J Korean Orthop Assoc.  2018 Oct;53(5):421-428. 10.4055/jkoa.2018.53.5.421.

Revision Anterior Cruciate Ligament Reconstruction: Analysis of the Causes of Failure, Associated Injuries and Clinical Results

• Youm YS
• Cho SD
• Cho HY
• Jung SH
• Kang SW
• Joo YT

• KMID: 2424101
• DOI: http://doi.org/10.4055/jkoa.2018.53.5.421

Abstract

PURPOSE
The aim of this study was to analyze the causes of failure after a primary anterior cruciate ligament reconstruction (ACLR), associated injuries, and the clinical results of revision ACLR.
MATERIALS AND METHODS
This study evaluated 46 patients (46 knees), who were followed at least two years after revision ACLR. The evaluations included the causes of failure after primary ACLR, associated injuries, 2000 International Knee Documentation Committee (IKDC) subjective knee scores, Lachman test, Pivot shift test, and KT-1000 arthrometer measurement.
RESULTS
The most common cause of failure was trauma (27 patients, 58.7%) and 19 failures (19 patients, 41.3%) were caused using an inappropriate surgical technique. The associated injuries were meniscus tears in 29 cases (63.0%) and articular cartilage injuries of Outerbridge grade II to IV in 19 cases (41.3%). The IKDC scores, Lachman test, Pivot shift test, and KT-1000 arthrometer measurements were improved significantly at the final follow-up.
CONCLUSION
The most common cause of failure after primary ACLR was trauma. One stage revision ACLR resulted in relatively satisfactory stability but less satisfactory clinical function than the primary reconstruction, as reported previously, which is believed to be due to the more associated injuries.

Keyword

anterior cruciate ligament; revision; associated injuries; causes of failure; clinical results

MeSH Terms

Anterior Cruciate Ligament Reconstruction*
Anterior Cruciate Ligament*
Cartilage, Articular
Follow-Up Studies
Humans
Knee
Tears

Figure

• 

  Figure 1 Preperation of Achilles tendon allograft and calcaneal bone for femoral and tibial bone.

• 

  Figure 2 Bone defects of pre-constructed femoral and tibial tunnels filled with calcaneal corticocancellous bone.

• 

  Figure 3 New femoral tunnels can be created even if they overlap with the previous tunnels.

Reference

1. Battaglia MJ 2nd, Cordasco FA, Hannafin JA, et al. Results of revision anterior cruciate ligament surgery. Am J Sports Med. 2007; 35:2057–2066.

2. Freedman KB, D'Amato MJ, Nedeff DD, Kaz A, Bach BR Jr. Arthroscopic anterior cruciate ligament reconstruction: a metaanalysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med. 2003; 31:2–11.

3. Martinek V, Imhoff AB. Revision of failed anterior cruciate ligament reconstruction. Orthopade. 2002; 31:778–784.

4. Pinczewski LA, Deehan DJ, Salmon LJ, Russell VJ, Clingeleffer A. A five-year comparison of patellar tendon versus four-strand hamstring tendon autograft for arthroscopic reconstruction of the anterior cruciate ligament. Am J Sports Med. 2002; 30:523–536.

5. Rappé M, Horodyski M, Meister K, Indelicato PA. Nonirradiated versus irradiated Achilles allograft: in vivo failure comparison. Am J Sports Med. 2007; 35:1653–1658.

6. Johnson DL, Coen MJ. Revision ACL surgery. Etiology, indications, techniques, and results. Am J Knee Surg. 1995; 8:155–167.

7. Johnson DL, Swenson TM, Irrgang JJ, Fu FH, Harner CD. Revision anterior cruciate ligament surgery: experience from Pittsburgh. Clin Orthop Relat Res. 1996; 325:100–109.

8. Wright RW, Gill CS, Chen L, et al. Outcome of revision anterior cruciate ligament reconstruction: a systematic review. J Bone Joint Surg Am. 2012; 94:531–536.

9. MARS Group. Wright RW, Huston LJ, et al. Descriptive epidemiology of the Multicenter ACL Revision Study (MARS) cohort. Am J Sports Med. 2010; 38:1979–1986.

10. Battaglia TC, Miller MD. Management of bony deficiency in revision anterior cruciate ligament reconstruction using allograft bone dowels: surgical technique. Arthroscopy. 2005; 21:767.

11. Wolf RS, Lemak LJ. Revision anterior cruciate ligament reconstruction surgery. J South Orthop Assoc. 2002; 11:25–32.

12. Schilaty ND, Nagelli C, Bates NA, et al. Incidence of second anterior cruciate ligament tears and identification of associated risk factors from 2001 to 2010 using a geographic database. Orthop J Sports Med. 2017; 5:2325967117724196.

13. Grassi A, Nitri M, Moulton SG, et al. Does the type of graft affect the outcome of revision anterior cruciate ligament reconstruction? a meta-analysis of 32 studies. Bone Joint J. 2017; 99:714–723.

14. Osti L, Buda M, Osti R, Massari L, Maffulli N. Preoperative planning for ACL revision surgery. Sports Med Arthrosc Rev. 2017; 25:19–29.

15. Allen CR, Giffin JR, Harner CD. Revision anterior cruciate ligament reconstruction. Orthop Clin North Am. 2003; 34:79–98.

16. Garofalo R, Djahangiri A, Siegrist O. Revision anterior cruciate ligament reconstruction with quadriceps tendon-patellar bone autograft. Arthroscopy. 2006; 22:205–214.

17. Grossman MG, ElAttrache NS, Shields CL, Glousman RE. Revision anterior cruciate ligament reconstruction: three- to nine-year follow-up. Arthroscopy. 2005; 21:418–423.

18. Cohen M, Amaro JT, Ejnisman B, et al. Anterior cruciate ligament reconstruction after 10 to 15 years: association between meniscectomy and osteoarthrosis. Arthroscopy. 2007; 23:629–634.

19. Shelbourne KD, Nitz PA. Anterior cruciate ligament injuries in school aged athletes. In : Reider B, editor. Sports medicine: the school aged athlete. Philadelphia: WB Saunders;1991.

20. Kamath GV, Redfern JC, Greis PE, Burks RT. Revision anterior cruciate ligament reconstruction. Am J Sports Med. 2011; 39:199–217.

21. Thomas NP, Kankate R, Wandless F, Pandit H. Revision anterior cruciate ligament reconstruction using a 2-stage technique with bone grafting of the tibial tunnel. Am J Sports Med. 2005; 33:1701–1709.