Skip to main content

Advertisement

SpringerLink
Log in

Third time’s a charm?: improving re-revision ACL reconstruction by addressing reasons for prior failures

  • Original Article
  • Published:
European Orthopaedics and Traumatology

Abstract

Purpose

The purpose of this study was to determine whether re-revision anterior cruciate ligament (ACL) reconstruction including careful assessment and treatment of reason for prior failures decreases knee laxity and improves International Knee Documentation Committee (IKDC) scores.

Methods

Re-revision ACL reconstructions were performed in eight patients at a mean age of 29.6 ± 6.9 years. All reported subjective knee instability preoperatively and demonstrated objectively increased laxity on physical examination and Lachman stress radiographs. Reasons for failure of the prior revision reconstructions were classified as tunnel malposition (two), associated posteromedial (one) or posterolateral (one) laxity, excessive tibial slope (one), and recurrent trauma (three). Specific steps were taken to address reasons for prior failure, including correcting malpositioned tunnels (two cases), posteromedial reefing (one case), posterolateral corner reconstruction (one case), or tibial deflexion osteotomy (one case). Follow-up evaluation included physical examination, radiographic evaluation including Lachman stress views, and a subjective IKDC evaluation.

Results

Seven patients were available for follow-up at 4.4 ± 2.3 years postoperative. Lachman examination improved with surgery in five patients and was unchanged in two patients (p = 0.013). The pivot shift examination, improved in five patients, was unchanged in one patient and worsened in one patient (p = 0.33). Two graft failures were diagnosed based on physical examination findings. Anterior tibial translation on stress radiographs decreased in all patients. The mean value decreased from 8.3 ± 2.9 to 3.0 ± 2.6 mm (p = 0.0025). The postoperative subjective IKDC score was 56.9 ± 16.9. Overall IKDC score improved in all patients.

Conclusion

Re-revision ACL reconstruction including identification and treatment of reasons for prior failure results in improved knee laxity and IKDC scores.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Garrett WE Jr, Swiontkowski MF, Weinstein JN, Callaghan J, Rosier RN, Berry DJ, Harrast J, Derosa GP (2006) American Board of Orthopaedic Surgery practice of the orthopaedic surgeon: part-II, certification examination case mix. J Bone Joint Surg Am 88:660–667

    Article  PubMed  Google Scholar 

  2. Drogset JO, Grontvedt T (2002) Anterior cruciate ligament reconstruction with and without a ligament augmentation device: results at 8-year follow-up. Am J Sports Med 30:851–856

    PubMed  Google Scholar 

  3. Keays SL, Bullock-Saxton JE, Keays AC, Newcombe PA, Bullock MI (2007) A 6-year follow-up of the effect of graft site on strength, stability, range of motion, function, and joint degeneration after anterior cruciate ligament reconstruction: patellar tendon versus semitendinosus and Gracilis tendon graft. Am J Sports Med 35:729–739

    Article  PubMed  Google Scholar 

  4. Liden M, Ejerhed L, Sernert N, Laxdal G, Kartus J (2007) Patellar tendon or semitendinosus tendon autografts for anterior cruciate ligament reconstruction: a prospective, randomized study with a 7-year follow-up. Am J Sports Med 35:740–748

    Article  PubMed  Google Scholar 

  5. O’Neill DB (2001) Arthroscopically assisted reconstruction of the anterior cruciate ligament. A follow-up report. J Bone Joint Surg Am 83-A:1329–1332

    PubMed  Google Scholar 

  6. Roe J, Pinczewski LA, Russell VJ, Salmon LJ, Kawamata T, Chew M (2005) A 7-year follow-up of patellar tendon and hamstring tendon grafts for arthroscopic anterior cruciate ligament reconstruction: differences and similarities. Am J Sports Med 33:1337–1345

    Article  PubMed  Google Scholar 

  7. Sajovic M, Vengust V, Komadina R, Tavcar R, Skaza K (2006) A prospective, randomized comparison of semitendinosus and gracilis tendon versus patellar tendon autografts for anterior cruciate ligament reconstruction: five-year follow-up. Am J Sports Med 34:1933–1940

    Article  PubMed  Google Scholar 

  8. Fox JA, Pierce M, Bojchuk J, Hayden J, Bush-Joseph CA, Bach BR Jr (2004) Revision anterior cruciate ligament reconstruction with nonirradiated fresh-frozen patellar tendon allograft. Arthroscopy 20:787–794

    Article  PubMed  Google Scholar 

  9. Noyes FR, Barber-Westin SD (2001) Revision anterior cruciate surgery with use of bone–patellar tendon–bone autogenous grafts. J Bone Joint Surg Am 83-A:1131–1143

    PubMed  CAS  Google Scholar 

  10. Noyes FR, Barber-Westin SD, Roberts CS (1994) Use of allografts after failed treatment of rupture of the anterior cruciate ligament. J Bone Joint Surg Am 76:1019–1031

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  12. Uribe JW, Hechtman KS, Zvijac JE, Tjin ATEW (1996) Revision anterior cruciate ligament surgery: experience from Miami. Clin Orthop Relat Res 325:91–99

    Article  PubMed  Google Scholar 

  13. Carson EW, Anisko EM, Restrepo C, Panariello RA, O’Brien SJ, Warren RF (2004) Revision anterior cruciate ligament reconstruction: etiology of failures and clinical results. J Knee Surg 17:127–132

    PubMed  Google Scholar 

  14. George MS, Dunn WR, Spindler KP (2006) Current concepts review: revision anterior cruciate ligament reconstruction. Am J Sports Med 34:2026–2037

    Article  PubMed  Google Scholar 

  15. Trojani C, Sbihi A, Djian P, Potel JF, Hulet C, Jouve F, Bussiere C, Ehkirch FP, Burdin G, Dubrana F, Beaufils P, Franceschi JP, Chassaing V, Colombet P, Neyret P (2011) Causes for failure of ACL reconstruction and influence of meniscectomies after revision. Knee Surg Sports Traumatol Arthrosc 19:196–201

    Article  PubMed  Google Scholar 

  16. Neyret P, Verdonk P, Ait Si Selmi T, Albouchi I, Ozturk M (2007) Reconstruction du ligament croise anterieur. In: Neyret P, Verdonk P, Ait Si Selmi T (eds) Chirurgie du Genou: my knee practice. Elsevier, Paris, pp 19–42

    Google Scholar 

  17. Ait Si Selmi T, Fabie F, Massouh T, Pourcher G, Adeleine P, Neyret P (2002) Greffe du LCA au tendon rotulien sous arthroscopie avec ou sans plastie anteroexterne. Etude prospective randomisee a propos de 120 cas. In: Chambat P, Neyret P, Deschamps G, Bonnin M, Dejour D, Ait Si Selmi T, Badet R (eds) Le Genou du Sportif. Sauramps Medical, Montpellier, pp 221–224

    Google Scholar 

  18. Bouattour K, Chatain F, Ait Si Selmi T, Neyret P (2002) Arthroscopic reconstruction of the anterior cruciate ligament. Rev Chir Orthop Reparatrice Appar Mot 88:130–138

    PubMed  CAS  Google Scholar 

  19. Stannard JP, Schenck RC, Fanelli GC (2009) Knee dislocations and fracture-dislocation. In: Bucholz RW, Court-Brown C, Heckman JD (eds) Rockwood and Green’s fractures in adults. Lippincott, Williams, and Wilkins, Philadelphia, pp 1832–1866

    Google Scholar 

  20. Sekiya JK, Kurtz CA (2005) Posterolateral corner reconstruction of the knee: surgical technique utilizing a bifid Achilles tendon allograft and a double femoral tunnel. Arthroscopy 21:1400

    PubMed  Google Scholar 

  21. Neyret P, Zuppi G, Ait Si Selmi T (2000) Tibial deflexion osteotomy. Oper Tech Sports Med 8:61–66

    Article  Google Scholar 

  22. Bonin N, Ait Si Selmi T, Donell ST, Dejour H, Neyret P (2004) Anterior cruciate reconstruction combined with valgus upper tibial osteotomy: 12 years follow-up. Knee 11:431–437

    Article  PubMed  CAS  Google Scholar 

  23. Dejour H, Neyret P, Boileau P, Donell ST (1994) Anterior cruciate reconstruction combined with valgus tibial osteotomy. Clin Orthop Relat Res 299:220–228

    PubMed  Google Scholar 

  24. Hefti F, Muller W, Jakob RP, Staubli HU (1993) Evaluation of knee ligament injuries with IKDC form. Knee Surg Sports Traumatol Arthrosc 1:226–234

    Article  PubMed  CAS  Google Scholar 

  25. Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P, Richmond JC, Shelborne KD (2001) Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 29:600–613

    PubMed  CAS  Google Scholar 

  26. Wegrzyn J, Chouteau J, Philippot R, Fessy MH, Moyen B (2009) Repeat revision of anterior cruciate ligament reconstruction: a retrospective review of management and outcome of 10 patients with an average 3-year follow-up. Am J Sports Med 37:776–785

    Article  PubMed  Google Scholar 

  27. Dejour H, Neyret P, Bonnin M (1994) Instability and osteoarthritis. In: Fu FH, Harner CD, Vince KG (eds) Knee surgery. Williams and Wilkins, Baltimore, pp 859–875

    Google Scholar 

  28. Engebretsen L, Lew WD, Lewis JL, Hunter RE (1990) The effect of an iliotibial tenodesis on intra-articular graft forces and knee joint motion. Am J Sports Med 18:169–176

    Article  PubMed  CAS  Google Scholar 

  29. Noyes FR, Barber SD (1991) The effect of an extra-articular procedure on allograft reconstructions for chronic ruptures of the anterior cruciate ligament. J Bone Joint Surg Am 73-A:882–892

    Google Scholar 

  30. Goertzen M, Schulitz KP (1994) Plastie isolée intra-articulaire au semi-tendinosus ou plastie combinée intra-et extra-articulaire, dans les laxités antérieures chroniques du genou. Rev Chir Orthop 80:113–117

    PubMed  CAS  Google Scholar 

  31. Lerat JL, Mandrino A, Besse JL, Moyen B, Brunet-Guedj E (1997) Influence d’une ligamentoplastie extra-articulaire externe sur les résultats de la reconstruction du ligament croisé antérieur avec le tendon rotulien avec 4 ans de recul. Rev Chir Orthop 83:591–601

    PubMed  CAS  Google Scholar 

  32. Kaseta MK, DeFrate LE, Charnock BL, Sullivan RT, Garrett WE (2008) Reconstruction technique affects femoral tunnel placement in ACL reconstruction. Clin Orthop Relat Res 466:1467–1474

    Article  PubMed  Google Scholar 

  33. Ferretti M, Ekdahl M, Shen W, Fu FH (2007) Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study. Arthroscopy 23:1218–1225

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, The Ohio State University School of Medicine, Columbus, OH, USA

    Robert A. Magnussen

  2. Department of Orthopaedic Surgery, Hôpital de la Croix-Rousse, Centre Albert Trillat, Lyon, France

    Sébastien Lustig, Guillaume Demey, Elvire Servien & Philippe Neyret

  3. Department of Orthopaedic Surgery, Faculty of Medicine, Fayoum University, Fayoum, Egypt

    Ahmed ElGuindy

Authors
  1. Robert A. Magnussen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sébastien Lustig
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Guillaume Demey
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ahmed ElGuindy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elvire Servien
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Philippe Neyret
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert A. Magnussen.

Additional information

Level of Evidence: Case Series—Level IV

Rights and permissions

Reprints and permissions

About this article

Cite this article

Magnussen, R.A., Lustig, S., Demey, G. et al. Third time’s a charm?: improving re-revision ACL reconstruction by addressing reasons for prior failures. Eur Orthop Traumatol 3, 55–60 (2012). https://doi.org/10.1007/s12570-012-0088-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12570-012-0088-8

Keywords

Search

Navigation