Failure Rates and Complications After Multiple-Revision ACL Reconstruction: Comparison of the Over-the-Top and Transportal Drilling Techniques

Abstract

Background: Multiple-revision anterior cruciate ligament reconstruction (ACLR) presents several technical challenges, often due to residual hardware, tunnel widening, malposition, or staged surgeries. Purpose: To compare failure and complication rates between the over-the-top (OTT) and transportal drilling (TD) techniques in patients undergoing surgery for failed revision ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: The medical records of patients with at least 2 revision ACLRs using either the OTT or TD technique were reviewed retrospectively. Data on patient demographics, graft characteristics, number of revisions, concomitant procedures, complications, and failures were collected. Between-group comparisons of continuous and categorical variables were conducted with the independent-samples t test and the Fisher exact or chi-square test, respectively. Results: A total of 101 patients undergoing multiple-revision ACLR with OTT (n = 37, 37%) and TD (n = 64, 63%) techniques were included for analysis. The mean follow-up time was 60 months (range, 12-196 months). There were no significant differences in age, sex, body mass index, laterality, or follow-up length between groups ( P > .05). Allograft was the graft used most frequently (n = 64; 67.3%) with no significant differences between groups in graft diameter ( P > .05). There were no statistically significant differences between groups regarding rate of concurrent medial and lateral meniscus, cartilage, or lateral extra-articular procedures ( P > .05). There was also no significant66 between-group difference in complication rate (OTT: n = 2 [5.4%]; TD: n = 8 [13%]) or graft failure rate (OTT: n = 4 [11%]; TD: n = 14 [22%]) ( P > .05 for both). Conclusion: The results of this study showed notably high failure and complication rates in challenging multiple-revision ACLR. Complication and failure rates were similar between techniques, demonstrating that the OTT technique is a valuable alternative that can be used in a revision ACLR, particularly as a single-stage approach when the single-stage TD technique is not possible.

Approximately half of pediatric or adolescent patients undergoing revision anterior cruciate ligament reconstruction return to the same level of sport or higher: A systematic review

“…allografts used, there were 28 anterior tibialis (12.3%), 21 achilles (9.2%), seven BPTB (3.1%) and one IT band (0.4%) with the rest being unspecified (75.0%). Mean graft diameter ranged from 9.05 to 9.9 mm in five studies [9,21,23,25,26] comprising 273 patients that reported values, with three studies [21,23,25] reporting significantly greater values in revision than primary procedures (p < 0.01, p < 0.001, p = 0.001).…”

“…R-ACLRs tend to result in worse outcomes than that of primary operations [5,6]. As such, technical aspects of r-ACLR have been studied extensively in the adult literature over the past several years, including optimal graft selection, tunnelling and fixation strategies, and staging [7][8][9]. Up to 90% of paediatric and adolescent patients return to sport after index procedures [10], therefore, it is critical for orthopaedic surgeons to have a comprehensive understanding of the most commonly used operative techniques in both primary and revision ACLR for the skeletally immature population.…”