Differences between traumatic and non-traumatic causes of ACL revision surgery

Jaecker, Vera; Zapf, T.; Naendrup, Jan‐Hendrik; Kanakamedala, Ajay C.; Pfeiffer, Thomas; Shafizadeh, Sven

doi:10.1007/s00402-018-2954-5

Cited by 26 publications

(28 citation statements)

References 41 publications

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“…The fact that incorrect positioning of the tunnels is one of the main causes of failure of ACL grafts needs to play a major role in the decision-making process. 13,14 Only patients requiring a 2-stage procedure were included in this study. Multiple studies on alternatives to the conventional autologous bone graft for tunnel augmentation have been published in recent years.…”

Section: Discussionmentioning

confidence: 99%

“…It should be noted that nonanatomic tunnel placement represents the most common etiology, occurring in 22% to 79% of cases. 13,14 A 2-stage procedure with filling of the tunnels is recommended for the first revision for tunnel enlargements of 10 to 15 mm and/or potential tunnel confluence. 13,[15][16][17] The tunnels are routinely filled with autologous iliac crest cancellous bone.…”

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confidence: 99%

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Autologous Bone Graft Versus Silicate-Substituted Calcium Phosphate in the Treatment of Tunnel Defects in 2-Stage Revision Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized Controlled Study With a Minimum Follow-up of 2 Years

Recum

Gehm

Guehring³

et al. 2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Purpose: To compare and evaluate knee laxity and functional outcomes between autologous bone graft and silicatesubstituted calcium phosphate (Si-CaP) in the treatment of tunnel defects in 2-stage revision anterior cruciate ligament reconstruction (ACLR). Methods: This prospective, randomized controlled trial was conducted between 2012 and 2015 with a total of 40 patients who underwent 2-stage revision ACLR. The tunnels were filled with autologous iliac crest cancellous bone graft in 20 patients (control group) and with Si-CaP in the other 20 patients (intervention group). After a minimum follow-up period of 2 years, functional outcomes were assessed by KT-1000 arthrometry (side-to-side [STS] difference), the Tegner score, the Lysholm score, and the International Knee Documentation Committee score. Results: A total of 37 patients (follow-up rate, 92.5%) with an average age of 31 years were followed up for 3.4 years (range, 2.2-5.5 years). The KT-1000 measurement did not show any STS difference between the bone graft group (0.9 AE 1.5 mm) and the Si-CaP group (0.7 AE 2.0 mm) (P ¼ .731). One patient in the intervention group (5%) had an STS difference greater than 5 mm. Both groups showed significant improvements in the Tegner score, Lysholm score, and International Knee Documentation Committee score from preoperative assessment to final follow-up (P .002), without any difference between the 2 groups (P ! .396). Complications requiring revision occurred in 4 control patients (22%) and in 2 patients in the intervention group (11%) (P ¼ .660). No complications in relation to Si-CaP were observed. Conclusions: Equivalent knee laxity and clinical function outcomes were noted 3 years after surgery in both groups of patients. Si-CaP bone substitute is therefore a safe alternative to autologous bone graft for 2-stage ACLR. Level of Evidence: Level I, prospective, randomized controlled clinical trial. See commentary on page 186 R upture of the anterior cruciate ligament (ACL) is one of the most common knee injuries, and a marked increase in anterior cruciate ligament reconstructions (ACLRs) has occurred over the past 20 years. 1,2 Because of the rise in operations, the number of revision procedures is also increasing

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Autologous Bone Graft Versus Silicate-Substituted Calcium Phosphate in the Treatment of Tunnel Defects in 2-Stage Revision Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized Controlled Study With a Minimum Follow-up of 2 Years

Recum

Gehm

Guehring³

et al. 2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…According to the current literature, incorrect tunnel placement is the most common cause of primary ACLR failure. 6 Ascertaining the position of the primary tunnels must therefore always be part of the preoperative evaluation before any planned revision. No attempt should be made to use incompletely or completely incorrectly positioned tunnels for the revision, irrespective of their diameter.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5] In addition to traumatic rupture of the graft, graft failure is the most common cause of primary ACLR failure. 6 The main reasons for ACL graft failure are nonanatomic tunnel placement, failed graft integration, and infection. 6,7 The revision procedure requires a precise analysis of the cause of failure of the primary ACLR.…”

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confidence: 99%

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Two-Stage Revision Anterior Cruciate Ligament Reconstruction Using Silicate-Substituted Calcium Phosphate

Schnetzke

Vetter

Linden

et al. 2019

Arthroscopy Techniques

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Revision surgery after failed primary anterior cruciate ligament reconstruction is technically demanding. In cases in which the tunnels of the primary anterior cruciate ligament reconstruction are widened to greater than 10 mm and/or are incorrectly positioned, a 2-stage procedure enables restoration of bone stock and thus free placement of the tunnels during the revision. The gold standard for tunnel augmentation is an autologous iliac crest cancellous bone graft. However, harvesting the graft is associated with high morbidity. This article describes an alternative method for managing bone deficiencies using the synthetic bone graft substitute silicate-substituted calcium phosphate.

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Compliance in post-operative rehabilitation is a key factor for return to sport after revision anterior cruciate ligament reconstruction

Villa¹,

Andriolo

Ricci³

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose To assess the rate of return to sport (RTS) following revision Anterior Cruciate Ligament Reconstruction (ACLR) in a rehabilitation-based cohort of patients. A secondary goal of the study was to evaluate the association between compliance in post-operative rehabilitation and RTS rate. Methods The study cohort included 79 sport-active patients (62 males, 17 females, 30.0 ± 10.2 years old) who underwent revision ACLR surgery and followed the same functional-oriented rehabilitation protocol. Patients were evaluated using a RTS survey: return to any kind of sport participation, return to the same pre-injury sport, return to the same sport at the same pre-injury level. With regards to compliance in post-operative rehabilitation, patients were then grouped in (1) Fully Compliant (FC), (2) Moderately Compliant (MC), (3) Scarcely Compliant (SC), and (4) Non-Compliant (NC). Results At an average follow-up of 29 ± 12 months, 86% of the patients returned to some kind of sport activity, 62% returned to the same pre-injury sport activity and 59% returned to the same pre-injury level of sport activity. While no surgical aspects were correlated with RTS, higher BMI was found to have a negative influence (p = 0.033). Regardless of the type of sport, compliance significantly affected RTS at the same pre-injury level (p = 0.006): 86% in FC, 67% in MC, 50% in SC, and 45% in NC. For each compliance goal achieved, the probability of RTS increased by 68% (OR = 1.68; p = 0.027). Conclusion RTS at the same pre-injury level after revision ACLR is challenging. A higher compliance in rehabilitation significantly increases the chances of RTS. Level of evidence IV.

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Differences between traumatic and non-traumatic causes of ACL revision surgery

Cited by 26 publications

References 41 publications

Autologous Bone Graft Versus Silicate-Substituted Calcium Phosphate in the Treatment of Tunnel Defects in 2-Stage Revision Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized Controlled Study With a Minimum Follow-up of 2 Years

Autologous Bone Graft Versus Silicate-Substituted Calcium Phosphate in the Treatment of Tunnel Defects in 2-Stage Revision Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized Controlled Study With a Minimum Follow-up of 2 Years

Two-Stage Revision Anterior Cruciate Ligament Reconstruction Using Silicate-Substituted Calcium Phosphate

Compliance in post-operative rehabilitation is a key factor for return to sport after revision anterior cruciate ligament reconstruction

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