The reasons for revision surgery after reconstruction of the anterior cruciate ligament: a systematic review

Abstract

Reconstruction of the anterior cruciate ligament (ACL) is a fairly successful surgical intervention that can achieve satisfactory results in 75-97 % of cases. In order to show the main categories of factors that can affect the functional outcomes of patients after ACL reconstruction and lead to unsatisfactory outcomes after surgery based on the literature data, we have run a search for English- and Russian-language publications in the electronic databases PubMed and RSCI for the period from 2000 to 2019 using the keywords: anterior cruciate ligament, ACL, revision, re-reconstruction, re-injury, re-rupture, graft failure. Out of 634 papers, 113 publications with the full text were selected. Inclusion criteria - more than 50 cases in the report; follow - up period of more than 2 years; the same groups of patients; assessment of knee joint function; application of various imaging options for the knee joint. 26 papers were included in this review. Based on the analysis of the multiple causes of failed ACL reconstruction outcomes were merged into four main groups: technical mistakes diagnosis and surgery (from 22 % to 79 %); re-injury (18 % to 79 %); biological factors (violation of the integration of the graft and its ligamental) (17 %); errors of rehabilitation and other (15 %). Thus, the review made it possible to systematize the causes of unsuccessful outcomes of ACL reconstruction and identify the most frequent.