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Multiple ACL Revision: Failure Analysis and Clinical Outcomes.

Francesco Dini1, Andrea Tecame1, Aldo Ampollini1

  • 1Department of Orthopaedic and Trauma Surgery, Città di Parma Clinic, Parma, Italy.

The Journal of Knee Surgery
|November 29, 2019
PubMed
Summary

Revision anterior cruciate ligament (ACL) reconstruction shows improved outcomes, but only a quarter of patients return to pre-injury sports levels. Common failure causes include tunnel malpositioning and meniscal or cartilage damage.

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Area of Science:

  • Orthopedic Surgery
  • Sports Medicine
  • Knee Reconstruction

Background:

  • Anterior cruciate ligament (ACL) reconstruction is a highly successful orthopedic procedure.
  • However, ACL revisions are frequent, indicating a persistent rate of surgical failures.
  • Understanding the causes and outcomes of ACL re-revisions is crucial for improving patient care.

Purpose of the Study:

  • To analyze the specific causes of failure in patients undergoing re-revision ACL reconstruction.
  • To evaluate the clinical outcomes of these patients following the re-revision surgery.

Main Methods:

  • Retrospective analysis of 263 ACL revisions performed between 2009 and 2017.
  • Inclusion criteria identified 17 patients who underwent ACL re-revision.
  • Preoperative and postoperative assessments included Lysholm score, IKDC, KT-2000 arthrometer, radiographs, and CT scans.

Main Results:

  • Common failure causes identified: anterior femoral tunnel (5 patients), vertical/posterior tibial tunnel (7 patients), meniscal tears (8 patients), and Outerbridge grade III-IV cartilage lesions (5 patients).
  • Significant improvements observed in IKDC (35% to 82%), Lysholm scores (43 to 87), and KT-2000 laxity (5.8mm to 1.5mm) post-re-revision.
  • Only 4 out of 17 patients returned to their pre-injury sport level; no osteoarthritis progression was noted.

Conclusions:

  • Re-revision ACL surgery can yield good clinical and radiological results in cases of multiple failures.
  • Technical errors (tunnel placement) and untreated peripheral injuries (meniscal, cartilage) are primary failure drivers.
  • High-grade chondral lesions are associated with poorer clinical outcomes, and return to sport remains a challenge.