The purpose of this multicenter retrospective study was to analyze the causes for failure of ACL reconstruction and the influence of meniscectomies after revision. This study was conducted over a 12-year period, from 1994 to 2005 with ten French orthopaedic centers participating. Assessment included the objective International Knee Documenting Committee (IKDC) 2000 scoring system evaluation. Two hundred and ninety-three patients were available for statistics. Untreated laxity, femoral and tibial tunnel malposition, impingement, failure of fixation were assessed, new traumatism and infection were recorded. Meniscus surgery was evaluated before, during or after primary ACL reconstruction, and then during or after revision ACL surgery. The main cause for failure of ACL reconstruction was femoral tunnel malposition in 36% of the cases. Forty-four percent of the patients with an anterior femoral tunnel as a cause for failure of the primary surgery were IKDC A after revision versus 24% if the cause of failure was not the femoral tunnel (P = 0.05). A 70% meniscectomy rate was found in revision ACL reconstruction. Comparison between patients with a total meniscectomy (n = 56) and patients with preserved menisci (n = 65) revealed a better functional result and knee stability in the non-meniscectomized group (P = 0.04). This study shows that the anterior femoral tunnel malposition is the main cause for failure in ACL reconstruction. This reason for failure should be considered as a predictive factor of good result of revision ACL reconstruction. Total meniscectomy jeopardizes functional result and knee stability at follow-up.

Retrospective case series, Level IV.

IV; retrospective study.

Numerous surgical techniques have been developed to treat osteochondral defects of the knee. A study reported encouraging outcomes of third-generation autologous chondrocyte implantation achieved using the solid agarose-alginate scaffold Cartipatch 1 . Whether this scaffold is better than conventional techniques remains unclear. This multicenter randomized controlled trial compared 2-year functional outcomes (IKDC score) after Cartipatch 1 versus mosaicplasty in patients with isolated symptomatic femoral chondral defects (ICRS III and IV) measuring 2.5-7.5 cm 2 . In addition, a histological evaluation based on the O'Driscoll score was performed after 2 years. We needed 76 patients to demonstrate an at least 10-point subjective IKDC score difference with a ¼ 5% and 90% power. During the enrolment period, we were able to include 55 patients, 30 of them were allocated at random to Cartipatch 1 and 25 to mosaicplasty. After 2 years, eight patients had been lost to follow-up, six in the Cartipatch 1 group, and two in the mosaicplasty group. The baseline characteristics of the two groups were not significantly different. The mean IKDC score and score improvement after 2 years were respectively 73.7 AE 20.1 and 31.8 AE 20.8 with Cartipatch 1 and 81.5 AE 16.4 and 44.4 AE 15.2 with mosaicplasty. The 12.6-point absolute difference in favor of mosaicplasty is statistically significant. Twelve adverse events were recorded in the Cartipatch 1 group against six in the mosaicplasty group. After 2 years, functional outcomes were significantly worse after Cartipatch 1 treatment compared to mosaicplasty for isolated focal osteochondral defects of the femur. ß

In partial ACL tear, selective AM bundle reconstruction conserving the posterolateral bundle remnant provides clinical results comparable to the standard single-bundle technique, with better control of anterior laxity. Longer follow-up, however, will be needed to compare evolution in anterior and rotational laxity and in subjective results over time.