Revision anterior cruciate ligament reconstruction: an update

Abstract

With the rising number of anterior cruciate ligament (ACL) reconstructions performed, revision ACL reconstruction is increasingly common nowadays. A broad variety of primary and revision ACL reconstruction techniques have been described in the literature. Recurrent instability after primary ACL surgery is often due to non-anatomical ACL graft reconstruction and altered biomechanics. Anatomical reconstruction must be the primary goal of this challenging revision procedure. Recently, revision ACL reconstruction has been described using double bundle hamstring graft. Successful revision ACL reconstruction requires an exact understanding of the causes of failure and technical or diagnostic errors. The purpose of this article is to review the causes of failure, preoperative evaluation, graft selection and types of fixation, tunnel placement, various types of surgical techniques and clinical outcome of revision ACL reconstruction.

The Effect of Anterior Cruciate Ligament Reconstruction Technique on Graft Signal Intensity at Mid-Term Follow-Up

“…Causes of graft failure are multifactorial with the most important being trauma, technical error and failure of graft incorporation (12). It has not yet been determined which fixation method and what position of the drilling tunnels offers a lower rate of graft failure (12,13). Graft failure rate in our study was 12% and the result is comparable with previous papers, which reported graft failure of quadruple stranded STGR in 4% -15.3% (13,14).…”

“…The most important finding of our study was the difference in IGSI between study groups. Causes of graft failure are multifactorial with the most important being trauma, technical error and failure of graft incorporation (12). It has not yet been determined which fixation method and what position of the drilling tunnels offers a lower rate of graft failure (12,13).…”

Ectopic tissue engineered ligament with silk collagen scaffold for ACL regeneration: A preliminary study

“…The remnant preserving technique, which provides more blood vessels and proprioceptive tissues, is demonstrated to result in increased ligamentization, ligament-bone integration and mechanical strength in animals [49][50][51]. By contrast, the delay or failure of vascularization is always associated with bad ligamentbone healing and insufficient ligament maturation, which may result in reconstruction failure as manifested by graft rupture and joint laxity [52,53].…”

Influence of Different Tibial Fixation Techniques on Initial Stability in Single-Stage Anterior Cruciate Ligament Revision With Confluent Tibial Tunnels: A Biomechanical Laboratory Study

“…9 For the planning of surgical revision, prior tunnel placement is subcategorized into 3 types: (1) correct tunnel positioning with congruent previously placed and new tunnels, (2) cases of revision for incomplete and incorrect positioning, and (3) positioning with a bone bridge between the old and new tunnels. 10 …”

“…9 For the planning of surgical revision, prior tunnel placement is subcategorized into 3 types: (1) correct tunnel positioning with congruent previously placed and new tunnels, (2) cases of revision for incomplete and incorrect positioning, and (3) positioning with a bone bridge between the old and new tunnels. 10 The surgical technique for ACL revision remains a matter of debate. If bone tunnels are not widened and are in the correct position, single-stage reconstruction can be performed.…”