Preoperative Planning for ACL Revision Surgery

Abstract

The number of patients undergoing revision surgery following failure of anterior cruciate ligament (ACL) reconstruction has increased over the recent past, following the overall increased number of primary ACL reconstruction performed. Failure of primary ACL reconstruction can be attributed to technical errors, biological failures, or new traumatic injuries. Technical errors include femoral and/or tibial tunnels malposition, untreated associated ligaments insufficiencies, uncorrected lower limb malalignment, and graft fixation failures. Candidates for revision surgery should be carefully selected, and the success of ACL revision requires precise preoperative planning to obtain successful results. Preoperative planning begins with the analysis of the mechanisms of ACL reconstruction failure, and information regarding previous surgery, such as the type of graft implanted, and the position of existing hardware. Appropriate imaging is necessary to evaluate the position of the femoral and tibial tunnels, and abnormal tunnel widening. On the basis of clinical examination and imaging, surgeon can perform an ACL revision procedure in 1 or 2 stages.

Stem Cell–Infused Anterior Cruciate Ligament Reconstruction

“…The gold-standard treatment for ACL tears in younger patients is an ACLR with autograft because of decreased retear rates 2, 13. However, Kaeding et al 2 .…”

“…The gold-standard treatment for ACL tears in younger patients is an ACLR with autograft because of decreased retear rates. 2,13 However, Kaeding et al 2 noted that the retear rate decreases by 9% each year the patient ages. By the time patients reach their mid thirties, there is no clinical significance between allograft and autograft.…”

“…9,14 In older patient populations in whom the clinical significance between allograft and autograft is minimal, the use of an allograft may be preferred because of decreased donor-site morbidity and postoperative pain (Table 2). 9 However, one disadvantage, as noted by Osti et al, 13 is that allografts heal and incorporate more slowly relative to autografts.…”

Revision Single-Stage Anterior Cruciate Ligament Reconstruction Using an Anterolateral Tibial Tunnel

“…Exclusion criteria were age < 18 or > 60, infection, chondral damage > grade III (International Cartilage Repair Society, ICRS; candidate for osteotomy), untreated associated ligament injury, uncorrected lower limb malalignment, and previous meniscectomy. 16,17 ACL graft rerupture was diagnosed by means of clinical examination (Lachman's test in 20-degree knee flexion, positive pivot shift test, and positive anterior drawer) and confirmed by magnetic resonance imaging (MRI). Three-dimensional computed tomography (CT) imaging was obtained for all patients to assess the femoral and tibial tunnels.…”

Ultrasound-Assisted Endoscopic Removal of Pretibial Cysts Related to Biointerference Screw Degradation

“…Finally, revision surgery can ideally be performed without any hardware removal. 2 However, reports dispute that (complete) bony integration is generally taking place. 3 , 4 Further, cases of painful pretibial cysts have been reported.…”