Revision anterior cruciate ligament surgery: state of the art

Koga, Hideyuki; Engebretsen, Lars; Fu, Freddie H.; Muneta, Takeshi

doi:10.1136/jisakos-2016-000071

Cited by 11 publications

(4 citation statements)

References 100 publications

(70 reference statements)

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“…Different surgical techniques has been described to deal with ACL revision surgery, but the surgeon should customize the choice to the patient, to the type of trauma and to the grade of knee stability [12, 37].…”

Section: Timing and Treatment Planmentioning

confidence: 99%

Allograft tendons are a safe and effective option for revision ACL reconstruction: a clinical review

Condello

Zdanowicz

Matteo

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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Revision anterior cruciate ligament reconstruction remains a challenge, especially optimising outcome for patients with a compromised knee where previous autogenous tissue has been used for reconstruction. Allograft tissue has become a recognized choice of graft for revision surgery but questions remain over the risks and benefits of such an option. Allograft tendons are a safe and effective option for revision ACL reconstruction with no higher risk of infection and equivalent failure rates compared to autografts provided that the tissue is not irradiated, or any irradiation is minimal. Best scenarios for use of allografts include revision surgery where further use of autografts could lead to high donor site morbidity, complex instability situations where additional structures may need reconstruction, and in those with clinical and radiologic signs of autologous tendon degeneration. A surgeon needs to be able to select the best option for the challenging knee facing revision ACL reconstruction, and in the light of current data, allograft tissue can be considered a suitable option to this purpose. Level of evidence IV.

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Section: Timing and Treatment Planmentioning

confidence: 99%

Allograft tendons are a safe and effective option for revision ACL reconstruction: a clinical review

Condello

Zdanowicz

Matteo

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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“…33,34,43 Graft tunnels placed outside the native femoral attachment site may result in loss of stability, 36 abnormal graft fiber–tensioning patterns, 61 and graft impingement with the roof of the intercondylar notch 28 or the posterior cruciate ligament. 32 Clinical studies have demonstrated that the most common technical error resulting in instability or graft failure after ACL reconstruction is nonanatomic graft placement 28,35,59 and that nonanatomic femoral tunnel position is closely correlated with poorer clinical outcome scores. 8 It is also thought that the routine accurate placement of ACL grafts within the native ACL attachment sites may reduce the long-term incidence of osteoarthritis.…”

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confidence: 99%

Anterior Cruciate Ligament Femoral Tunnel Placement: An Analysis of the Intended Versus Achieved Position for 221 International High-Volume ACL Surgeons

et al. 2020

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Background: Femoral tunnels that are not anatomically placed within the native anterior cruciate ligament (ACL) footprint during ACL reconstruction are associated with residual instability, graft rupture, and poor clinical outcomes. Although surgeons may intend to place their femoral tunnels within the native ACL attachment, this is not always achieved. This study assesses the variation between intended and achieved femoral tunnel positions in a large cohort of experienced ACL surgeons. Hypothesis: The accuracy with which experienced ACL surgeons achieve their intended femoral tunnel position is dependent on viewing portal, localization strategy, and drilling technique. Study Design: Controlled laboratory study. Methods: A total of 221 surgeons indicated their intended femoral tunnel location on a true lateral radiograph of a cadaveric knee specimen and a scaled photograph. Each surgeon then arthroscopically demonstrated the femoral tunnel on the specimen. The position was captured using fluoroscopy. The Euclidean distance (the straight-line distance between 2 points) between the intended and achieved tunnel positions, referenced to a grid applied to the lateral femoral condyle, was compared. Data were analyzed according to surgeons’ viewing portal (anteromedial [AM] or anterolateral [AL]), tunnel localization strategy (offset aimer, estimation from landmarks, ACL ruler, or C-arm fluoroscopy), and stated drilling technique (transtibial, AM portal, or outside-in). Results: Surgeons who viewed the lateral intercondylar notch wall through the AM portal were closer (mean distance, 9.5) to their intended position than those who viewed through the AL portal (mean distance, 15.1; P < .0001). By localization strategy, the mean distance between achieved and intended tunnel positions was greater for surgeons who used an offset aimer (14.5) and estimated the femoral tunnel position (12.9) than for those using a malleable ACL ruler (8.1; P < .0001) and fluoroscopy (4.3; P < .0001). Surgeons’ preferred drilling technique (AM portal, transtibial, or outside-in) had no effect on distance between intended and achieved positions. However, the mean achieved position was higher in the intercondylar notch for those using transtibial drilling ( P < .042). Conclusion: Surgeons using the AM portal to view the femoral attachment site were closer to their intended tunnel position than those who viewed it with the arthroscope in the AL portal. Surgeons who used fluoroscopy to localize femoral tunnel position were the closest to their intended position. Those who used estimation or an offset aimer had the farthest distance between achieved and intended tunnel positions. Clinical Relevance: Although accurate tunnel placement can be achieved using any method, given the disparity between intended and achieved tunnel positions, it may be advisable, even for high-volume surgeons, to verify the placement of their tunnels using either fluoroscopy or a malleable ACL ruler to ensure that they achieve their intended position. Fluoroscopy may be particularly useful for cases where the native femoral stump is no longer visible and for revisions. Viewing through the AM portal is recommended to aid accuracy of tunnel placement.

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“…Targeted positioning of the graft within the native footprint 11,22,26-28 is important to replicate the anatomy and function of the ACL for each patient, as suboptimal placement is a well-recognized contributor to poor clinical outcomes postoperatively. 15 Previous studies showed that 82% of ACLRs that failed because of technical error were a result of tunnel malpositioning. 18 Therefore, accurate postoperative assessment of tunnel position is a critical variable in the assessment of outcomes of ACLR.…”

mentioning

confidence: 99%

Validation of an MRI Protocol for Routine Quantitative Assessment of Tunnel Position in Anterior Cruciate Ligament Reconstruction

Grasso

Linklater²,

et al. 2018

Am J Sports Med

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This study demonstrated that, in addition to being the optimum modality for assessment of soft tissue injury of the knee, a high-resolution 3D turbo spin echo proton density sequence can provide an accurate assessment of tunnel placement, without the use of ionizing radiation. Therefore, this protocol provides the foundation for an objective standardized platform to quantitatively evaluate the location of ACL bone tunnels and graft orientation for routine postoperative assessment, presurgical planning, and evaluation of clinical outcomes.

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Revision anterior cruciate ligament surgery: state of the art

Cited by 11 publications

References 100 publications

Allograft tendons are a safe and effective option for revision ACL reconstruction: a clinical review

Allograft tendons are a safe and effective option for revision ACL reconstruction: a clinical review

Anterior Cruciate Ligament Femoral Tunnel Placement: An Analysis of the Intended Versus Achieved Position for 221 International High-Volume ACL Surgeons

Validation of an MRI Protocol for Routine Quantitative Assessment of Tunnel Position in Anterior Cruciate Ligament Reconstruction

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