Revision Anterior Cruciate Ligament Reconstruction

Abstract

➤ Technical errors such as nonanatomic tunnel placement are some of the most common causes of graft failure after primary anterior cruciate ligament reconstruction (ACLR).➤ When considering a revision ACLR in a patient with ACL graft failure, it is crucial to perform preoperative imaging, which should include an initial radiographic series, magnetic resonance imaging, and possibly computed tomography for further assessment of tunnel locations.➤ Revision ACLR may be performed in a 1 or 2-stage procedure depending on the size and location of the existing tunnels, bone stock, existing hardware, and infection status.➤ Use of autograft ligament tissue for revision ACLR has been shown to correlate with higher patient-reported outcomes and a significantly lower risk of subsequent graft rupture in comparison with allograft use.➤ Multiple studies have shown that the rate of return to the preinjury level of sport is significantly lower following revision ACLR than following primary ACLR procedures.

Injury Recurrence Among High School Athletes in the United States: A Decade of Patterns and Trends, 2005-2006 Through 2015-2016

“…These studies showed that the rate of return to sports after revision ACL reconstruction is not significantly different compared with primary ACL reconstruction, although the rate of return to the preinjury sport is significantly lower following a revision. 2,3,13,20,22 Furthermore, the incidence of a primary ACL injury has been reported at 0.81 per 1000 athlete-years among adolescents. 40 However, the risk of graft rupture is much higher for adolescents who have undergone primary ACL reconstruction, with a graft failure rate at 3.2 years in 8.5% of patients aged 14 to 17 years 24 ; some studies have reported even higher rates of failure, especially for females.…”

Clinical Outcomes of Isolated Revision Anterior Cruciate Ligament Reconstruction or in Combination With Anatomic Anterolateral Ligament Reconstruction

“…Except for new trauma, the most common cause for failure of primary anterior cruciate ligament (ACL) reconstruction (ACLR) is a nonanatomic tunnel position, which produces recurrent rotatory instability and graft reruptures. 2,24 Untreated instability resulting from concomitant injuries to the posterolateral corner or anterolateral ligament (ALL) at the time of primary reconstruction is also a key factor that contributes to failure. 2 Although acceptable clinical results have been reported after revision ACLR, 24 numerous studies have reported that revision ACLR has less favorable results than primary ACLR.…”

“…2,24 Untreated instability resulting from concomitant injuries to the posterolateral corner or anterolateral ligament (ALL) at the time of primary reconstruction is also a key factor that contributes to failure. 2 Although acceptable clinical results have been reported after revision ACLR, 24 numerous studies have reported that revision ACLR has less favorable results than primary ACLR. 2,32,62 Hence, we need to carefully evaluate the reasons for the failure of primary reconstruction and try to minimize residual rotational instability related to functional outcomes.…”

A Definition of Significant Instability and a Scoring System for Predicting Meniscal Tears in ACL-Deficient Knees

“…Anterior cruciate ligament (ACL) reconstruction (ACLR) is one of the most commonly performed ligament reconstructions worldwide. 4,14 The outcomes of ACLR are generally good, but poorer outcomes have been associated with concurrent meniscal injuries. 6,7,18,23,24 Several studies have mentioned that the incidence of meniscal injuries is significantly higher if surgery is delayed beyond 6 to 12 months postinjury.…”