Revision anterior cruciate ligament surgery: experience from Pittsburgh

Twenty-five patients who underwent revision anterior cruciate ligament reconstruction after failure of a previous intraarticular reconstruction were retrospectively reviewed. Before revision, all patients reported functional instability with sports or activities of daily living and exhibited increased anterior patholaxity on physical examination. Fresh frozen irradiated allograft tissue was used for all revisions. A comprehensive knee analysis using a subjective and objective system was done for all patients preoperatively and at the time of final followup. The mean age at revision surgery was 25 years and average time from primary to revision surgery was 30 months. Average length of followup was 28 months. The anteroposterior displacement was improved in all patients. Sixty-four percent of patients had less than 5 mm side to side difference on arthrometric testing. Eighty percent had either a Grade 0 or Grade 1 pivot shift. The average modified Cincinnati Knee Score was 68 with the results of 88% of patients rated abnormal by International Knee Documentation Committee guidelines. Seventy-six percent of patients were satisfied with their results and would elect to have revision surgery again. These results show that patients having revision anterior cruciate ligament reconstruction for a failed intraarticular reconstruction had improvement in their functional status compared with prerevision; however, they did not achieve the same level of satisfactory results as primary anterior cruciate ligament reconstruction.