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Revision ACL Reconstruction: Principles and Practice.

Sachin Tapasvi1, Anshu Shekhar1

  • 1The Orthopaedic Speciality Clinic, 16 Status Chambers, 1221/A Wrangler Paranjpe Road, Pune, 411004 India.

Indian Journal of Orthopaedics
|April 30, 2021
PubMed
Summary
This summary is machine-generated.

Revision anterior cruciate ligament reconstruction (ACLR) is complex due to various factors. Careful patient assessment and surgical planning are crucial for successful outcomes, though results may be inferior to primary ACLR.

Keywords:
Anterior cruciate ligamentAnterior cruciate ligament reconstructionAutograftOne-stage reconstructionPosterior tibial slopeRe-tearRevisionTunnel dilatationTunnel malpositionTwo-stage reconstruction

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Area of Science:

  • Orthopedic Surgery
  • Sports Medicine
  • Biomechanical Engineering

Background:

  • Increasing incidence of primary anterior cruciate ligament reconstruction (ACLR) leads to a rise in revision ACLR surgeries.
  • ACL failure presents with recurrent instability, pain, and stiffness.
  • Revision ACLR addresses complex cases following initial surgical failure.

Purpose of the Study:

  • To outline critical factors and considerations for planning and executing revision anterior cruciate ligament reconstruction (ACLR).
  • To discuss common causes of ACLR failure and appropriate management strategies.
  • To highlight the complexities and expected outcomes of revision ACLR compared to primary procedures.

Main Methods:

  • Review of factors contributing to ACLR failure, including patient-related, surgeon-related, and biological elements.
  • Emphasis on detailed pre-operative assessment: patient evaluation, imaging, and index surgery analysis.
  • Discussion of surgical approaches (one-stage vs. two-stage), graft choices (autografts preferred), and management of associated injuries.

Main Results:

  • Tunnel malposition and recurrent trauma are identified as primary causes of ACLR failure.
  • Pre-operative assessment must rule out infection and address osseous malalignment.
  • Revision ACLR often requires managing associated meniscus tears, cartilage damage, and anterolateral instability.

Conclusions:

  • Revision ACL reconstruction is a challenging procedure due to graft limitations, altered anatomy, and frequent associated injuries.
  • Patient expectations should be managed, as functional outcomes and return to sport are typically inferior to primary ACLR.
  • Thorough pre-operative planning and appropriate surgical techniques are essential for optimizing outcomes in revision ACLR.