Allograft Salvage Procedure in Multiple-Revision Anterior Cruciate Ligament Reconstruction

Abstract

A 2-stage revision is an accepted option in cases of excessive tunnel enlargement and bone loss, especially on the femoral side, to achieve anatomic reconstruction. Nonanatomic over-the-top ACL reconstruction and lateral extra-articular plasty technique allow one to overcome difficult anatomic situations on the femoral side, permitting a 1-step surgery. The overall results obtained in this series are comparable with those of other ACL revision series. The higher rate of mild instability observed in our series may not be attributable to the surgical technique but rather to the chronic instability suffered by these knees before last revision.

Outcomes and Risk Factors of Rerevision Anterior Cruciate Ligament Reconstruction: A Systematic Review

“…Five studies reported on a total of 50 males and 13 females, [12][13][14][15][16] with the remaining study of 151 patients composed of 60% males. 8 Two studies reported an average body mass index of 26.5 (n ¼ 151) 8 and 27.3 (n ¼ 15), respectively.…”

“…Of note, subsequent revisions resulted in greater chondral injury, and the location of the chondral damage tended to shift to the patellofemoral joint. 8 Of the 24 patients included in their study, Buda et al 12 reported diffuse cartilage lesions in 8 cases (International Cartilage Repair Society [ICRS] grades I [2], II [4], and III [2]) and focal osteochondral lesions in 4 cases (ICRS grades III [2] and IV [2]). Signs of focal chondral damage were further reported to be between 50% 12 and 67% 14 for evaluated subjects.…”

“…Tibial and femoral bone grafting procedures were performed in 2 stages in 25% and 23% of cases, respectively. Buda et al 12 reported the use of an over-the-top reconstruction technique with extraarticular plasty.…”

“…12,13,15 In all studies that reported on rehabilitation protocols, passive and active motion was started in the immediate postoperative period. Patients were made full weight bearing between 1 and 3 months 12,15 and allowed to return to sport between 6 months 13 and 1 year, 15 which was also sport specific.…”

“…13 Three studies reported significant improvements in subjective IKDC scores compared with preoperative scores. 12,14,15 Four studies collected IKDC objective scores, all of which showed improvement compared with preoperative scores. 12,13,15,16 Buda et al 12 reported significantly improved subjective and objective IKDC scores and a higher return to sport in traumatic failures compared with atraumatic failures.…”