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

Abstract

Revision anterior cruciate ligament (ACL) reconstruction is a technically demanding enterprise. Management of widened or previously malpositioned tunnels is challenging and often requires innovative approaches. The purpose of this study was to evaluate the function and clinical results of revision single-stage ACL surgery using an anterolateral tibial tunnel (ALTT). A consecutive series of knees with arthroscopic ACL revision surgery were analyzed prospectively between April 2012 and September 2015. Among the 93 patients presented with revision ACL reconstruction, 25 patients met the study inclusion criteria for the ALTT technique and were followed up for a minimum of 2 years (range: 24–51 months). The clinical results were evaluated by means of the Lysholm score, International Knee Documentation Committee (IKDC) score, and Tegner activity level scale, and the knee stability was assessed by the Lachman test, pivot shift test, and anterior drawer test. Magnetic resonance imaging (MRI) of the index knee before the surgery and 2 years after revision surgery was assessed. The mean IKDC subjective score, mean Tegner activity level scale, and mean Lysholm score significantly improved in all study participants. This study showed that ACL revision surgery with ALTT can reliably restore stability and provide fair functional outcomes in patients with ACL retear. One could expect acceptable lateral tibial tunnel length compared with medial tibial tunnel in classic ACL revision, intact bony surround, and good graft fixation. This technique is clinically relevant in that making an anterolateral tunnel in one-stage ACL revision surgery had a good subjective result with low complication rate in midterm follow-up.

Four-year comparative analysis of return to sport and psychological recovery following ACL revision: Artificial ligament vs. anterior tibial tendon allograft

“…In the literature on ACL revision, researchers primarily focus on the recovery of knee function, surgical strategies, and relevant techniques [ [31] , [32] , [33] , [34] , [35] ]. Regrettably, the assessment of patients' psychological recovery is often overshadowed [ 14 ].…”

Functional results of multiple revision anterior cruciate ligament with anterolateral tibial tunnel associated with anterolateral ligament reconstruction

“…[ 8 ] concluded that it is possible to use an anterolateral tunnel in the tibia with adequate knee stability to avoid an eventual medial defect, and a clinical study by Keyhani et al. [ 15 ] with 25 patients also showed promising results in the case of the first ACL revision. Some authors have studied the benefit of performing reconstruction with a lateral tibial tunnel for PCL reconstruction for reasons other than enlarged tunnels [ 14 , 16 ].…”

Study on the use of 3D printed guides in the individualized reconstruction of the anterior cruciate ligament

“…Inclusion criteria were [11][12][13] : 1. unilateral ACL injury of the knee; 2. grade I or II injury of the meniscus; 3. Outbridge grade I-II injury of the knee cartilage;…”