Outcome After Anterior Cruciate Ligament Revision

Abstract

Purpose of Review To describe the current literature related to anterior cruciate ligament (ACL) revision in terms of surgical aspects, graft choices, concomitant injuries, patient-reported outcome, return to sport, and objective measurement outcome. Recent Findings An ACL rupture is a common knee injury, and the number of primary ACL reconstructions is increasing, implying a subsequent increase of ACL revisions in the future. It is widely accepted that an ACL revision is surgically challenging with a myriad of graft options to choose from. In many cases, simultaneous injuries to the index limb including meniscal and chondral lesions, respectively, are observed in the setting of a secondary ACL injury. Furthermore, the general understanding is that an ACL revision results in inferior outcome compared with a primary ACL reconstruction. Summary Surgical treatment of an ACL revision can be performed as one-stage or two-stage procedure depending on, for example, the presence of limb malalignments, concomitant injuries, and tunnel widening. Nonirradiated allografts and autologous patella tendon, hamstring tendon, and quadriceps tendon are feasible options for ACL revision. Concomitant injuries to the affected knee such as intraarticular chondral lesions are more common in the setting of an ACL revision compared with primary ACL reconstruction while a lower presence of concomitant meniscal pathology is reported at ACL revision. Patients undergoing ACL revision have lower clinical and patient-reported outcome and lower rates of return to sport when compared with primary ACL surgery cases. However, long-term follow-ups with large study cohorts evaluating outcome of ACL revision are limited. Further research is needed to confirm the present findings of this review.

Recognizing the better autograft and the factors influencing outcomes of revision anterior cruciate ligament reconstruction

“…The BPTB autograft is well known to be associated with anterior knee pain and patellofemoral symptoms affecting kneeling activities. [18] Patients reported inferior short-and long-term outcomes after revision ACLR with BPTB grafts. [19] Quadriceps tendon and hamstring being the most preferred autograft for revision, both are reported to be associated with anterior knee pain and donor site morbidity influencing the functional outcome.…”

Management of Bone Loss and Tunnel Widening in Revision ACL Reconstruction

“…In terms of autograft options, an ipsilateral or contralateral BPTB autograft is often employed because of the ability of bone blocks to fill the tunnel and the low rerupture rates 33 . The potential drawbacks of ipsilateral BPTB grafts include knee stiffness, anterior knee pain, and worse patient-reported out-come measures relative to allograft or hamstring autograft in some studies 31,34 . Notably, ipsilateral reharvesting of BPTB autografts have been associated with inferior short-term and long-term patient-reported outcomes 35,36 .…”

The reasons for revision surgery after reconstruction of the anterior cruciate ligament: a systematic review

“…Основной целью реконструкции ПКС у физически активных молодых людей является полноценное восстановление функции коленного сустава и возвращение к прежнему уровню спортивных нагрузок. Артроскопическая пластика ПКС представляет собой одно из самых распространенных ортопедических операций [1] и достаточно успешное вмешательство, позволяющее достичь удовлетворительных результатов в 75−97 % случаев [7,8]. Не существует общепринятого и однозначного определения неудачного исхода реконструкции ПКС, тем не менее сюда, как правило, относят пациентов с наличием субъективной и/или объективной нестабильности, болью, а также ограничением амплитуды движений в коленном суставе [9−11].…”