Revision Anterior Cruciate Ligament Reconstruction Using a 2-Stage Technique with Bone Grafting of the Tibial Tunnel

Thomas, Neil P.; Kankate, Raghu; Wandless, F.; Pandit, Hemant

doi:10.1177/0363546505276759

Cited by 168 publications

(199 citation statements)

References 35 publications

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“…Finally, the characteristics of our study subjects, such as the male predominance (93%) and Asian population, might limit direct application of our findings in populations with different characteristics. Although more frequent medial meniscus injury and/or cartilage damage at the medial tibiofemoral joint has been reported consistently in several studies with various populations [1,4,8,23], further study would be required to draw a conclusion for this issue. Our findings support the hypothesis that patients undergoing revision ACL reconstruction have more frequent varus malalignment than those undergoing primary ACL reconstruction.…”

Section: Discussionmentioning

confidence: 95%

“…One of the most important causes of the inferior outcomes could be an established medial tibiofemoral joint problem, such as an irreparable medial meniscal tear and/or progressed medial tibiofemoral joint OA, conditions that frequently are combined in patients undergoing revision ACL reconstruction [1,4,8,23]. Given that medial tibiofemoral joint problems can result in more serious clinical consequences when coupled with varus malalignment, information regarding coronal limb alignment in patients undergoing revision ACL reconstruction is crucial to establishing management plans with better outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…The presence of concomitant knee lesions such as meniscus injuries and osteoarthritis (OA) may be associated with inferior outcomes [1]. Multiple authors have reported that patients undergoing revision ACL reconstruction have concomitant advanced meniscal and/or articular damage, particularly at the medial tibiofemoral joint, such as irreparable tears of the medial meniscus and/or established medial tibiofemoral OA [1,4,8,23]. Additionally, it has been our anecdotal observation that patients undergoing revision ACL reconstruction have varus malalignment more frequently than patients undergoing primary ACL reconstruction.…”

Section: Introductionmentioning

confidence: 99%

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Coronal Limb Alignment and Indications for High Tibial Osteotomy in Patients Undergoing Revision ACL Reconstruction

Won

Chang

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Failed ACL reconstruction frequently is accompanied by irreparable medial meniscal tear and/or visible osteoarthritis (OA) in the medial tibiofemoral joint. Thus, assessment for the presence of varus malalignment is important in caring for patients in whom revision ACL reconstruction is considered. Questions/purposesWe determined whether patients undergoing revision ACL reconstruction (1) have more frequent varus malalignment coupled with more severe degrees of medial meniscal injury and/or medial tibiofemoral OA, and (2) would meet potential indications for high tibial osteotomy more frequently than patients undergoing primary ACL reconstruction. Methods We compared 58 patients undergoing revision ACL reconstruction and 116 patients undergoing primary ACL reconstruction. The mechanical tibiofemoral angle and the weight loading line (%) of the knee were measured. Additionally, radiographic degrees of OA in the tibiofemoral joints, and meniscal conditions were assessed. Then, proportions of potential candidates for high tibial osteotomy between the two groups were compared based on the following indications: (1) weight loading line less than 5%, (2) weight loading line less than 25% and medial tibiofemoral OA Kellgren-Lawrence Grade 3 or greater, or (3) weight loading line less than 25% and Kellgren-Lawrence Grade 2 medial tibiofemoral OA plus subtotal or total medial meniscectomy status. Results The revision ACL reconstruction group had more frequent varus malalignment in terms of proportion of knees with more varus mechanical tibiofemoral angle than varus 5°(19% versus 8%, p = 0.029) and knees with weight loading line less than 25% (22% versus 9%, p = 0.011). This group also had more frequent high-grade injury of the medial meniscus (34% versus 16%, p = 0.007) and tended to have more frequent higher-grade radiographic OA at the medial tibiofemoral joint (19% versus 9%, p = 0.076). The percentage of patients meeting potential indications for high tibial osteotomy was greater in this group (14% versus 2%, p = 0.003). Conclusions We found that many patients undergoing revision ACL surgery may be reasonable candidates for concurrent high tibial osteotomy to address concomitant alignment and OA issues in the medial compartment. However, whether that additional intervention is offset by added risk and morbidity should be the focus of a future study, as it cannot be answered by a study of this design.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Coronal Limb Alignment and Indications for High Tibial Osteotomy in Patients Undergoing Revision ACL Reconstruction

Won

Chang

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…With the growing number of ACL reconstructions performed, the number of patients undergoing revision ACL reconstruction has also been on the rise, as the graft may fail due to mechanical, technical and biological factors (25). Values are expressed as the mean ± standard deviation.…”

Section: Discussionmentioning

confidence: 99%

Double-bundle revision anterior cruciate ligament reconstruction is effective in rescuing failed primary reconstruction and re-introducing patients to physical exercise

Jiang

Chen

et al. 2017

Exp Ther Med

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Abstract. The anterior cruciate ligament (ACL) is one of a pair of cruciate ligaments in the human knee and is critical for knee stability, as it limits anterior tibial translation on the femur, restrains rotation and resists varus and valgus joint forces. The present study aimed to assess the effect of double-bundle revision anterior cruciate ligament (ACL) reconstruction in improving the subjective and objective functions and re-introducing patients to physical activity after primary ACL reconstruction had failed. A total of 34 patients who underwent double-bundle ACL revision surgeries were included in the present retrospective study. Lysholm, Tegner and IKDC scores as well as KT-2000 arthrometry measures were obtained pre-and post-operatively. The follow-up time was at least 2 years. The results indicated that the IKDC, Lysholm and Tegner scores as well as KT-2000 flexion scores were significantly improved after revision ACL reconstruction. All patients resumed to performing physical exercise activities after revision surgeries, 65% of whom reached pre-injury levels. In conclusion, these results demonstrated that double-bundle revision ACL reconstruction was consistently effective in rescuing failed primary ACL reconstruction and re-introducing patients to physical exercise.

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“…People presenting for revision ACLR are more likely to have concurrent meniscal and chondral damage than those undergoing a primary ACLR (Ahn, Lee, & Ha, 2008;Brophy, Haas, Huston, Nwosu, & Wright, 2015;Kievit, Jonkers, Barentsz, & Blankevoort, 2013;Thomas, Kankate, Wandless, & Pandit, 2005;Widener, Wilson, Galvin, Marchant, & Arrington, 2015).…”

Section: Subsequent Injury and Revision Surgerymentioning

confidence: 99%

Long-term quality of life following anterior cruciate ligament injury and reconstruction

Filbay¹

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The anterior cruciate ligament (ACL) serves to stabilise the knee complex and prevent intraarticular knee structures from sustaining damage during multiaxial, high impact movement. An ACL rupture most commonly occurs in adolescents and young adults taking part in competitive sports and causes substantial disruption to the knee joint. Anterior cruciate ligament reconstruction (ACLR) is the most common treatment offered to ACL-ruptured individuals worldwide. Individuals undergoing this surgery often have high expectations that rarely match surgical outcomes. Return to sport rates are low, re-injury fears are widespread and many individuals develop knee osteoarthritis within ten years of ACLR. This mismatch between expectations and actual outcomes has great potential to impact longer-term quality of life (QOL). The primary aims of this thesis were to: (i) generate a detailed picture of longer-term QOL following ACLR, and (ii) identify factors related to longer-term QOL in people with knee pain, symptoms or functional limitations following ACLR.The first study in this thesis is a systematic review that revealed impaired knee-related QOL at 5 to 20 years after ACLR. However, it became evident that research into factors impacting upon QOL in this population was scarce. The systematic review found that having a subsequent knee injury, an additional knee surgery after ACLR, and developing severe radiographic osteoarthritis were associated with worse QOL outcomes. The second study in this thesis is a systematic review that investigated QOL more than five years after ACL rupture in individuals who remained ACL-deficient (did not undergo ACLR) and compared QOL between ACLdeficient and ACL-reconstructed groups. This systematic review found that ACL-deficient individuals reported comparable QOL outcomes to those who underwent ACLR 5 to 25 years previously. All studies that reported QOL after ACLR included asymptomatic participants without knee difficulties, which may underestimate the degree of QOL impairment experienced by people with ongoing knee difficulties.The third study in this thesis used a cross-sectional design to describe QOL outcomes in 162 individuals with knee pain, symptoms or functional limitations 5 to 20 years following ACLR.It showed that individuals who did not return to sport after ACLR reported poorer knee-related and health-related QOL, compared to people who returned to pre-injury levels of sport. Higher body mass index (BMI) and subsequent surgery were also related to worse QOL after ACLR.This was the first study to show that return to sport was associated with QOL impairment more than five years after ACLR. However, quantitative assessment of QOL may overlook important considerations with regard to an individual's life priorities, expectations, values and concerns.To provide a detailed understanding of QOL following ACLR, qualitative interviews were performed with 17 individuals with knee difficulties 5 to 20 years following ACLR. This was the first qualitative study to explore QOL following...

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Revision Anterior Cruciate Ligament Reconstruction Using a 2-Stage Technique with Bone Grafting of the Tibial Tunnel

Abstract: This study establishes that the laxity measurements achieved with a 2-stage revision anterior cruciate ligament reconstruction can be similar to those achieved after primary anterior cruciate ligament reconstruction, although the International Knee Documentation Committee rating is lower.

Cited by 168 publications

References 35 publications

Coronal Limb Alignment and Indications for High Tibial Osteotomy in Patients Undergoing Revision ACL Reconstruction

Coronal Limb Alignment and Indications for High Tibial Osteotomy in Patients Undergoing Revision ACL Reconstruction

Double-bundle revision anterior cruciate ligament reconstruction is effective in rescuing failed primary reconstruction and re-introducing patients to physical exercise

Long-term quality of life following anterior cruciate ligament injury and reconstruction

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