of motion following ACL surgery has been reported to range from 5.5% to 24%.52, 64, 122 The large variation in the reported incidence reflects differences in the criteria used to define the problem, differences between studies in the timing of surgery, and differences in surgical technique and postoperative rehabilitation. Delaying
Errors in Surgical Technique
Errors in surgical technique are the most frequent cause of graft failure.68, 69, 70, 72, 126, 151, 155, 157, 158 Nonanatomic graft placement is the most common surgical error responsible for failure of the primary ACL graft. * An improperly positioned femoral or tibial tunnel results in excessive length changes of the ACL graft as the knee moves through a range of motion.44, 47, 55, 94, 138 Because biologic ACL grafts can
PREOPERATIVE EVALUATION
Preoperative evaluation is one of the most important aspects of revision ACL surgery. First and foremost, it must be determined if the previous surgery has truly failed. Because of the different categories of failure and overlap between them, determining whether the patient's residual complaints are primarily caused by graft failure can at times be very difficult. Current indications for revision ACL surgery include instability with activities of daily living or athletic activities, and the
PREOPERATIVE PLANNING
Once the preoperative evaluation has been completed, the surgeon should have determined the origins of the primary failure and determined whether the patient is a candidate for revision ligament surgery. Patient compliance and motivation are important factors that are critical to the success of revision ACL surgery. If revision ACL surgery is recommended, the patient must be given a realistic expectation of the expected outcome, and not be promised too much. In general, the results of revision
Skin Incisions
Careful planning of skin incisions around the knee is needed to avoid wound healing problems. Meticulous surgical technique and handling of the soft tissues is critical. In general, previous incisions should be used or extended if they allow simultaneous hardware removal, graft harvest, and proper placement and fixation of the new graft.
Old vertical incisions can be extended proximally or distally to harvest either a patellar tendon or hamstring tendon graft for the revision procedure (Fig. 16)
SUMMARY
An increasing number of revision ACL reconstructions are being performed each year. Revision ACL surgery is challenging and cannot be approached in the same manner as primary ACL surgery. Successful revision ACL surgery requires a detailed history, a comprehensive physical examination, appropriate radiologic studies, and careful preoperative planning. The results of revision ACL surgery do not equal the results of primary ACL surgery, and this should be explained to the patient prior to surgery.
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Cited by (205)
Allograft Bone Dowels Show Better Incorporation in Femoral Versus Tibial Tunnels in 2-Stage Revision Anterior Cruciate Ligament Reconstruction: A Computed Tomography–Based Analysis
2021, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :The authors noted further incorporation at 24 weeks and suggested that autogenous grafts increased bone formation in the tunnels. They performed a 2-stage revision for tibial tunnels with an aperture greater than 20 mm, taking into consideration that a bone tunnel of 15 mm diameter with 45° of inclination resulted in a tibial tunnel aperture of >20 mm.31 We compared our findings with the previously published study, since the prior study used a similar graft diameter.
Revision Anterior Cruciate Ligament Reconstruction After Primary Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction: A Case Series of 40 Patients
2020, Arthroscopy - Journal of Arthroscopic and Related SurgeryOrtho-Biologics for Ligament Repair and Reconstruction
2019, Clinics in Sports Medicine
Address reprint requests to Charles H. Brown, Jr, MD, Brigham and Women's Hospital, Department of Orthopaedic Surgery, 75 Francis Street, Boston, MA 02115
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