In general, the results of revision acl reconstruction do not appear to be as favorable. The clinical outcomes after revision acl reconstruction are largely based on level iv case series. Expected immediate postoperative acl tunnel diameter should be around 10 mm regardless of graft selection. The preoperative planning for the revision of a previous. In order to maximize the success of revision acl surgery, a methodic and organized approach is required. Anterior cruciate ligament acl revision rehabilitation protocol the following is a protocol for postoperative patients following acl reconstruction.
Revision anterior cruciate ligament surgery bernard r. New techniques for anterior cruciate ligament revision surgery. Multivariate analysis revealed that revision acl surgery was only predicted by age at the time of surgery and graft type autograft vs allograft. Loss of knee extension has been shown to result in a limp, quadriceps muscle weakness, and anterior knee pain. Acl revision surgery failed acl reconstruction knee. Technical considerations for revision acl reconstruction surgery.
In this video, dr darren johnson discusses revision acl surgery and the main things the surgeon needs to dohave to understand the reason for the revision and how to correct the acl. Thus, the workup for acl revision surgery has to include an evaluation of biology, evaluation of the patients alignment and their secondary restraints, a careful assessment of the posterior horn of the medial meniscus and also an evaluation of the previous reconstruction tunnel placement and size. Acl conservative rehabilitation autologous hamstring, allograft or revision acl surgery i. Revision acl reconstruction causes of failure and graft. Revision reconstruction of the acl is becoming a common operation following the failure of primary graft.
Arthroscopic revision acl reconstructions are done under general anesthesia, which means you will be completely asleep. Treatment for failed acl repair is complex and technically challenging, and the results of revision acl surgery are not as good as an initial acl reconstruction. Surgical decisionmaking before revision acl reconstruction is based on a thorough history and physical examination, as well as imaging studies to identify. A revision acl reconstruction is a lot more complicated than your initial acl surgery. Revision acl reconstruction indications and technique. Twostage revision anterior cruciate ligament reconstruction. Mar 04, 2016 a revision acl reconstruction is a lot more complicated than your initial acl surgery.
This booklet aims to improve your understanding of the procedure of revision reconstruction anterior cruciate ligament acl and the rehabilitation afterwards. Aaos 2017 annual meeting an evening with the masters. Managing tunnel malposition and widening in revision anterior. The acl runs from the front of the tibia to the back of the femur. A twostage revision involves an initial bone grafting procedure to fill the tunnels, followed at least 3 months later with revision surgery. Pdf revision of anterior cruciate ligament acl reconstruction. Therefore, a significant number of patients who undergo acl reconstruction may have a less than satisfactory outcome, leading to a revision acl surgery. Anterior cruciate ligament acl reconstruction has become one of the more common procedures performed by orthopaedic surgeons over the past. One of the most common complications following acl reconstruction is loss of motion, especially loss of extension. More than 200,000 anterior cruciate ligament acl reconstructions are estimated to be performed annually in the united states. Can i return to sports after revision acl surgery howard j. If it is determined that a revision acl reconstruction is required, then a thorough discussion with the orthopedic surgeon should explain the plan, graft options, and other surgeries that may be required.
His first acl tear occurred while in college, and the retear happened while in the nfl. Anterior cruciate ligament acl and how do todays reconstruction techniques attempt to recreate it. Does revision acl reconstruction measure up to primary. The incidence of loss of motion following acl surgery has been reported to range from 5. Subsequent surgery after revision anterior cruciate ligament reconstruction rates and risk factors from a multicenter cohort the mars groupy investigation performed at the department of orthopaedic surgery, university of california, san francisco, san francisco, california, usa.
This is a more challenging operation for the orthopedic surgeon. During a revision surgery we need to determine if your first acl was performed properly and we can use the old tunnels or we need to determine if we need to close up your old tunnels with a bone graft and come back in a few months to put the revision acl. Measurements of bone tunnel size in anterior cruciate ligament reconstruction. Acl reconstruction is based on a thorough medical history, including information on the. Carson, md the importance of the anterior cruciate ligament acl to the main tenance of normal knee function is now well accepted. Hackett spends quality time gathering previous operative reports, obtaining additional xrays or cat scans, and sometimes alignment film, so he can identify what needs to. Revision acl considerations southern california orthopedic. A revision acl reconstruction is a second surgery needed to repair a torn anterior cruciate ligament. Acl conservative rehabilitation autologous hamstring. Technical considerations in revision anterior cruciate ligament. Anterior cruciate ligament reconstruction is a complex process, although the success rate of acl reconstruction surgery is generally 85 95%.
The number of patients undergoing revision surgery following failure of anterior cruciate ligament acl reconstruction has increased over the recent past, following the overall increased number. What are possible technical complications associated with the reconstruction. Patient information and rehabilitation guidelines following. At surgery, we generally employ the following steps for an acl revision. We detail our approach to revising a failed primary acl reconstruction. Sep 18, 2019 preoperative planning for revision acl surgery is essential for a successful outcome. It is our belief that anatomic restoration of acl anatomy in the revision setting is best accomplished using the doublebundle technique in the majority of cases. Revision acl getting the surgery right the second time university of colorado anschutz medical campus. Acl reconstruction revision with staged bone grafting. The primary goal of this protocol is to protect the reconstruction while steadily progressing towards and ultimately achieving preinjury level of activity. In cases of acl revision, your physician must first attempt to determine the cause of failure, in order and to plan acl revision for failed acl surgery, to lower the risk of second failure. Although anterior cruciate ligament acl reconstruction has a high success rate, a substantial number of patients are left with unsatisfactory results. The overall revision acl surgery rate after primary unilateral acl reconstruction was.
The causes of failure are numerous and multifactorial. What is a current technique of an acl reconstruction and what is its rationale. A tunnel diameter greater than 15 mm will require twostage surgery when the original tunnels are in anatomic. Predictors of revision surgery after primary anterior. James madison university speakers preferred technique. As the number of primary acl reconstructions continues to increase, so will the need for revision surgery.
A primary cause of failure is a poorly positioned acl graft. Studies have demonstrated that the timing of acl surgery has a significant influence on the development of postoperative. Depending on the extent of failure in the original reconstruction, multiple surgeries may be necessary. Robert griffin iii also known as rg3 is a famous nfl quarterback that has recently undergone revision acl surgery on his right knee. Primary acl reconstructions are performed using different techniques, so the surgeon must take multiple factors into account when planning for the more complex procedure. The physician should stress to the patient that revision acl surgery is considered a salvage procedure to stabilize the knee, prevent further damage to the menisci and articular cartilage, and. This presentation is meant to concentrate on the technical aspects of revision acl surgery.
Can i return to sports after revision acl surgery howard. Failure of an acl reconstruction is often hard to describe. If this is the case, preparatory surgeries are first performed to remove the old hardware, administer bone grafts to heal and fill drill holes so that new hardware can properly fit, and to realign the knee so that successful revision may be achieved. No other variables were significantly associated with revision acl surgery. Subsequent surgery after revision anterior cruciate ligament. Subsequent surgery after revision anterior cruciate ligament reconstruction rates and risk factors from a multicenter cohort the mars groupy investigation performed at the department of orthopaedic surgery. Anterior cruciate ligament acl reconstruction surgery is one of the most frequently performed operative procedures in orthopaedic surgery.
Complex reconstructions, innovative techniques san diego, ca, usa, march 1418,2017. Anterior cruciate ligament acl injuries are common in the athletic population. The knee joint lies between the femur thighbone and the tibia shinbone. The number of patients undergoing primary acl reconstruction is increasing 3, 4, and it is likely that acl revision will increase in the future 3, 5. The patient can have complaints of knee instability, pain, stiffness, or the inability to return to desired activities. Preoperative planning for revision acl surgery is essential for a successful outcome. Concise chapters by a leading group of international orthopedic surgeons cover the diagnosis of failed acl reconstruction, patient evaluation, preoperative planning for revision acl surgery and complex. Revision anterior cruciate ligament acl reconstruction. Techniques and avoiding pitfalls timothy hosea, md university orthopaedic associates. Loss of motion is one of the most common complications following knee ligament surgery. Keys for a successful acl surgery and recovery duration. There are estimates that 100,000 new acl injuries occur annually. Relevance of symptom pattern instability only optimum condition for revision surgery pain only revision for pain only results in unsatisfactory outcome rule out infection, arthrosis, chondral damage, meniscal insufficiency, or arthrofibrosis pain and instability pain from instability may be addressed by revision pain independent of instability. However, understanding the exact cause of failure before undertaking a revision acl surgery is paramount in providing the patient with a successful outcome.
Reconstruction of the ruptured acl is accepted as standard treatment for athletes as it allows them to resume sporting activities. Revision anterior cruciate ligament reconstruction surgery. The purposes of this study are to describe an acl femoral tunnel classification system for use in planning revision acl reconstruction based on 3d computed tomography ct reconstructions and to. Indications and technique provides detailed strategies for planning and executing revision acl reconstructions. Anterior cruciate ligament acl reconstruction represents one of the most successful orthopedic surgical procedures. It is estimated that between 2,900 and,000 patients will require a revision acl reconstruction each year. Revision acl surgery is an operation that reconstructs a previous failed acl reconstruction. Apr 28, 2020 anterior cruciate ligament acl reconstruction has become one of the more common procedures performed by orthopaedic surgeons over the past 10 years. In general, the success rates in the literature for acl revision surgery are approximately 75%. The nurses will register you, shave and prep the surgery area, and place an iv and start the preventative antibiotics. Chapter 1 rehabilitation of revision acl reconstruction. Because more and more people, especially young athletes, are tearing their acls and choosing to have them reconstructed, revision acl surgery is becoming a more common procedure. Revision anterior cruciate ligament surgery charles h. The important stages in assessing a patient with failed acl surgery include history, patient selection, physical examination and investigations, choice of graft, surgical technique, and rehabilitation.
Major reasons to proceed with a twostage strategy include tunnelwidening or other loss of bone stock. In fact, acl reconstruction has become one of the most common orthopedic procedures with over 100,000 being performed annually. Pdf the number of patients undergoing revision surgery following failure of anterior cruciate ligament acl reconstruction has increased. Concise chapters by a leading group of international. Revision acl reconstruction british journal of sports medicine. Lowe and his staff that after you have an anterior cruciate ligament acl reconstruction you lead a normal injury free return to all activities. Timing of acl surgery time interval is not as important as the condition. Revision acl getting the surgery right the second time youtube. Pdf a case report is presented in which an amateur football player required a second acl revision. Subsequent surgery after revision anterior cruciate. Th is chapter discusses the surgical planning and technique of revision acl reconstruction.
What is the history of acl reconstruction and its evolution. Hackett spends quality time gathering previous operative reports, obtaining additional xrays or cat scans, and sometimes alignment film, so he can identify what needs to be revised. Oct 09, 2017 revision acl getting the surgery right the second time university of colorado anschutz medical campus. Anterior cruciate ligament acl rupture is a common sporting injury.
First, the patient is prepared for surgery in a sterile manner, and arthroscopic portals are established to allow for visualization of the procedure and insertion points for the instruments. Much of the existing literature is heterogenous with regard to patient populations, primary and revision surgical techniques, concomitant ligamentous injuries, and additional procedures performed at the time of the revision, which limits generalizability. Results of revision anterior cruciate ligament reconstruction using a. This study looked at the aetiology of primary acl graft failure and choices of graft used.
Arthroscopic revision acl reconstructions are done under general anesthesia, which. To describe the current literature related to anterior cruciate ligament acl revision in terms of surgical aspects, graft choices, concomitant injuries, patientreported outcome, return to sport, and objective measurement outcome. Revision anterior cruciate ligament surgery sciencedirect. The initial reconstruction is referred to as a primary acl reconstruction. Treatment for a failed acl may require a staged approach with other surgeries done first before the revision acl surgery. Injury to the anterior cruciate ligament acl is common, with an estimated incidence of 200,000 primary acl ruptures annually only in the usa 1, 2. Revision for failed acl surgery revision acl reconstruction. Purpose to compare patientreported and clinicianreported outcomes, and radiographic results between patients who had had revision acl reconstruction and those who had had primary acl reconstruction. Millstein can provide you with the best possible results. Brace brace locked in extension weight bearing two crutches wbat exercises ankle pumps passive knee extensions to 0 degrees terminal knee extension quad sets 20 degrees gluteal sets. With the increase in number of anterior cruciate ligament acl reconstructions being performed, and with patients desire to return to highlevel sports activities, the prevalence of acl revision has been rising despite recent improvements in acl reconstruction technique.