Technical Considerations in Revision Anterior Cruciate Ligament Reconstruction for Operative Techniques in Orthopaedics

Abstract

As the incidence of anterior cruciate ligament (ACL) reconstruction continues to increase, the rate of revision surgery continues to climb. Revision surgery has inherent challenges that must be addressed in order to achieve successful results. The cause of the primary ACL reconstruction failure should be determined, and careful preoperative planning should be performed to address the cause(s) of failure. Each patient undergoing revision surgery should undergo a thorough history and physical examination, receive full length alignment radiographs, lateral radiographs, 45-degree flexion weight-bearing postero-anterior radiographs, and patellofemoral radiographs. 3-dimensional computed topography (CT) scan should be performed to assess tunnel position and widening. Magnetic resonance imaging (MRI) should be used to assess for intra-articular soft tissue pathology. Meniscal tears, meniscal deficiency, anterolateral capsule injuries, bony morphology, age, activity level, connective tissue diseases, infection, graft choice, and tunnel position can all impact the success of ACL reconstruction surgery. Meniscal lesions should be repaired, and in cases of persistent rotatory instability, extra-articular procedures may be indicated. Furthermore, osteotomies may be needed to correct malalignment or excess posterior tibial slope. Depending on the placement and condition of the original femoral and tibial tunnels, revision surgery may be performed in a single procedure or in a staged manner. In most cases, the surgery can be performed in one procedure. Regardless, the surgeon must communicate with the patient openly regarding the implications of revision ACL surgery and the treatment plan should be developed in a shared fashion between the surgeon and the patient.

The Impact of Resident Involvement on Surgical Outcomes following Anterior Cruciate Ligament Reconstruction

“…While ACLR failure is multifactorial, technical error (specifically femoral tunnel malposition) has been frequently cited as one of the primary causes. [29][30][31] Surgical trainees have been reported to mistake the lateral intercondylar ridge, termed as "resident's ridge," for the posterior femoral condyle which leads to anterior tunnel malposition and premature ACLR failure. 32 Therefore, further investigations may be warranted to determine whether resident participation influences the long-term success of ACLR.…”

Tests und Assessments für die Rehabilitation nach VKB-Rekonstruktion

“…Hier sind auch die Daten von Noyes et al [24] zu erwähnen, laut denen das Vorkommen einer Osteoarthritis nach VKB-Verletzungen zwischen 50 % und 90 % liegt [25] und bereits 1 Jahr nach dem Trauma erkannt werden kann [26]. Bei einer wiederholten Verletzung des VKB und einer Revision der Bandrekonstruktion ist der Knorpelschaden signifikant höher [27] [28].…”

Two-Stage Anterior Cruciate Ligament Reconstruction Revision Surgery for Severe Bone Defects With Anterolateral Ligament Reconstruction Technique

“…4 Therefore, 2-stage revision is reserved for cases wherein 1-stage reconstruction may yield a suboptimal graft choice, tunnel position, graft fixation, or biological environment for graft-bone interface healing. [5][6][7][8] We use allografts for cavity filling and grafting, which helps avoid donor-area morbidity. In addition, we combine ACL repair with an extra-articular anterolateral ligament (ALL) reconstruction stage to increase the knee rotational stability.…”