Revision ACL Reconstruction: Principles and Practice

Tapasvi, Sachin; Shekhar, Anshu

doi:10.1007/s43465-020-00328-8

Cited by 23 publications

(24 citation statements)

References 71 publications

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“…Regarding clinical results, the technique presented was compatible with the literature. As for primary reconstructions, revisions already tend to have worse functional results and a lower rate of return to sport, and multiple revisions tend to have even worse results [ 27 ]. Yoon et al.…”

Section: Discussionmentioning

confidence: 99%

Functional results of multiple revision anterior cruciate ligament with anterolateral tibial tunnel associated with anterolateral ligament reconstruction

Helito

Silva

Guimarães

et al. 2022

Knee Surg & Relat Res

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Background Revision anterior cruciate ligament (ACL) reconstructions are usually complex owing to previous tunnels. The objective of this study is to report the results of a revision ACL reconstruction technique with a tibial tunnel performed from the anterolateral plateau associated with an anterolateral ligament (ALL) reconstruction. Methods Patients with at least two ACL reconstructions that failed and who had significant enlargement and confluence of tunnels in the medial tibial plateau and underwent revision ACL reconstruction associated with ALL reconstruction with the tibial tunnel for the ACL performed from the lateral plateau between 2017 and 2019 were evaluated. All patients were evaluated by physical examination, International Knee Documentation Committee (IKDC), and Lysholm functional scales. Results Six patients who underwent this surgical procedure were evaluated. All patients were sports practitioners and presented a grade 3 pivot shift. The mean age was 28.5 ± 8.2 years, and the mean follow-up time was 34.1 ± 12.8 months. No patient had a new graft rupture, but three (50%) had grade 1 pivot shift. Four patients had minor complications with no clinical impact on the final result. All except one patient were able to return to pre-injury type of sports, at a mean time of 14.6 ± 2.3 months after surgery. Conclusion The anterolateral tibial tunnel technique using an Achilles tendon allograft for revision ACL reconstruction after multiple failures associated with an ALL reconstruction showed good results and no major complications. The anterolateral tunnel can be considered a good alternative in cases of medial tibial confluence or significant enlargement of the medial tunnels in re-revision procedures.

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Section: Discussionmentioning

confidence: 99%

Functional results of multiple revision anterior cruciate ligament with anterolateral tibial tunnel associated with anterolateral ligament reconstruction

Helito

Silva

Guimarães

et al. 2022

Knee Surg & Relat Res

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“…However, a recently concluded study found no difference between the two techniques [22]. Nevertheless, well-designed studies are required to establish the superiority of AM over AL portal in 'accurate' identification of the femoral footprint as inaccurate tunnel placement remains one of the key factors in failed ACLR [23].…”

Section: B) Intra-operative Trendsmentioning

confidence: 99%

Trends in Primary Anatomical Single-Bundle Anterior Cruciate Ligament Reconstruction Practice in Adult Patients Prevalent Among Arthroscopy Surgeons of Six Southern States of India

Pandey

Madi

Thonse

et al. 2022

JOIO

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Background Although guidelines from multiple scientific studies decide the general trend in ACLR practice, there is often a variation between scientific guidelines and actual practice. Methods A 17-member committee comprised of sports surgeons with experience of a minimum of 10 years of arthroscopy surgery finalized a survey questionnaire consisting of concepts in ACL tear management and perioperative trends, intraoperative and post-operative practices regarding single-bundle anatomic ACLR. The survey questionnaire was mailed to 584 registered sports surgeons in six states of south India. A single, non-modifiable response was collected from each member and analyzed. Results 324 responses were received out of 584 members. A strong consensus was present regarding Hamstring tendons preference for ACLR, graft diameter ≥ 7.5 mm, viewing femoral footprint through the anterolateral portal, drilling femoral tunnel from anteromedial portal guided by ridges and remnants of femoral footprint using a freehand technique, suspensory devices to fix the graft in femur and interference screw in the tibia and post-operative bracing. A broad consensus was achieved in using a brace to minimize symptoms of instability of an ACL tear and antibiotic soaking of graft. There was no consensus regarding the timing of ACLR, preferred graft in athletes, pre-tensioning, extra-articular procedure, and return to sports. There was disagreement over hybrid tibial fixation and suture tapes to augment graft. Conclusion Diverse practices continue to prevail in the management of ACL injuries. However, some of the consensuses reached in this survey match global practices. Contrasting or inconclusive practices should be explored for potential future research.

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“…Additionally, it is a deficiency that can be reduced by using practical strength training and neuromuscular rehabilitation methods. Bilateral landing knee joint loading patterns are significantly impacted by isometric quadriceps femoris strength deficiencies of more than 15% [22,23] . In a recent study, Schmitt and colleagues discovered that people with quadriceps femoris strength impairments had altered landing patterns.…”

Section: Final Postoperative Obstaclesmentioning

confidence: 99%

Postoperative complications following ACL reconstruction: Prevention and management

Rao¹,

Reddy²,

Reddy³

2022

Nat. J. Clin. Orthop.

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This article aims to conduct a literature analysis on the current care and prevention strategies for postoperative problems following the repair of the anterior cruciate ligament (ACL). A presentation will be given on current trends in rehabilitation procedures, suggestions for interventions, and anticipated milestones in the healing process after ACL surgery. In recent years, protocols for ACL repair have progressed to a criterion-based progression rather than a tissue healing time frame. Because of advancements in ACL surgical reconstruction techniques and rehabilitation protocols, the danger of postoperative complications can manifest itself at any point during the recovery process. This includes both the beginning and the end of the process. In this paper, we will examine the significance of preventative measures for postoperative patient who has undergone ACL repair. Infection and loss of knee motion and strength are short-term complications that can occur after an ACL reconstruction. Longterm complications can include a secondary ACL injury to either the involved knee or the contralateral knee and the inability to return to high-level sports after this procedure. The multifaceted causes of secondary ACL injuries and the limited capacity of patients to return to high-level activities should continue to be the focus of future research.

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Revision ACL Reconstruction: Principles and Practice

Cited by 23 publications

References 71 publications

Functional results of multiple revision anterior cruciate ligament with anterolateral tibial tunnel associated with anterolateral ligament reconstruction

Functional results of multiple revision anterior cruciate ligament with anterolateral tibial tunnel associated with anterolateral ligament reconstruction

Trends in Primary Anatomical Single-Bundle Anterior Cruciate Ligament Reconstruction Practice in Adult Patients Prevalent Among Arthroscopy Surgeons of Six Southern States of India

Postoperative complications following ACL reconstruction: Prevention and management

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