Repeat Revision Anterior Cruciate Ligament Reconstruction Remains a Challenge for Orthopedic Surgeons

Document Type : In Brief

Author

Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain

10.22038/abjs.2024.76809.3549

Abstract

The re-revision of anterior cruciate ligament reconstruction (ACLR) can be contemplated a secure and 
efficacious surgical technique with good results, whether it is performed in one -stage or two-stages or 
is performed with autograft or allograft. With reg ard to the surgical technique, there is no evidence that 
performing ACLR in one stage is superior to performing it in two stages. With respect to graft choice, 
allograft is the most chosen, and the allograft most frequently utilized is the Achilles tendon. However, 
the best graft to use for re-revision is not yet known. For revision ACLR orthopedic surgeons have to 
contemplate the amendment of an outrageous posterior tibial slope, especially after having failed two 
or more consecutive interventions. The potential benefit of combining ACLR with an anterolateral 
ligament reconstruction is to achieve greater rotational stability. It will diminish both the elevated failure 
percentages observed specifically in young individuals and increasing osteoarthritic chang es 
encountered following sole ACLR.
 Level of evidence: III

Keywords

Main Subjects

References

  1. Annear PT, Rohr EJ, Hille DM, Gohil S, Ebert JR. No clinical difference in 10-year outcomes between standard and minimal graft debridement techniques in patients undergoing anterior cruciate ligament reconstruction using autologous hamstrings: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2019; 27(2):516-523. doi: 10.1007/s00167-018-5146-5.
  2. Rangasamy K, Baburaj V, Gopinathan NR, Dhillon MS, Parikh SN. Quadriceps tendon autograft is promising with lower graft rupture rates and better functional Lysholm scores than hamstring tendon autograft in pediatric ACL reconstruction. A systematic review and meta-analysis. J Orthop. 2023; 49:156-166. doi: 10.1016/j.jor.2023.12.014.
  3. Honeywill C, Salmon L, Pinczewski L, Sundaraj K, Roe J. Comparison of contralateral ACL rupture versus ACL graft rupture in Australian netballers after ACL reconstruction. Orthop J Sports Med. 2024; 12(5):23259671241247488. doi: 10.1177/23259671241247488.
  4. Pettinari F, Carrozzo A, Saithna A, et al. Effect of lateral extra-articular procedures combined with ACL reconstruction on the rate of graft rupture in patients aged older than 30 years: a matched-pair analysis of 1102 patients from the SANTI study group. Am J Sports Med. 2024; 52(7):1765-1772. doi: 10.1177/03635465241247760.
  5. Geffroy L, Lefevre N, Thevenin-Lemoine C, et al. French Arthroscopy Society. Return to sport and re-tears after anterior cruciate ligament reconstruction in children and adolescents. Orthop Traumatol Surg Res. 2018; 104(8S):S183-S188. doi: 10.1016/j.otsr.2018.09.006.
  6. Ebert JR, Edwards P, Annear PT. Selective bundle reconstruction for symptomatic partial anterior cruciate ligament tears demonstrates good functional scores, high return to sport rates and a low re-tear rate. Knee. 2022; 36:53-64. doi: 10.1016/j.knee.2022.04.007.
  7. Homan MD, Braaten JA, Banovetz MT, Monson JK, Kennedy NI, LaPrade RF. Principles for optimizing anterior cruciate ligament reconstruction outcomes in elite athletes: a review of current techniques. Ann Jt. 2024; 9:19. doi: 10.21037/aoj-22-40.
  8. Liu Z, Jiang J, Yi Q, et al. An increased posterior tibial slope is associated with a higher risk of graft failure following ACL reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2022; 30(7):2377-2387. doi: 10.1007/s00167-022-06888-6.
  9. Wegrzyn J, Chouteau J, Philippot R, Fessy MH, Moyen B. 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. 2009; 37(4):776-85. doi: 10.1177/0363546508330141.
  10. Griffith TB, Allen BJ, Levy BA, Stuart MJ, Dahm DL. Outcomes of repeat revision anterior cruciate ligament reconstruction. Am J Sports Med 2013; 41(6):1296-301. doi: 10.1177/0363546513482568.
  11. Sonnery-Cottet B, Mogos S, Thaunat M, et al. Proximal tibial anterior closing wedge osteotomy in repeat revision of anterior cruciate ligament reconstruction. Am J Sports Med 2014; 42(8):1873-1880. doi: 10.1177/0363546514534938.
  12. Engler ID, Salzler MJ, Wall AJ, et al. Patient-reported outcomes after multiple-revision ACL reconstruction: good but not great. Arthrosc Sports Med Rehabil 2020; 2(5):e539-e546. doi: 10.1016/j.asmr.2020.06.013.
  13. Gorodischer TD, Zicaro JP, Yacuzzi C, Costa Paz M. Good short-term clinical outcomes and low rates of return to sports after repeat revision ACL reconstruction. J Knee Surg. 2022; 35(12):1312-1319. doi: 10.1055/s-0041-1723765.
  14. Fradin T, Saithna A, Haidar IM, et al. Management of the failed first revision ACL reconstruction: clinical outcomes of nonsurgical management versus second revision ACL reconstruction from the SANTI group. Am J Sports Med 2022; 50(12):3236-3243. doi: 10.1177/03635465221119202.
  15. Roethke LC, Braaten JA, Rodriguez AN, LaPrade RF. Revision anterior cruciate ligament reconstruction (ACLR): causes and how to minimize primary ACLR failure. Arch Bone Jt Surg. 2023; 11(2):80-93. doi: 10.22038/ABJS.2022.60187.2970.
  16. Bitar AC, Abreu G, Scalize ARH, Garofo G, D'Elia C, Castropil W. Double and single bundle in athletes: a comparison in medium and long-term rates to return to sport and re-injury. Arch Bone Jt Surg. 2024; 12(1):19-25. doi: 10.22038/ABJS.2023.66143.3168.
  17. D'Ambrosi R, Meena A, Raj A, et al. multiple revision anterior cruciate ligament reconstruction: not the best but still good. Knee Surg Sports Traumatol Arthrosc 2023; 31(2):559-571. doi: 10.1007/s00167-022-07197-8.

 

 

 

 

The Archives of Bone and Joint Surgery
Volume 13, Issue 2
February 2025
Pages 114-118

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History

  • Receive Date: 11 December 2023
  • Revise Date: 10 December 2024
  • Accept Date: 09 December 2024

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