Revision Anterior Cruciate Ligament Reconstruction – Etiology of Failures and Clinical Results

Abstract

A retrospective study was performed to determine the etiology of failed primary anterior cruciate ligament (ACL) reconstruction and evaluate the clinical results of revision ACL surgery. From January 1989 to January 1996, 90 patients with failed ACL reconstructions underwent revision ACL surgery. The etiology of failed ACL reconstruction included 47 surgical technical errors, 22 traumatic reinjuries, 7 lack of graft incorporation, 3 loss of motion, 3 related to synthetic grafts, and 8 alignment or combined ligamentous instability patterns not addressed. Of 52 revision ACL patients with minimum 2-year follow-up, 43responded to a questionnaire and underwent a comprehensive physical examination. The Hospital for Special Surgery knee ligament evaluation revealed 63% good/excellent results. Objective laxity test revealed 77% of all patients had 0/ϩ ϩ1 grade on Lachman and a mean 2.86-mm KT 1000. The overall results of revision ACL surgery are encouraging in providing symptomatic relief and restoring stability; however, they are significantly lower than primary ACL surgery.

Radiographic Anatomy of the Native Anterior Cruciate Ligament: a Systematic Review

“…Several studies report that greater than 50% of ACL reconstruction failures occur as a result of technical considerations [4,7,13,26]. The largest such study, Multicenter ACL Revision Study (MARS), reported that technical error accounted for ACL reconstruction failure in 24% of patients, which was second only to acute trauma (37%) [29].…”

Tunnel position and graft orientation in failed anterior cruciate ligament reconstruction: a clinical and imaging analysis

“…As we encounter a highly active aging population and increasing numbers of primary ACL reconstructions are being performed every year, ACL reconstruction failure may become a recurring problem [5,6]. The cause of ACL reconstruction failure can be multifactorial and include preoperative knee laxity and range of motion, status of articular and meniscal cartilage, malalignment, integrity of secondary restraints, selection of graft material, surgical technique, postoperative rehabilitation and patient expectations and compliance [6,7].…”

“…The cause of ACL reconstruction failure can be multifactorial and include preoperative knee laxity and range of motion, status of articular and meniscal cartilage, malalignment, integrity of secondary restraints, selection of graft material, surgical technique, postoperative rehabilitation and patient expectations and compliance [6,7]. Graft failure was reported as one of the main reasons for failed ACL reconstruction [5]. At the time of revision, 22-79% of reconstruction failures were thought to be due to technical errors, with the most common being incorrect tunnel position [5][6][7][8].…”

“…Graft failure was reported as one of the main reasons for failed ACL reconstruction [5]. At the time of revision, 22-79% of reconstruction failures were thought to be due to technical errors, with the most common being incorrect tunnel position [5][6][7][8]. Marchant et al [9] reported a nonanatomically positioned graft in 88% of failed ACL reconstructions.…”

Surgical approach to the posteromedial corner: indications, technique, outcomes

“…Recognizing the difference between injuries involving the medial collateral ligament and the structures of the PMC has important clinical implications. Failure to recognize this difference has been implicated as a potential reason for failure of reconstructed cruciate ligaments in combined injuries [1][2][3]. This article provides information based on review of recent literature that describes the anatomy, biomechanical function, and current treatment principles regarding the PMC.…”