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Costa-Paz, Matias, Julieta Puig Dubois, Juan Pablo Zicaro, Alejandro Rasumoff, and Carlos Yacuzzi. "ACL Revision." Orthopaedic Journal of Sports Medicine 5, no. 1_suppl (January 1, 2017): 2325967117S0003. http://dx.doi.org/10.1177/2325967117s00035.
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Objectives: The purpose of this study was to evaluate a series of patients one year after an ACL revision with clinical evaluation and MRI, to consider their condition before returning to sports activities. Methods: A descriptive, prospective and longitudinal study was performed. A series of patients who underwent an ACL revision between March 2014 and March 2015 were evaluated after one year post surgery. They were evaluated using the Lysholm score, IKDC, Tegner, artrometry and MRI (3.0 t). A signal pattern and osteointegration was determined in the MRI. Graft signal intensity of the ACL graft using the signal/noise quotient value (SNQ) was also determined to evaluate the ligamentatization process state. Results: A total of 18 male patients were evaluated with a mean age of 31 years old.Average scores were: Lysholm 88 points, IKDC 80 points, Pre-surgical Tegner 9 points and postoperative 4 points. Artrhometry (KT1000) at 20 newtons showed a side to side difference of less than 3 mm in 88%. Only 44% of patients returned to their previous sport activity one year after revision.The MRI showed a heterogeneous signal in neoligaments in 34% of patients. SNQ showed graft integration in only 28%. Synovial fluid was found in bone-graft interphase in 44% of tunnels, inferring partial osteointegration. The heterogeneous signal was present in 50% of patients who did not return to the previous sport level activity. (Fisher statistics: p = 0.043) There were no meaningful differences in patients with auto or allografts. Conclusion: Although the clinical evaluation was satisfactory, only 44% of patients returned to the previous level of sport activity one year after the ACL surgery. The ligamentatization process was found in 28% of knees evaluated with MRI one year later. Partial osteointegration is inferred in 44%. Results showed a meaningful relation between the signal of neoligaments in the MRI and the return to sport activity in said series of patients. MRI is a useful tool to consider the return to sports one year after the ACL revision.
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Pike, Andrew N., Tim Bryant, Takahiro Ogura, and Tom Minas. "Intermediate- to Long-Term Results of Combined Anterior Cruciate Ligament Reconstruction and Autologous Chondrocyte Implantation." Orthopaedic Journal of Sports Medicine 5, no. 2 (February 1, 2017): 232596711769359. http://dx.doi.org/10.1177/2325967117693591.
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Background: Cartilage injury associated with anterior cruciate ligament (ACL) ruptures is common; however, relatively few reports exist on concurrent cartilage repair with ACL reconstruction. Autologous chondrocyte implantation (ACI) has been utilized successfully for treatment of moderate to large chondral defects. Hypothesis: ACL insufficiency with relatively large chondral defects may be effectively managed with concurrent ACL reconstruction and ACI. Study Design: Case series; Level of evidence, 4. Methods: Patients undergoing concurrent ACL primary or revision reconstruction with ACI of single or multiple cartilage defects were prospectively evaluated for a minimum 2 years. Pre- and postoperative outcome measures included the modified Cincinnati Rating Scale (MCRS), Western Ontario and McMaster Universities Osteoarthritis Index, visual analog pain scales, and postsurgery satisfaction surveys. ACI graft failure or persistent pain without functional improvement were considered treatment failures. Results: Twenty-six patients were included, with 13 primary and 13 revision ACL reconstructions performed. Mean defect total surface area was 8.4 cm2, with a mean follow-up of 95 months (range, 24-240 months). MCRS improved from 3.62 ± 1.42 to 5.54 ± 2.32, Western Ontario and McMaster Universities Osteoarthritis Index from 45.31 ± 17.27 to 26.54 ± 17.71, and visual analog pain scale from 6.19 ± 1.27 to 3.65 ± 1.77 (all Ps <.001). Eight patients were clinical failures, 69% of patients were improved at final follow-up, and 92% stated they would likely undergo the procedure again. No outcome correlation was found with regard to age, body mass index, sex, defect size/number, follow-up time, or primary versus revision ACL reconstruction. In subanalysis, revision ACL reconstructions had worse preoperative MCRS scores and greater defect surface areas. However, revision MCRS score improvements were greater, resulting in similar final functional scores when compared with primary reconstructions. Conclusion: Challenging cases of ACL tears with large chondral defects treated with concurrent ACL reconstruction and ACI can lead to moderately improved pain and function at long-term follow-up. Factors associated with clinical failure are not clear. When combined with ACI, patients undergoing revision ACL reconstructions have worse function preoperatively compared with those undergoing primary reconstructions but have similar final outcomes.
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El Khoury, Georges, Alexandre Hardy, Adrien Saint-Etienne, Elie Saghbiny, Alain Meyer, Olivier Grimaud, Antoine Gerometta, Nicolas Lefevre, and Yoann Bohu. "Return to Sport After Revision ACL Reconstruction: A Comparative Cohort Study of Outcomes After Single- Versus Multiple-Revision Surgeries." Orthopaedic Journal of Sports Medicine 10, no. 11 (November 1, 2022): 232596712211337. http://dx.doi.org/10.1177/23259671221133762.
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Background: The return-to-sport rate at 2 years after multiple-revision anterior cruciate ligament (ACL) reconstructions has not been evaluated. Hypothesis: It was hypothesized that patients who undergo multiple-revision ACL reconstructions would have a lower return-to-sport rate at 2 years after surgery than those who undergo a single-revision reconstruction. Furthermore, it was hypothesized that the multiple-revision group would have lower functional scores. Study Design: Cohort study; Level of evidence, 3. Methods: A single-center cohort study in patients who underwent revision ACL reconstruction was begun in 2012. This study included 2 groups: Patients who underwent a single revision, and those who underwent multiple revisions. The main evaluation criterion was the return to sport at the 2-year follow-up. The secondary criteria were the International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm, and ACL–Return to Sport after Injury (ACL-RSI) functional knee scores at the 1- and 2-year follow-ups. Results: A total of 322 patients (single-revision group: n = 302; multiple-revision group: n = 20) were included. A significant difference in the percentage of patients who stopped all sports activity was found between the 2 groups at 2 years (single-revision group: 19.4%; multiple-revision group: 50%). The return-to-sport rate at the same or lower level of performance was higher in the single-revision group as well (17% vs 14.3% for return at the same level; 45.6% vs 14.3% for return at a lower level; P = .03). At the 2-year follow-up, the functional scores of the single-revision group were significantly higher those than in the multiple-revision group: IKDC (77.7 ± 13.82 vs 64.79 ± 15.22; P < .001), KOOS (72.66 ± 17.63 vs 52.5 ± 15.64; P < .001), Lysholm (84.05 ± 11.88 vs 72.5 ± 13.49; P < .001), and ACL-RSI (52.34 ± 21.83 vs 46.43 ± 14.8; P = .0036). Conclusion: Only a small percentage of patients returned to the same level of sport after single- revision and multiple-revision ACL reconstruction, yet significantly more in the former. More patients who underwent multiple revisions gave up their sport. Functional scores were higher for single-revision than multiple-revision surgeries.
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Erickson, Brandon J., Gregory L. Cvetanovich, Rachel M. Frank, Andrew J. Riff, and Bernard R. Bach. "Revision ACL Reconstruction." JBJS Reviews 5, no. 6 (June 2017): e1-e1. http://dx.doi.org/10.2106/jbjs.rvw.16.00094.
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Gilmore, Carl Jan, Joshua C. Hamann, Cree M. Gaskin, John Joseph Carroll, Joseph M. Hart, and Mark D. Miller. "ACL Revision Reconstruction." Orthopaedic Journal of Sports Medicine 1, no. 4_suppl (January 2013): 2325967113S0007. http://dx.doi.org/10.1177/2325967113s00072.
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Leung, Fay, Patrick Y. K. Chin, and Michael K. Gilbart. "Revision ACL Reconstruction." Techniques in Knee Surgery 11, no. 1 (March 2012): 18–25. http://dx.doi.org/10.1097/btk.0b013e3182485bf4.
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Lee, Eric, Stephanie Kliethermes, Tamara Scerpella, and Kallie Chen. "Poster 261: Increased TT-TG and Tibial Slope are Independent Predictors of ACLR Failure." Orthopaedic Journal of Sports Medicine 10, no. 7_suppl5 (July 1, 2022): 2325967121S0082. http://dx.doi.org/10.1177/2325967121s00822.
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Objectives: Tibial tubercle-trochlear groove (TT-TG) distance is a surrogate measure of valgus and rotational stress on the anterior cruciate ligament (ACL) and may predict ACL injury. Increased posterior tibial slope has been associated with risk of ACL re-tear but no studies have evaluated TT-TG as a predictor of ACL re-tear. We hypothesized TT-TG distance and posterior tibial slope would be independent predictors of ACL graft re-tear. Methods: All patients who underwent ACL revision surgery between 2010-2018 at a single institution were identified. A control cohort underwent primary ACL reconstruction (ACLR) between 2006-2015, with no evidence of graft failure at 8.1 ± 2.5 yrs post-op. Record review included anthropometrics, graft type, and estimated highest Tegner activity score at ≥ 6 months post primary ACLR. Magnetic resonance images (MRI) following native ACL tear (controls) or graft failure (revision cohort) were assessed for the following: 1) medial, lateral, and coronal tibial slope, 2) depth of tibial plateau concavity, 3) TT-TG distance, and 4) tunnel position. Logistic regression analyses were used to associate ACL graft failure with radiographic parameters, surgical variables, and demographics. Sensitivity analyses, excluding patients in the revision group with tunnel malposition, were performed to confirm multivariable results. Results: Participants included 153 revisions and 146 controls. Controls were older than revisions (26.6 ± 8.8 yrs vs. 20.6 ± 7.3 yrs). Mean TT-TG distance and lateral tibial slope values were smaller for the control vs. revision group (TT-TG = 9.4 ± 3.9 mm vs. 11.2 ± 4.2 mm; lateral tibial slope = 6.2o ± 3.4° vs. 7.2o ± 3.6°). TT-TG distance and lateral tibial slope were associated with increased risk of ACL graft failure by multivariable analysis (OR: 1.14, CI: 1.07, 1.22, p < 0.001 and OR: 1.11, CI: 1.02, 1.20, p = 0.007, respectively). With sensitivity analyses, age at index surgery, TT-TG distance, and lateral tibial slope remained significant predictors of ACL revision. Conclusions: Increased TT-TG distance, increased lateral tibial slope, and younger age are associated with increased odds of ACL graft failure. These patients may require a more comprehensive strategy to reduce the risk of ACL re-tear. [Table: see text]
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Etcheto, H. Rivarola, J. Zordán, G. Escobar, C. Collazo, M. Palanconi, C. Autorino, and E. Alvarez Salinas. "ACL Revision in Synthetic ACL graft failure." Orthopaedic Journal of Sports Medicine 5, no. 1_suppl (January 1, 2017): 2325967117S0003. http://dx.doi.org/10.1177/2325967117s00037.
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The development of synthetic grafts as an alternative to biological grafts for reconstruction of the anterior cruciate ligament dates from 1980. The interest is awakened due to the potential advantages of: The absence of morbidity associated with donor site, and early return to sport. However, this surgical technique has had multiple complications associated with graft: mechanical failures (synthetic graft failure, loss of fixation), synovial foreign body reaction, recurrent stroke, recurrent instability and ultimately, early osteoarthritis. Objectives: We describe the synthetic graft failure LCA, intraoperative findings and details of surgical technique. Methods: Patient 35 years old, with a history of ACL reconstruction four years of evolution in another health center, consultation with the Service knee arthroscopy for acute knee pain left knee during secondary sporting event to a rotation mechanism with fixed foot. On physical examination, presents and positive Lachman maneuver Pivot. Radiografia in a widening of the tibial tunnel is observed. NMR shows a discontinuity of fibers of synthetic graft. Results: First time arthroscopic revision where synthetic plastic LCA identifies with Disruption fiber pattern. Intraoperatively, hypertrophic chronic synovitis localized predominantly in intercóndilo is observed. debridement thereof is performed, and proceeds to the extraction of the synthetic ligament. Then he was made prior cruentado and revival of the edges of the tunnel, filling them with non-irradiated structural bone allograft. At four months as planned and after confirmation by studies incorporating bone graft was performed the second time with the new plastic ACL. It was planned like a primary graft surgery with autologous hamstring prepared in fourfold form, and fixation with modified transtibial technique Biotransfix system proximal and distal screw Biocomposite (arthrex®). A quadruple graft 9 mm was obtained, making good positioning of tunnels and stable fixation. Conclusion: While ACL reconstruction with synthetic graft has favorable medium-term results, the proportion of patients with complications of irreversible nature and high rates of dissatisfaction in the long term we are inclined to dismiss the indication of this technique in primary ACL reconstruction, to despite the potential benefits it offers.
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Cain, E., Brent Ponce, Hikel Boohaker, Martha George, Gerald McGwin, James Andrews, Lawrence Lemak, William Clancy, Jeffrey Dugas, and Glenn Fleisig. "Variables Associated with Chondral and Meniscal Injuries in Anterior Cruciate Ligament Surgery." Journal of Knee Surgery 30, no. 07 (November 28, 2016): 659–67. http://dx.doi.org/10.1055/s-0036-1593875.
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This article aims to evaluate factors associated with chondral and meniscal lesions in primary and revision anterior cruciate ligament (ACL) reconstructions. ACL reconstructions from 2001 to 2008 at a single institution were retrospectively analyzed. Logistic regression was used to estimate the association between chondral and meniscal injuries and age, gender, tear chronicity, additional ligamentous injuries, sport type, and participation level. Of the 3,040 ACL reconstructions analyzed, 90.4% were primary reconstructions and 9.6% were revisions. Meniscal injuries were significantly lower in the revision group (44.0 vs. 51.9%; p = 0.01), while chondral injuries were significantly higher in the revision group (39.9 vs. 24.0%; p < 0.0001). Inspection of the small subgroup (n = 85) receiving both primary and revision ACL surgery at our center indicated that meniscal injuries at revision were evenly split between menisci with and without previous repairs, whereas the vast majority of Grade III and IV chondral lesions were new. More patients presented for surgery later in the revision group than in the primary group (56.5 vs. 35.3%; p < 0.0001). Male gender, primary reconstruction, and short interval (less than 2 weeks) between injury and surgery were associated with increased likelihood of meniscus tear. Age (greater than 22 years) and long interval (greater than 6 weeks) between injury to surgery and higher sport activity level were associated with chondral lesions. Revision ACL reconstructions are associated with a higher proportion of chondral lesions and a lower proportion of meniscal tears. Early primary and revision ACL construction is recommended to reduce the probability of chondral lesions.
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Cheatham, Seth A., and Darren L. Johnson. "Anatomic Revision ACL Reconstruction." Sports Medicine and Arthroscopy Review 18, no. 1 (March 2010): 33–39. http://dx.doi.org/10.1097/jsa.0b013e3181c14998.
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Saithna, Adnan, Charles Pioger, Johnny Rayes, Ibrahim Haidar, Thomas FRADIN, Ngbilo Cédric, Thais Vieira, and Bertrand Sonnery-Cottet. "Significant Increase in the Rate of Meniscal and Chondral Injuries Between Primary and Revision Anterior Cruciate Ligament Reconstruction. (188)." Orthopaedic Journal of Sports Medicine 9, no. 10_suppl5 (October 1, 2021): 2325967121S0030. http://dx.doi.org/10.1177/2325967121s00302.
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Objectives: Anterior cruciate ligament (ACL) injuries are often associated with meniscal and chondral lesions. Meniscal lesions are present in up to 50% of ACL injured knees, and chondral lesions occur with an incidence of 20% to 40% in acute ACL-injured knees. The major importance of this lies in the fact that menisectomy and severe chondral damage are important predictors of poor outcomes including the subsequent development of knee osteoarthritis. Furthermore, patient reported outcomes following revision ACL reconstruction remain inferior to primary ACL reconstruction and this may, at least in part, be due to an increased incidence and severity of meniscal and chondral injuries. Although multiple studies have demonstrated that meniscal and chondral lesions are generally present at a higher rate at the time of revision ACL reconstruction when compared to primary ACL reconstruction, large studies following individual patients through primary and revision ACL reconstruction and tracking the change in the occurence of these injuries are scarce. The primary objective of this study was to determine the proportion of patients with meniscal and chondral injuries at the time of primary ACL reconstruction and determine how this rate changed by the time they underwent revision ACL reconstruction. The hypothesis was that the proportion of patients with meniscal and/or chondral lesions would be significantly greater at revision ACL reconstruction when compared to the primary procedures. Methods: Consecutive patients who underwent primary and then revision ACL reconstruction between March 1999 and February 2018 were identified using a single center registry. Patient characteristics, and intraoperative data from each procedure were collected and analyzed. This specifically included the occurrence and type of meniscal and chondral pathology. Descriptive statistics were used to evaluate the study sample using medians, descriptive data analysis was conducted depending on the nature of the criteria. Comparison between variables were assessed with student’s t test for quantitative variables and Mcnemar test for categorical variables. Statistical significance was set a t p<0.05. Results: 213 consecutive patients underwent both primary ACL reconstruction and then revision surgery during the study period. The average time from primary ACLR to Revision was 46.8 ± 36.6 months (range 5-181).The mean age of patients at primary ACLR was 22.21±7.21 years. The mean age of patients at revision ACLR 26.1 ± 8.3 years. The mean IKDC for the entire population was 85.53 ± 11.59, The mean ACL-RSI score was 71.89 ± 23.95. The mean Lysholm score was 91.77±10.24. The proportion of patients with chondral lesions significantly increased from 7% at primary ACL to 15.5% at revision ACL (p < 0.05). Meniscal lesions also significantly increased from 44.6 % at primary ACLR to 70% at revision ACLR (p < 0.05). There was no significant difference in the rate of lateral meniscal lesions (11.7 vs 13.1, p > 0.05). However, the proportion of patients with a medial meniscus lesion (25.4 vs 36.2, p < 0.05) and bimeniscal lesions (7.5 vs 20.7, p < 0.05) increased significantly at revision ACL reconstruction. Conclusions: The proportion of patients with meniscal and//or chondral injuries at the time of revision ACL reconstruction is significantly higher than at the time of primary ACL reconstruction. Specifically, the rate of medial meniscus and bimeniscal injuries is significantly higher in patients undergoing revision ACL reconstruction
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Wilde, Jeffrey, Asheesh Bedi, and David W. Altchek. "Revision Anterior Cruciate Ligament Reconstruction." Sports Health: A Multidisciplinary Approach 6, no. 6 (August 20, 2013): 504–18. http://dx.doi.org/10.1177/1941738113500910.
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Context: Reconstruction of the anterior cruciate ligament (ACL) is one of the most common surgical procedures, with more than 200,000 ACL tears occurring annually. Although primary ACL reconstruction is a successful operation, success rates still range from 75% to 97%. Consequently, several thousand revision ACL reconstructions are performed annually and are unfortunately associated with inferior clinical outcomes when compared with primary reconstructions. Evidence Acquisition: Data were obtained from peer-reviewed literature through a search of the PubMed database (1988-2013) as well as from textbook chapters and surgical technique papers. Study Design: Clinical review. Level of Evidence: Level 4. Results: The clinical outcomes after revision ACL reconstruction are largely based on level IV case series. 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. Nevertheless, there is a general consensus that the outcomes for revision ACL reconstruction are inferior to primary reconstruction. Conclusion: Excellent results can be achieved with regard to graft stability, return to play, and functional knee instability but are generally inferior to primary ACL reconstruction. A staged approach with autograft reconstruction is recommended in any circumstance in which a single-stage approach results in suboptimal graft selection, tunnel position, graft fixation, or biological milieu for tendon-bone healing. Strength-of-Recommendation Taxonomy (SORT): Good results may still be achieved with regard to graft stability, return to play, and functional knee instability, but results are generally inferior to primary ACL reconstruction: Level B.
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Thorolfsson, Baldur, Eleonor Svantesson, Thorkell Snaebjornsson, Mikael Sansone, Jon Karlsson, Kristian Samuelsson, and Eric Hamrin Senorski. "Adolescents Have Twice the Revision Rate of Young Adults After ACL Reconstruction With Hamstring Tendon Autograft: A Study From the Swedish National Knee Ligament Registry." Orthopaedic Journal of Sports Medicine 9, no. 10 (October 1, 2021): 232596712110388. http://dx.doi.org/10.1177/23259671211038893.
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Background: Previous studies have identified young age as a risk factor for anterior cruciate ligament (ACL) revision. However, few studies have looked separately at pediatric patients and adolescents with regard to outcomes after ACL reconstruction. Purpose: To determine whether patient age at ACL reconstruction affects the risk of undergoing revision surgery in young patients. Study Design: Cohort study; Level of evidence, 3. Methods: This study was based on data from the Swedish National Knee Ligament Registry. Patients aged 5 to 35 years who underwent a primary ACL reconstruction with a hamstring tendon autograft between January 1, 2005, and December 31, 2015, were included. The cohort was stratified into different age groups of pediatric patients, adolescents, and young adults to estimate patients with open, recently closed, and closed epiphyses, respectively. The primary endpoint was ACL revision. A multivariable Cox regression model was used to assess the ACL revision rate. The results were expressed as hazard ratios (HRs) and 95% CIs. Results: A total of 36,274 ACL reconstructions were registered during the study period. Of these, 2848 patients were included in the study: 47 pediatric patients (mean age, 13.6 years; range, 9-15 years), 522 adolescents (mean age, 17.4; range, 14-19 years), and 2279 young adults (mean age, 27.0; range, 20-35 years). A total of 31 patients (1.1%) underwent ACL revision within 2 years (0 pediatric patients, 9 adolescents [1.7%], and 22 young adults [1.0%]) and a total of 53 patients (2.6%) underwent ACL revision within 5 years (2 pediatric patients [6.9%], 15 adolescents [3.9%], and 36 young adults [2.2%]). The adolescent age group had a 1.91 times higher rate of ACL revision compared with the young adults (HR = 1.91 [95% CI, 1.13-3.21]; P = .015). There were no differences in revision rates between the pediatric age group and the young adults (HR = 2.93 [95% CI, 0.88-9.79]; P = .081). Conclusion: Adolescents had almost twice the rate of revision ACL reconstruction compared with young adults.
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Mathew, Cristin J., Jeremiah E. Palmer, Bradley S. Lambert, Joshua D. Harris, and Patrick C. McCulloch. "Single-stage versus two-stage revision anterior cruciate ligament reconstruction: a systematic review." Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine 3, no. 6 (September 15, 2018): 345–51. http://dx.doi.org/10.1136/jisakos-2017-000192.
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ImportanceDespite advances in surgical techniques and postoperative rehabilitation, long-term anterior cruciate ligament (ACL) graft rupture rate remains high. The increasing number of primary ACL reconstructions in an ageing population will lead to increasing revision reconstructions. Revision cases may have higher failure rates and worse patient-reported outcomes compared with primaries. While two-stage revisions may be indicated in certain complex cases, whether this is comparatively equivalent or even superior to revisions done in a single stage would assist preoperative planning.ObjectiveThe objective of this systematic review was to analyse and compare patient-reported outcomes and failure rate of single-stage versus two-stage revision ACL reconstruction.Evidence reviewUsing PubMed, MEDLINE Complete and Ovid MEDLINE databases, a review was performed using Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines to identify level I–IV outcomes of revision ACL reconstruction with a minimum follow-up of 24 months.FindingsThree studies reported outcomes of two-stage revisions with mean follow-up of 61.6 months, while 21 studies reported single-stage revisions with mean follow-up of 47.4 months. Pooled rate of two-stage revisions was 3.1% compared with 6.8% in single-stage (p=0.068). Clinical failure was reported in 5.1% of 79 two-stage patients compared with 13.8% of 533 single-stage patients (p<0.05). Within the single-stage cohort, there was a greater clinical failure rate (+8.7%, p<0.05) for patients with less than 48 months follow-up. Those with > 48 months follow-up had a higher rerupture rate (+5%, p<0.05) and a significantly greater sum of squared deviations (p<0.05) compared with those with < 48 months follow-up. Patient-reported outcomes have demonstrated two-stage revision patients with higher IKDC A and B scores than single-stage.Conclusions and relevanceAlthough two-stage revisions may be performed in more complex cases, there are limited short-term data available regarding their outcomes. Two-stage revisions demonstrated comparable clinical outcomes and lower rate of revision surgery and clinical failure compared with single-stage revisions. Studies with shorter follow-up (24–48 months) showed higher clinical failure rates. Those with longer follow-up (>48 months) showed higher graft rerupture rates. The decision to perform staged reconstruction should made on whether adequate tunnel placement and fixation can be established in a single setting.Level of evidenceLevel IV.
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Ouillette, Ryan, Eric Edmonds, Henry Chambers, Tracey Bastrom, and Andrew Pennock. "Outcomes of Revision Anterior Cruciate Ligament Surgery in Adolescents." American Journal of Sports Medicine 47, no. 6 (April 17, 2019): 1346–52. http://dx.doi.org/10.1177/0363546519837173.
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Background: Although primary anterior cruciate ligament (ACL) reconstructions have been well studied in children and adolescents, the literature lacks information about revision ACL reconstructions in this population. Purpose: This study aims to analyze the outcomes of revision ACL surgeries in the pediatric population. Study Design: Case series; Level of evidence, 4. Methods: A retrospective study was performed on all revision ACL reconstructions performed at a single institution between 2009 and 2017. Patient demographic, injury, and operative data from both the initial surgery and the revision were documented. Outcome measures included the Lysholm score, Single Assessment Numeric Evaluation (SANE) score, Tegner activity score, visual analog scale for pain, Hospital for Special Surgery Pediatric Functional Activity Brief Scale score, patient satisfaction, ability to return to the same level of sport, and any additional injury and/or surgery. Outcomes of the revision surgeries were compared with our institution’s outcome database of primary ACL reconstructions. Results: During the study period, 60 revision ACL reconstructions were performed in 57 patients. Of these patients, 84% (n = 48) were available for a minimum 2-year follow-up and a mean follow-up of 4.4 years. A greater number of meniscal tears and cartilage injuries were documented in the revision cohort. Compared with the primary cohort, the revision cohort had lower SANE scores, Lysholm scores, and satisfaction. Furthermore, the revision cohort had a higher rate of graft failure than the primary cohort (21% vs 9%, respectively; P = .015), and only 27% of revision patients returned to the same level of sport. In a comparison of revision procedures performed with autograft versus allograft tissue, the autograft patients had higher Lysholm scores than the allograft patients (91 vs 83, respectively; P = .045) and trended toward a lower failure rate (11% vs 27%, respectively; P = .199). Conclusion: Adolescent patients undergoing revision ACL reconstruction had more meniscal and cartilage abnormalities, poorer functional outcomes, and higher graft failure rates than patients undergoing primary ACL reconstructions. Additionally, revision procedures performed with allograft tissue resulted in lower Lysholm scores and a trend toward higher failure rates. When an ACL graft fails in a young patient, strong consideration should be given to using autograft tissue for the revision.
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Matzkin, Elizabeth. "The Revision ACL Rehabilitation Conundrum." Journal of Bone and Joint Surgery 101, no. 9 (May 2019): e40. http://dx.doi.org/10.2106/jbjs.19.00003.
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Smith, Andrew H., Bernard R. Bach, and Charles A. Bush-Joseph. "Allograft for Revision ACL Reconstruction." Sports Medicine and Arthroscopy Review 13, no. 2 (June 2005): 86–92. http://dx.doi.org/10.1097/01.jsa.0000162552.16118.56.
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Bach, Bernard. "Revision ACL—An Intergalactic Journey." Journal of Knee Surgery 20, no. 04 (January 20, 2010): 259–60. http://dx.doi.org/10.1055/s-0030-1248054.
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Webster, Kate E., Julian A. Feller, Alexander J. Kimp, and Timothy S. Whitehead. "Revision Anterior Cruciate Ligament Reconstruction Outcomes in Younger Patients: Medial Meniscal Pathology and High Rates of Return to Sport Are Associated With Third ACL Injuries." American Journal of Sports Medicine 46, no. 5 (January 30, 2018): 1137–42. http://dx.doi.org/10.1177/0363546517751141.
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Background: There are limited data evaluating the outcomes of revision anterior cruciate ligament (ACL) reconstruction surgery in younger patients despite recent reports that the rates of graft rupture are higher in young cohorts. Purpose: To explore the outcomes of revision ACL reconstruction surgery in younger patients with the specific aims of determining the rates of third ACL injury and whether knee pathology at the time of revision surgery and return to sport were associated with further injury. Study Design: Case-control study; Level of evidence, 3. Methods: The study cohort consisted of 151 consecutive patients who were aged 25 years or younger at the time of their first revision ACL reconstruction. The number of subsequent ACL injuries (graft rerupture or contralateral injury to the native ACL) was determined at a mean follow-up time of 4.5 years (range, 2-9 years). Surgical details were recorded, along with a range of sport participation outcomes. Contingency tables were used to assess the associations between subsequent ACL injury and return to sport, knee pathology, and the drilling of new femoral or tibial tunnels at revision surgery. Results: The follow-up rate was 85% (128/151). Graft reruptures occurred in 20 patients (16%) at a mean time of 2 years after revision surgery. Contralateral ACL injuries occurred in 15 patients (12%) at a mean time of 3.9 years. The total number of patients who had a third ACL injury was 35 (27%). There was a significant association between having medial meniscal pathology and sustaining a graft rerupture ( P = .03), but there was no association between graft rerupture and using the same tunnels from the primary procedure at revision surgery. After revision reconstruction, 68% of patients (95% CI, 55%-71%) returned to their preinjury level of sport, compared with 83% (95% CI, 69%-84%) after primary reconstruction in the same patients. Those who had a third ACL injury had a significantly higher rate of return to preinjury sport (83%) after the revision procedure than did the group that did not have further ACL injuries (62%, P = .02). Conclusion: Younger patients are at significant risk of having multiple ACL injuries. The high rate of third ACL injuries presents a significant issue for future knee health in these young athletes. Medial meniscal pathology and returning to high-risk sport are factors that are significantly associated with the high multiple ACL injury rate in the young.
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Ragab, Abdelaleem, Waleed Akeel, Vinayak Ghanate, Omar Elalfy, Randy Guro, Amit Chandratreya, and Amit Chandratreya. "Outcome of Single Stage Revision ACL Reconstruction. Retrospective Study and Review of Literature." Ortopedia Traumatologia Rehabilitacja 22, no. 3 (June 30, 2020): 187–94. http://dx.doi.org/10.5604/01.3001.0014.3235.
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Background. Pragmatic review of outcomes for single stage revision ACL reconstruction performed in a single center and the reasons for failure in primary surgery. Material and methods. Retrospective study included 59 patients with revision ACL reconstruction done by one surgeon from 2007 to 2017.Clinical records, operative notes and x-rays were assessed to find the reasons of failure. Results. The cause of failure was traumatic in 26 (44.1%) patients after primary reconstruction, incorrect tunnel position in 18(30.5%) and biological failure in 15 (25.4%). All ACL revisions were done using autografts; patellar tendon grafts in 33 patients (55.9%), ipsilateral hamstrings in 12 (20.3%), contralateral hamstrings in 9 (15.3%) and quadriceps tendons in 5 (8.5%). Twenty-one patients were contactable as regards postoperative functional outcome scores. There was an average 18 point improvement in Oxford knee score (OKS) post-operatively, 1.6 point improvement in Tegner scores and 30 point improvement in Lysholm scores. One patient (1.7%) developed septic arthritis, 4 (6.8%) had superficial infection, while 6 (10.2%) had residual instability after revision but did not have further surgery. There was lack of full extension in 4 (6.8%) patients. In BTB grafts, 2 (6.1%) patients sustained a post-traumatic patellar fracture. Conclusions: 1. Good outcomes of single stage revision ACL reconstruction surgery are achievable as demonstrated in our cohort. 2. There is need for good quality research to identify whether BTB, hamstrings or quadriceps autografts are better for ACL Reconstruction.
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Zordan, J., H. Rivarola Etcheto, C. Collazo Blanchod, M. Palanconi, E. Álvarez Salinas, CM Autorino, and G. Escobar. "Anterolateral Ligament Reconstruction." Orthopaedic Journal of Sports Medicine 5, no. 1_suppl (January 1, 2017): 2325967117S0003. http://dx.doi.org/10.1177/2325967117s00039.
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Anterior cruciate ligament (ACL) reconstruction is a common procedure in daily practice with 75 to 97% excellent long-term results. But in certain cases, some patients perceive rotational instability, for this reason the revision rate can be 10 to 15%. Objectives: evaluate functional outcome in revisions of ACL reconstruction associated with ALL. Methods: Between July 2015 and February 2016 (11 knees) Eleven Revision ACL reconstruction were performed with ALL with double incision technique performed by the same surgical team. Inclusion criteria were: ACL reconstruction failures with a grade 2 or 3 Lachman test, a grade 3 pivot-shift without other ligamentary injury lesions associated and complete range of motion. Results: The concept of rotational instability associated with ACL injury has been described more than a decade ago. However, there is no consensus on how to quantify rotational instability in ACL injuries; so when associating an extracapsular technique. Currently there is a lack of high-level evidence comparing isolated ACL repair and associated with the modified reconstruction of ALL that allows us to define therapeutic approaches. The ALL reconstruction associate an ACL reconstruction remains a matter of study. Conclusion: We obtain excellent results in antero – posterior and rotational stability after performing the procedure.
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Saprykin, A. S., S. A. Bantser, M. V. Rybinin, and N. N. Kornilov. "Current aspects of preoperative planning and selection of surgical techniques for revision anterior cruciate ligament reconstruction." Genij Ortopedii 28, no. 3 (June 2022): 444–51. http://dx.doi.org/10.18019/1028-4427-2022-28-3-444-451.
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Introduction Reconstruction of the anterior cruciate ligament (ACL) is one of the most common surgical procedures around the knee. Despite good long-term outcomes in general, thousands of revisions after ACL reconstruction are performed annually in the world due to graft failures, repeated injuries, technical errors, disorders in ligamentization process or inadequate rehabilitation. The aim of the study was to evaluate the current evidence and describe the relevant clinical features of planning and performing revision ACL reconstruction. Materials and methods A search was conducted for English- and Russian-language publications in the electronic databases PubMed and e-LIBRARY for the period from 2000 to 2020 using the keywords: anterior cruciate ligament, ACL, revision, re-reconstruction, re-rupture. Among 572 publications, 107 corresponded to the study topic. Based on the inclusion criteria (more than 50 reported cases; follow-up more than 2 years; homogeneous groups of patients; assessment with knee function scores; application of various imaging options), 31 articles were included in this review. There were no Russian studies that met the above-mentioned criteria. Results and discussion The analysis of the literature identified four clinically relevant features in the treatment of patients with failures of ACL reconstruction: criteria and principles for the implementation of a one- or two-stage approach; additional features of the revision ACL reconstruction; determination of the optimal graft type. Conclusion Most of the revision ACL reconstructions can be performed at one stage, combined with bone grafting if needed. For a successful treatment outcome, in some cases, correction of frontal and sagittal deformity of the lower limb, management of the injury to other knee joint stabilizers, to cartilage or menisci is required. Surgeons’ preferences in the choice of plastic material has shifted to autografts with bone blocks, or allografts, especially if reconstruction of several stabilizers is necessary.
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Grassi, Alberto, Luca Macchiarola, Gian Andrea Lucidi, Federico Stefanelli, Mariapia Neri, Annamaria Silvestri, Francesco Della Villa, and Stefano Zaffagnini. "More Than a 2-Fold Risk of Contralateral Anterior Cruciate Ligament Injuries Compared With Ipsilateral Graft Failure 10 Years After Primary Reconstruction." American Journal of Sports Medicine 48, no. 2 (January 7, 2020): 310–17. http://dx.doi.org/10.1177/0363546519893711.
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Background: Failure of anterior cruciate ligament (ACL) reconstruction or an injury to the ACL in the contralateral knee represents a devastating event for patients, especially those young and physically active. However, controversies are still present regarding long-term failure rates and risk factors. Purpose: To assess the long-term rate of ipsilateral graft failure and contralateral ACL injuries after ACL reconstruction performed at a single center using the same surgical technique with a hamstring autograft and to investigate the effect of sex, age, and preinjury activity level as predictors of second ACL injuries. Study Design: Case series; Level of evidence, 4. Methods: The study cohort consisted of 244 consecutive patients (mean age, 30.7 years) who underwent ACL reconstruction with a single bundle plus lateral plasty technique using the hamstring tendon between November 2007 and May 2009. The number of subsequent ACL injuries (ipsilateral ACL revision or contralateral ACL reconstruction) was determined at a minimum follow-up of 10 years. Survivorship of either knee and subgroup analysis included sex, age, preoperative Tegner activity level, timing of ACL reconstruction, body mass index, and smoking status. Results: Ipsilateral ACL revision was performed in 8 (3.4%) patients and contralateral ACL reconstruction in 19 (7.8%) patients. Only 1 patient had both ipsilateral and contralateral injuries. No predictors were found for ipsilateral ACL revision, while age <18 years and preoperative Tegner level ≥7 had a higher risk of contralateral ACL reconstruction. The highest rate of a second ACL reconstruction procedure was in young (<18 years) and active (Tegner ≥7) patients, in whom the 10-year survival of either knee was 61.1%. Six years after primary ACL reconstruction, the rate of contralateral ACL reconstruction was significantly higher than that of ipsilateral ACL revision (hazard ratio, 2.4-3.6). Conclusion: In the long term, a second injury to either the ipsilateral or the contralateral knee in young and active populations could reach 40%, with a more than double-fold risk of contralateral ACL reconstruction compared with ipsilateral ACL revision.
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Keyhani, Sohrab, Behzad Hanafizadeh, René Verdonk, Mohammadreza Minator Sajjadi, and Mehran Soleymanha. "Revision Single-Stage Anterior Cruciate Ligament Reconstruction Using an Anterolateral Tibial Tunnel." Journal of Knee Surgery 33, no. 04 (February 6, 2019): 410–16. http://dx.doi.org/10.1055/s-0039-1677812.
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AbstractRevision anterior cruciate ligament (ACL) reconstruction is a technically demanding enterprise. Management of widened or previously malpositioned tunnels is challenging and often requires innovative approaches. The purpose of this study was to evaluate the function and clinical results of revision single-stage ACL surgery using an anterolateral tibial tunnel (ALTT). A consecutive series of knees with arthroscopic ACL revision surgery were analyzed prospectively between April 2012 and September 2015. Among the 93 patients presented with revision ACL reconstruction, 25 patients met the study inclusion criteria for the ALTT technique and were followed up for a minimum of 2 years (range: 24–51 months). The clinical results were evaluated by means of the Lysholm score, International Knee Documentation Committee (IKDC) score, and Tegner activity level scale, and the knee stability was assessed by the Lachman test, pivot shift test, and anterior drawer test. Magnetic resonance imaging (MRI) of the index knee before the surgery and 2 years after revision surgery was assessed. The mean IKDC subjective score, mean Tegner activity level scale, and mean Lysholm score significantly improved in all study participants. This study showed that ACL revision surgery with ALTT can reliably restore stability and provide fair functional outcomes in patients with ACL retear. One could expect acceptable lateral tibial tunnel length compared with medial tibial tunnel in classic ACL revision, intact bony surround, and good graft fixation. This technique is clinically relevant in that making an anterolateral tunnel in one-stage ACL revision surgery had a good subjective result with low complication rate in midterm follow-up.
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Napier, Richard J., Enrique Garcia, Brian M. Devitt, Julian A. Feller, and Kate E. Webster. "Increased Radiographic Posterior Tibial Slope Is Associated With Subsequent Injury Following Revision Anterior Cruciate Ligament Reconstruction." Orthopaedic Journal of Sports Medicine 7, no. 11 (November 1, 2019): 232596711987937. http://dx.doi.org/10.1177/2325967119879373.
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Background: Increased posterior tibial slope has been identified as a possible risk factor for injury to the anterior cruciate ligament (ACL) and has also been shown to be associated with ACL reconstruction graft failure. It is currently unknown whether increased posterior tibial slope is an additional risk factor for further injury in the context of revision ACL reconstruction. Purpose: To determine the relationship between posterior tibial slope and further ACL injury in patients who have already undergone revision ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 330 eligible patients who had undergone revision ACL reconstruction between January 2007 and December 2015 were identified from a clinical database. The slope of the medial and lateral tibial plateaus was measured on perioperative lateral radiographs by 2 fellowship-trained orthopaedic surgeons using a digital software application. The number of subsequent ACL injuries (graft rupture or a contralateral injury to the native ACL) was determined at a minimum follow-up of 2 years (range, 2-8 years). Tibial slope measurements were compared between patients who sustained further ACL injury to either knee and those who did not. Results: There were 50 patients who sustained a third ACL injury: 24 of these injuries were to the knee that underwent revision ACL reconstruction, and 26 were to the contralateral knee. Medial and lateral slope values were significantly greater for the third-injury group compared with the no–third injury group (medial, 7.5° vs 6.3° [ P = .01]; lateral, 13.6° vs 11.9° [ P = .001]). Conclusion: Increased posterior tibial slope, as measured from lateral knee radiographs, was associated with increased risk of graft rupture and contralateral ACL injury after revision ACL reconstruction. This is consistent with the concept that increased posterior slope, particularly of the lateral tibial plateau, is an important risk factor for recurrent ACL injury.
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Borque, Kyle, Mary Jones, Simon Ball, Andy Williams, and Nathan White. "Single-Stage Revision Anterior Cruciate Ligament Reconstruction: Experience with 92 cases (41 elite athletes), Using an Algorithm." Orthopaedic Journal of Sports Medicine 8, no. 7_suppl6 (July 1, 2020): 2325967120S0050. http://dx.doi.org/10.1177/2325967120s00509.
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Objectives: The increased prevalence of anterior cruciate ligament (ACL) reconstructions has led to an increased need for revision ACL reconstructions. Despite the lack of comparative literature, two-stage revisions are often undertaken under the pretense they are safer. Through careful patient selection, pre-operative planning, and meticulous attention to detail, single stage revisions can be performed with good outcomes, decreasing healthcare costs, morbidity and recovery time for the patient. The objective of this paper is to present an algorithm (Figure 1) to determine single-stage or two-stage approaches to ACL revision with good outcomes in recreational and elite athletes. Methods: All revision ACL reconstructions performed by the senior author from September 2009 to July 2016, with minimum two year follow-up, were retrospectively reviewed. Outcomes measured were: any further surgery, graft re-rupture, re-revision, Tegner score, and knee injury and osteoarthritis outcomes score (KOOS). For the elite athlete population, return to play time, duration and level compared to pre-injury were also determined. Results: Ninety-four procedures were performed in 93 patients. This included 41 in elite athletes. In this series only 2 (2%) two-stage procedures were undertaken. At an average of 4.3 years (range: 2-8.5 years) post surgery, there had been two re-revisions. There were two further instances of graft failure which had not been re-revised. The graft failure rate was therefore 4.3%. There were 17 subsequent procedures, including six arthroscopic partial meniscectomies, five removal of prominent implants, and one total knee arthroplasty. The average Tegner score was 8.2 preoperatively, and 7.1 at follow up. At follow up, the average KOOS scores were 79.3 for symptoms, 88.0 for pain, 94.2 for activities of daily living, 73.6 for sport, and 68.9 for quality of life. Thirty-six of 41 elite athletes returned to play, at an average of 338 days post surgery. At an average of 4.6 years, 29 were still playing professionally. Of these, 15 were at the same level, and 14 at a lower level. Five players returned to play but have since retired. This occurred at an average of 3.1 years post op, at an age of 30. Conclusion: Single stage ACL revisions can be performed reliably in the majority, but not all, patients with persistent or recurrent instability following failed ACL reconstruction with good clinical outcomes and return to play, even in the elite athletic population. [Figure: see text]
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Godin, Jonathan, Travis John Dekker, William E. Garrett, and Jonathan Charles Riboh. "Risk Factors for Revision or Contralateral ACL Reconstruction." Orthopaedic Journal of Sports Medicine 5, no. 3_suppl3 (March 1, 2017): 2325967117S0013. http://dx.doi.org/10.1177/2325967117s00130.
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Objectives: Physical therapy (PT) is routinely prescribed after anterior cruciate ligament (ACL) reconstruction, and is considered a significant contributor to the cost of ACL care. With the upcoming implementation of alternative reimbursement models, data about the true cost and value of ACL rehabilitation are necessary to guide its utilization. The purpose of this study is to evaluate the effects of age, gender, and physical therapy (PT) utilization on second ACL reconstruction rates and to assess the value of post-operative PT. Methods: Patients who underwent ACL reconstruction (Current Procedural Terminology (CPT) code 29888) between 2007 and 2014 were identified using the PearlDiver database. Demographic data including age and sex were obtained for this cohort. Physical therapy utilization was determined by the percentage of patients with at least one post-operative PT-related code at 2, 4, 6, 12 and 24 weeks after surgery. Patients with a subsequent ACL injury (ipsilateral or contralateral) requiring reconstruction within 24 months of the index procedure were identified. The effects of age, sex and PT utilization on the risk of subsequent ACL surgery were calculated using contingency analysis (chi-square test). Risk ratios (RR) with 95% confidence intervals were calculated for each predictor. Results: A total of 11,272 patients undergoing ACL reconstruction were identified between 2007 and 2014. PT utilization steadily increased at each time point, and 89.8% of patients had at least one PT visit in the 6 months following ACL reconstruction. A total of 513 patients had subsequent ACL surgery, for a composite subsequent ACL surgery rate of 4.6%. Age under 19 years carried a higher risk of subsequent ACL surgery (8.3% vs. 3.8%, RR = 2.21, 95% CI 1.88 - 2.61, p < 0.0001). Women had a slightly higher rate of subsequent ACL surgery than men (5.1% vs. 4.2%, RR = 1.22, 95% CI 1.03 - 1.44, p = 0.02). Participation in any PT significantly decreased the risk of subsequent ACL surgery (3.9% vs. 10.6%, RR = 0.36, 95% CI = 0.30 - 0.44, p < 0.0001). Subsequent surgery rates were not affected by the number of PT visits if less than 30 visits were utilized. However, patients utilizing greater than 30 visits had a higher risk of subsequent ACL surgery (16.5% vs. 2.3%, RR = 7.15, 95% CI = 5.68 - 9.01, p < 0.0001). The total cost associated with ACL reconstruction within 24 months was $19,191 per patient. The weighted per-person average reimbursement (PPAR) for PT was $1,879, or 9.8% of the total cost of care. Conclusion: Physical therapy utilization is currently high after ACL reconstruction (89.8%). Participation in PT reduces the incidence of subsequent ACL surgery (ipsilateral or contralateral) nearly three-fold (3.9% vs. 10.6%), at a cost of only $1,879 per patient (< 10% of total cost of care). PT after ACL reconstruction therefore offers significant value, particularly in young (< 19 years) athletes who have a higher risk of subsequent injury. However, excessive PT use after ACLR (> 30 visits) may be an indicator of patients with a sustained risk of re-injury.
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Wright, Rick W., Laura J. Huston, Amanda K. Haas, Samuel K. Nwosu, Christina R. Allen, Allen F. Anderson, Daniel E. Cooper, et al. "Meniscal Repair in the Setting of Revision Anterior Cruciate Ligament Reconstruction: Results From the MARS Cohort." American Journal of Sports Medicine 48, no. 12 (August 21, 2020): 2978–85. http://dx.doi.org/10.1177/0363546520948850.
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Background: Meniscal preservation has been demonstrated to contribute to long-term knee health. This has been a successful intervention in patients with isolated tears and tears associated with anterior cruciate ligament (ACL) reconstruction. However, the results of meniscal repair in the setting of revision ACL reconstruction have not been documented. Purpose: To examine the prevalence and 2-year operative success rate of meniscal repairs in the revision ACL setting. Study Design: Case-control study; Level of evidence, 3. Methods: All cases of revision ACL reconstruction with concomitant meniscal repair from a multicenter group between 2006 and 2011 were selected. Two-year follow-up was obtained by phone and email to determine whether any subsequent surgery had occurred to either knee since the initial revision ACL reconstruction. If so, operative reports were obtained, whenever possible, to verify the pathologic condition and subsequent treatment. Results: In total, 218 patients (18%) from 1205 revision ACL reconstructions underwent concurrent meniscal repairs. There were 235 repairs performed: 153 medial, 48 lateral, and 17 medial and lateral. The majority of these repairs (n = 178; 76%) were performed with all-inside techniques. Two-year surgical follow-up was obtained on 90% (197/218) of the cohort. Overall, the meniscal repair failure rate was 8.6% (17/197) at 2 years. Of the 17 failures, 15 were medial (13 all-inside, 2 inside-out) and 2 were lateral (both all-inside). Four medial failures were treated in conjunction with a subsequent repeat revision ACL reconstruction. Conclusion: Meniscal repair in the revision ACL reconstruction setting does not have a high failure rate at 2-year follow-up. Failure rates for medial and lateral repairs were both <10% and consistent with success rates of primary ACL reconstruction meniscal repair. Medial tears underwent reoperation for failure at a significantly higher rate than lateral tears.
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Glasbrenner, Johannes, Clemens Kösters, Lena Spickermann, Christoph Kittl, Christoph Domnick, Mirco Herbort, Michael J. Raschke, and Benedikt Schliemann. "Repair vs. Reconstruction for Acute Isolated ACL Tears- 2-Year Results of a Prospective Randomized Study." Orthopaedic Journal of Sports Medicine 8, no. 5_suppl4 (May 1, 2020): 2325967120S0032. http://dx.doi.org/10.1177/2325967120s00326.
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Aims and Objectives: Recently, due to the development of new techniques, ACL repair has returned back into focus of experimental and clinical research. Newer studies highlight the fact that ACL repair can lead to satisfying functional results and healing rates. Aim of the present study was to compare the functional results after ACL repair in comparison to primary ACL reconstruction for acute isolated ACL tears. It was hypothesized, that functional results and knee joint stability after ACL repair are comparable to those after ACLR. Materials and Methods: A prospective randomized study (Level of evidence 1) including a total of 85 patients with acute ACL tears was performed. Patients were randomized to undergo either ACL repair or primary ACL reconstruction with a semitendinosus autograft. The preinjury activity level and function were recorded. Follow-up examinations were performed at six weeks, six, twelve and 24 months postoperatively. At each follow up, the Tegner activity scale, the International Knee Documentation Committee (IKDC) subjective score and the Lysholm score were acquired. Furthermore, anterior tibial translation (ATT) was evaluated by Rolimeter testing. The rate of recurrent instability and other complications were recorded. Results: 79 patients could be re-evaluated (follow-up rate 93%). No significant differences between ACL repair and ACLR were found for the Tegner, IKDC and Lysholm score at any time of the follow-up. ATT was increased in the ACL repair group ( ATT 1.9 vs. 0.9). This difference was statistically significant (p=0.0086). Seven patients (17%) of the ACL repair group presented with recurrent instability and underwent single-stage revision reconstruction with hamstring autografts. Another three patients showed increased laxity with insufficient healing after ACL repair but did not require revision. In the ACLR group, five patients (13%) sustained a re-tear after return to their previous activity level. However, in three cases, a two-staged revision was required. Recurrent instability was associated with young age and higher Tegner scores in both groups. Conclusion: Functional results after ACL repair for acute tears are comparable to those after ACLR. However, the rate of ACL insufficiency seems to be slightly increased after ACL repair. In the revision situation, single-stage revision was possible in all cases following primary repair, whereas after primary reconstruction, a two-staged revision had to be performed in three of five cases. The current study supports the use of ACL repair as an option to treat acute ACL tears.
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Lemme, Nicholas J., Daniel S. Yang, Brooke Barrow, Ryan O’Donnell, Alan Daniels, and Aristides I. Cruz. "RISK FACTORS FOR FAILURE FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN A PEDIATRIC POPULATION: A NOVEL PREDICTION ALGORITHM." Orthopaedic Journal of Sports Medicine 9, no. 7_suppl3 (July 1, 2021): 2325967121S0002. http://dx.doi.org/10.1177/2325967121s00027.
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Background: Pediatric anterior cruciate ligament (ACL) reconstruction is becoming increasingly common, however, there is limited literature on the risk factors for failure in this demographic. Hypothesis/Purpose: In the present study we sought to: 1. To determine the rate of pediatric ACL reconstruction (ACLR) failure requiring revision surgery in a nationally representative sample. 2. To determine the associated patient/injury-specific risk factors for ACLR failure. 3. To examine the differences in the rate and risks of failure between pediatric and adult patients. Methods: Patient records were drawn from Humana individual health plans and Medicare medical records. Adult and pediatric patients who underwent primary ACLR and subsequent reoperation for either ACL revision surgery or a revision meniscal procedure between 2011-2016 were identified. Multivariate regression was used to determine the significant risk factors for ACL revision and overall reoperation rates in pediatric and adult patients. A risk algorithm was developed to predict the risk of ACL revision following pediatric ACL reconstruction. Results: Pediatric patients were significantly more likely to require ACL revision within one year (OR=1.97, 95%CI 1.57-2.45, p<0.0001) and five years (OR=3.22, 95%CI 2.77-3.72, p<0.0001) following their index ACLR compared to adults. Survivorship of the index ACL procedure was significantly decreased in pediatric patients (log-rank test p<0.0001) (Figure 1). Pediatric patients were also at higher risk of sustaining a contralateral ACL tear compared to adults (5.9% vs. 1.4%, respectively, p<0.0001). Meniscus injury was a risk factor for overall re-operation (OR=2.18, 95%CI 1.67-2.89 p<0.0001) as well as ACL revision (OR=2.28, 95%CI=1.66-3.21, p<0.0001) in the pediatric cohort. This increased risk was sustained despite the type of meniscal tear intervention, with patients undergoing concurrent meniscal repair (OR=1.84, 95%CI 1.43-2.38, p<0.0001) or meniscectomy (OR=2.20, 95%CI 1.72-2.82, p<0.0001) having a higher likelihood of requiring a revision ACLR. Concomitant MCL injury but not LCL injury was a risk factor for ACL revision in this cohort (OR=1.70, 95%CI 1.31-2.19, p<0.0001). Male sex and (OR=0.78, 95%CI 0.63-0.96, p=0.0204) and being >14 years old (OR=0.62, 95%CI 0.45-0.86, p=0.0035) was associated with a decreased risk of overall reoperation. The risk algorithm demonstrated the highest probability for ACLR failure in females, less than 15 years of age, with concomitant meniscus and MCL injury, demonstrating a 36% risk of failure (Table 1). Conclusion: Compared to adults, pediatric patients have an increased likelihood of ACL revision surgery, contralateral ACL tears, and meniscal reoperation within 5 years of an index ACLR. [Table: see text][Figure: see text]
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Porter, Mark D., Bruce Shadbolt, and Samantha Pomroy. "The Augmentation of Revision Anterior Cruciate Ligament Reconstruction With Modified Iliotibial Band Tenodesis to Correct the Pivot Shift: A Computer Navigation Study." American Journal of Sports Medicine 46, no. 4 (February 1, 2018): 839–45. http://dx.doi.org/10.1177/0363546517750123.
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Background: Iliotibial band (ITB) tenodesis improves stability and functional outcomes when added to anterior cruciate ligament (ACL) reconstruction. Its precise indications are unknown. Persistence of the pivot shift after revision ACL reconstruction may be one indication. Hypothesis: The addition of ITB tenodesis for a persistent pivot shift after revision ACL reconstruction will improve stability and activity levels. Study Design: Cohort study; Level of evidence, 2. Methods: Adults with recurrent ACL ruptures underwent revision ACL reconstruction, followed by a pivot-shift test before the surgery ended. If the pivot shift was grade 0 or 1, no further surgery was performed (group 1). If it was grade 2 or 3, ITB tenodesis was performed (group 2). The pivot-shift test was performed, graded, and measured using computer navigation before revision ACL reconstruction and after revision ACL reconstruction with and without ITB tenodesis. Tegner activity scores were obtained 2 years after surgery. Groups were compared with regard to anterior translation and internal rotation during the pivot shift as well as Tegner activity scores ( P < .05). Results: There were 20 patients in group 1 and 18 in group 2. The mean anterior translation improved in group 1, from 17.7 ± 3.5 mm to 6.6 ± 1.9 mm, and group 2, from 18.5 ± 3.3 mm to 6.1 ± 1.2 mm, after revision ACL reconstruction ( P < .001), with no difference between the groups ( P = .15). After ITB tenodesis, the reduction in anterior translation in group 2 (5.3 ± 1.5 mm) became greater than that in group 1 (6.6 ± 1.9 mm) ( P = .03). In both groups after revision ACL reconstruction, there was a reduction in internal rotation (group 1: 24.2° ± 4.0° to 10.3° ± 1.1°; group 2: 25.4° ± 3.7° to 14.6° ± 2.8°; P < .001), but this change was less in group 2 ( P = .02). After ITB tenodesis, internal rotation in group 2 (8.3° ± 2.6°) became less than that in group 1 (10.3° ± 1.1°) ( P = .02). The mean Tegner activity scores in group 1 were 8.1 ± 1.1 before surgery and 7.4 ± 0.9 after surgery, while in group 2 they were 7.0 ± 1.3 and 7.2 ± 0.4, respectively, and not significantly different ( P = .29). Conclusion: ITB tenodesis improved laxity, although it did not affect activity levels, when there was a persistent pivot shift after revision ACL reconstruction. Clinical Relevance: An indication to perform ITB tenodesis is the persistence of a grade ≥2 pivot shift after revision ACL reconstruction.
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Wright, Rick W., Laura J. Huston, Amanda K. Haas, Christina R. Allen, Allen F. Anderson, Daniel E. Cooper, Thomas M. DeBerardino, et al. "Predictors of Patient-Reported Outcomes at 2 Years After Revision Anterior Cruciate Ligament Reconstruction." American Journal of Sports Medicine 47, no. 10 (July 18, 2019): 2394–401. http://dx.doi.org/10.1177/0363546519862279.
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Background: Patient-reported outcomes (PROs) are a valid measure of results after revision anterior cruciate ligament (ACL) reconstruction. Revision ACL reconstruction has been documented to have worse outcomes when compared with primary ACL reconstruction. Understanding positive and negative predictors of PROs will allow surgeons to modify and potentially improve outcome for patients. Purpose/Hypothesis: The purpose was to describe PROs after revision ACL reconstruction and test the hypothesis that patient- and technique-specific variables are associated with these outcomes. Study Design: Cohort study; Level of evidence, 2. Methods: Patients undergoing revision ACL reconstruction were identified and prospectively enrolled by 83 surgeons over 52 sites. Data included baseline demographics, surgical technique and pathology, and a series of validated PRO instruments: International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index, and Marx Activity Rating Scale. Patients were followed up at 2 years and asked to complete the identical set of outcome instruments. Multivariate regression models were used to control for a variety of demographic and surgical factors to determine the positive and negative predictors of PRO scores at 2 years after revision surgery. Results: A total of 1205 patients met the inclusion criteria and were successfully enrolled: 697 (58%) were male, with a median cohort age of 26 years. The median time since their most recent previous ACL reconstruction was 3.4 years. Two-year questionnaire follow-up was obtained from 989 patients (82%). The most significant positive predictors of 2-year IKDC scores were a high baseline IKDC score, high baseline Marx activity level, male sex, and having a longer time since the most recent previous ACL reconstruction, while negative predictors included having a lateral meniscectomy before the revision ACL reconstruction or having grade 3/4 chondrosis in either the trochlear groove or the medial tibial plateau at the time of the revision surgery. For KOOS, having a high baseline score and having a longer time between the most recent previous ACL reconstruction and revision surgery were significant positive predictors for having a better (ie, higher) 2-year KOOS, while having a lateral meniscectomy before the revision ACL reconstruction was a consistent predictor for having a significantly worse (ie, lower) 2-year KOOS. Statistically significant positive predictors for 2-year Marx activity levels included higher baseline Marx activity levels, younger age, male sex, and being a nonsmoker. Negative 2-year activity level predictors included having an allograft or a biologic enhancement at the time of revision surgery. Conclusion: PROs after revision ACL reconstruction are associated with a variety of patient- and surgeon-related variables. Understanding positive and negative predictors of PROs will allow surgeons to guide patient expectations as well as potentially improve outcomes.
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Tisherman, Robert, Joseph De Groot, Benjamin Rothrauff, Kevin Byrne, Sean J. Meredith, and Volker Musahl. "The role of anatomic ACL reconstruction in ACL revision surgery." Annals of Joint 3 (December 2018): 103. http://dx.doi.org/10.21037/aoj.2018.11.14.
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Ormseth, Benjamin, Alex DiBartola, David Flanigan, Robert Siston, Katie Geers, Matthew Dorweiler, Christopher Kaeding, Robert Magnussen, and Robert Duerr. "Increased Posterior Tibial Slope is Associated with Revision Anterior Cruciate Ligament Reconstruction Graft Re-Rupture." Orthopaedic Journal of Sports Medicine 9, no. 7_suppl4 (July 1, 2021): 2325967121S0023. http://dx.doi.org/10.1177/2325967121s00235.
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Objectives: Anterior cruciate ligament reconstruction (ACLR) graft failure continues to be a problem with failure rates reported up to 11%. Following revision ACLR, 3.3 – 4.3% of these patients suffer re-tear of the revision ACL graft. The purpose of this study was to evaluate the influence of posterior tibial slope (PTS) on ACL graft re-tear after revision ACLR. It was hypothesized that increased posterior tibial slope (PTS) is associated with an increased risk of ACL graft re-tear following revision ACLR. Methods: Retrospective chart review identified patients who underwent revision ACLR between 2005 and 2016 at a single institution. Patients who suffered an ACL re-tear following revision surgery were matched by age, sex, and graft type to controls who had intact revision ACLR grafts at a minimum of 2 years follow-up. Medial posterior tibial slope (MPTS) and lateral posterior tibial slope (LPTS) were measured on lateral radiographs and sagittal magnetic resonance imaging (MRI). Tibial slope was then compared between groups using independent sample t-tests. Results: Twenty-nine patients with a graft failure after revision ACLR were included and compared to 29 matched controls with a mean follow-up of 5.8 years (range: 2 to 11.3 years). Each group included 16 males and 13 females. Average age was 26 +/- 8.3 years at time of revision ACLR. Both x-ray and MRI demonstrated increased LPTS in the failure group versus controls (12.7 ± 3.2 degrees vs. 10.6 ± 3.6 degrees, p = 0.02 and 8.1 ± 3.4 degrees vs. 5.0 ± 3.5 degrees, p = 0.001, respectively). There was no significant difference in MPTS between the failure and control groups on x-ray (11.9 ± 2.9 degrees vs. 11.1 ± 3.6 degrees, p = 0.3772) nor MRI (4.3 ± 3.5 degrees vs. 3.3 ± 3.0 degrees, p = 0.2486). Conclusions: Matching for age, sex, and graft type, increased LPTS measured on both x-ray and MRI is associated with increased risk of a subsequent ACL injury following revision ACLR. Identification of at-risk patients may guide pre-operative discussions regarding revision ACL graft failure risk.
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Tapasvi, Sachin, and Anshu Shekhar. "Revision ACL Reconstruction: Principles and Practice." Indian Journal of Orthopaedics 55, no. 2 (January 19, 2021): 263–75. http://dx.doi.org/10.1007/s43465-020-00328-8.
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Rugg, Caitlin M., Austin A. Pitcher, Christina Allen, and Nirav K. Pandya. "Revision ACL Reconstruction in Adolescent Patients." Orthopaedic Journal of Sports Medicine 8, no. 9 (September 1, 2020): 232596712095333. http://dx.doi.org/10.1177/2325967120953337.
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Background: High failure rates have been documented after anterior cruciate ligament reconstruction (ACLR) in pediatric patients, and revision surgery is indicated due to high activity levels of children and adolescents. Purpose: To define trends in revision ACLR in patients who underwent initial ACLR at younger than 18 years. Study Design: Case series; Level of evidence, 4. Methods: An electronic medical record was used to retrospectively identify revision ACLR procedures performed by 2 surgeons between the years 2010 and 2016 in patients younger than 18 years at initial reconstruction. Descriptive information, intraoperative findings, surgical techniques, and rehabilitation data were recorded from initial and revision surgeries. Descriptive statistics were used. Results: A total of 32 patients (17 girls, 15 boys) met the inclusion criteria, with a mean age of 15.8 years at initial reconstruction. For initial reconstructions, 15 patients underwent transphyseal procedures, 3 patients underwent adult-type procedures using an anatomic reconstruction technique that did not take into account the physis, and 2 patients underwent partial intraepiphyseal procedures. Graft types included hamstring autograft (n = 17), allograft (n = 5), hybrid (n = 4), and bone–patellar tendon–bone autograft (BTB; n = 3). Average primary reconstruction graft diameter was 8.0 mm (girls, 7.72 mm; boys, 8.36 mm; P = .045). After initial reconstruction, 10 patients had postoperative protocol noncompliance, and 8 patients reported delayed recovery. Mean time to retear was 565 days (range, 25-1539 days). At revision, BTB autograft was used in 50% (n = 16), followed by hamstring autograph (31.3%; n = 10) and allograft (12.5%; n = 4); mean graft diameter was 9.05 mm. Chondral surgery was more common during revision (25% for revision vs 0% for index; P = .031). There were 4 patients who required staged reconstruction with bone grafting. At mean final follow-up of 29.5 months (SD, 22.2 months), there were 3 graft failures (9.4%) and 5 contralateral ACL ruptures (15.6%). Conclusion: Most patients with ACL graft failure were adequately treated with a single revision. Conversion from a soft tissue graft to a BTB autograft was the most common procedure. Infrequently, patients required staged reconstructions. Providers should have a high index of suspicion for associated intra-articular injuries resulting from graft failure in adolescent patients.
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Wright, Rick, Kurt Spindler, Laura Huston, Annunziato Amendola, Jack Andrish, Rob Brophy, James Carey, et al. "Revision ACL Reconstruction Outcomes: MOON Cohort." Journal of Knee Surgery 24, no. 04 (October 27, 2011): 289–94. http://dx.doi.org/10.1055/s-0031-1292650.
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Sisto, Domenick J., and Debbie L. Cook. "Revision of failed synthetic ACL reconstructions." Arthroscopy: The Journal of Arthroscopic & Related Surgery 12, no. 3 (June 1996): 351. http://dx.doi.org/10.1016/s0749-8063(96)90081-x.
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Ferretti, Andrea, Edoardo Monaco, Ludovico Caperna, Tommaso Palma, and Fabio Conteduca. "Revision ACL reconstruction using contralateral hamstrings." Knee Surgery, Sports Traumatology, Arthroscopy 21, no. 3 (May 10, 2012): 690–95. http://dx.doi.org/10.1007/s00167-012-2039-x.
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Goertzen, Meinolf. "Donor Tissue Choices in ACL Revision." Sports Medicine and Arthroscopy Review 5, no. 2 (1997): 128–35. http://dx.doi.org/10.1097/00132585-199700520-00007.
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Eufemio, Edgar Michael T. "Revision Anterior Cruciate Ligament (ACL) Reconstruction." Orthopaedic Journal of Sports Medicine 7, no. 11_suppl6 (November 1, 2019): 2325967119S0044. http://dx.doi.org/10.1177/2325967119s00445.
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The goal of an ACL reconstruction is to approximate the strength and characteristics of the native tissue. So, if the original ACL can rupture, it is logical to think that the reconstructed ligament can also tear. It is more difficult to deal with a revision case. Your decision what to do is dependent on what was done during the primary ACL reconstruction (ACLR). It is important to plan the surgery carefully and prepare for all possible scenarios intra-operatively. The three key questions you need to answer are the following? What was the GRAFT used? How were the TUNNELS made? What were the IMPLANTS used? It would be helpful to know who did the primary ACLR because you may be aware of some of the tendencies of that surgeon which may assist you in your surgery. There are seven situations that will be discussed: Bone-Patellar Tendon-Bone (BPTB) autograft using a trans-tibial technique Semitendinosus/Gracilis Tendon (ST/G) autograft using a trans-tibial technique With the advent of the medial portal technique, the position of the femoral tunnel changed dramatically. Five other circumstances arose from this: 3. ST/G autograft using endo-buttons 4. ST/G autograft using screws – femoral tunnel in ideal position 5. ST/G autograft using screws – femoral tunnel near where you want it to be 6. ST/G autograft using screws – femoral tunnel far from where you want it to be 7. Implant-less ACLR Always have a back-up plan when doing revisions. It is imperative that the rehabilitation program be delayed so as to give the graft more time to incorporate. Usually, twelve months before going back to sports is acceptable.
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Lee, Byung, David Paller, Eve Hoffman, Wendell Heard, Keith Monchik, Paul Fadale, and Steve Behrens. "Mechanical Properties of Revision ACL Reconstruction." Journal of Knee Surgery 27, no. 02 (October 11, 2013): 119–24. http://dx.doi.org/10.1055/s-0033-1357493.
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Osti, Leonardo, Matteo Buda, Raffaella Osti, Leo Massari, and Nicola Maffulli. "Preoperative Planning for ACL Revision Surgery." Sports Medicine and Arthroscopy Review 25, no. 1 (March 2017): 19–29. http://dx.doi.org/10.1097/jsa.0000000000000140.
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Miao, Shuai, Shuoda Li, Zhonggao Wu, Hui Wang, and Ming Li. "The Clinical Efficacy and Risk Factors after Revision and Reconstruction of Anterior Cruciate Ligament." Journal of Healthcare Engineering 2021 (December 17, 2021): 1–5. http://dx.doi.org/10.1155/2021/6606492.
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The aim of this study was to study the clinical efficacy and prognostic factors after revision and reconstruction of anterior cruciate ligament. All the patients who underwent the first revision of anterior cruciate ligament (ACL) reconstruction in the department of sports medicine from January 2001 to December 2015 were collected. The demographic information, the first revision and reconstruction information of ACL, and the information during the first ACL reconstruction were collected. A total of 335 cases were included. Lysholm score, Tegner activity score, and IKDC subjective score at the last follow-up were significantly higher than those before operation. Compared with graft failure caused by sports injury, the postoperative scores of patients with revision due to life accidents or initial reconstruction techniques were significantly lower ( P < 0.05 ). The postoperative Lysholm score of patients with femoral canal drilling through the tibial canal was lower than that of patients with anterior internal approach. The postoperative IKDC score of patients who underwent medial meniscus suture at the same time was higher than that of patients without meniscus combined injury. ACL revision can improve the stability and function of knee joint. Compared with the revision caused by life accident or technical reasons of primary reconstruction surgery, the patients with graft failure caused by sports injury have better postoperative recovery. Medial meniscus suture and anterior internal approach drilling of the femoral bone canal have a statistically protective effect on the clinical function after ACL revision.
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Eysturoy, Niclas H., Kåre Amtoft Nissen, Torsten Nielsen, and Martin Lind. "The Influence of Graft Fixation Methods on Revision Rates After Primary Anterior Cruciate Ligament Reconstruction." American Journal of Sports Medicine 46, no. 3 (January 16, 2018): 524–30. http://dx.doi.org/10.1177/0363546517748924.
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Background: The method of graft fixation in primary anterior cruciate ligament (ACL) reconstruction is important for initial stability of the graft. Poor graft fixation can result in failure of the reconstruction. The effect of ACL graft fixation principles and fixation implant combinations on the risk of revision after ACL reconstruction is not well understood. Purpose: The study aimed to compare the risk of revision among 4 categories of femoral fixation divided by their principle of function using a hamstring tendon (HT) graft only. Furthermore, this study aimed to compare the risk of revision among the most frequently used combinations (tibia and femur) of graft fixation implants in a national patient cohort. Study Design: Cohort study; Level of evidence, 3. Methods: The authors divided the femoral fixation constructs into 4 categories by their principle of function: cortical suspensory fixation, adjustable cortical suspensory fixation, intratunnel transfixation, and interference screw (aperture) fixation. Data on revision rates and graft fixation methods were extracted from the Danish ACL Reconstruction Registry. The study included patients who underwent primary ACL reconstruction with either an HT or patellar tendon (PT) graft and were followed up at 2 to 10 years. Revision rates at 2-year and full follow-up were extracted for the category of graft fixation in the femur as well as for the most common implant combinations (those involving >175 patients). Patients with infrequently used fixation devices were excluded from this analysis. The HT group included 14 frequently used combinations (n > 175), and there were 2 such combinations in the PT group. A total of 13,200 ACL reconstructions were included in the study. For ACL reconstruction with an HT graft, there were 4680 with cortical suspensory fixation, 577 with adjustable cortical suspensory fixation, 5921 with intratunnel transfixation, and 617 with interference screw fixation. There were 1405 ACL reconstructions with a PT graft. Results: When only comparing primary ACL reconstructions using an HT graft, cortical suspensory fixation exhibited a significantly higher risk of revision at 2-year follow-up than the other categories of femoral fixation (hazard ratio [HR], 1.24 [95% CI, 1.07-1.44]; P < .05). Intratunnel transfixation exhibited a significantly lower risk of revision (HR, 0.83 [95% CI, 0.73-0.94]; P < .05). Comparing the most frequently used femoral/tibial fixation implant combinations with the mean risk of revision, Endobutton/Intrafix and Endobutton/Biosure PEEK for HT grafts exhibited an increased risk of revision, with an relative risk (RR) of 1.36 (95% CI, 1.03-1.81; P < .05) and 1.55 (95% CI, 1.15-2.09; P < .05), respectively. The Atlantech metal screw/metal screw and Softsilk/Softsilk combinations (both for PT grafts) exhibited a significantly decreased risk of revision, with an RR of 0.41 (95% CI, 0.18-0.91; P < .05) and 0.36 (95% CI, 0.15-0.87; P < .05), respectively. Conclusion: When comparing ACL graft fixation methods in the 4 categories using an HT graft, cortical suspensory fixation was found to have a significantly increased risk of revision, while intratunnel transfixation exhibited a lower risk of revision. Both Endobutton/Intrafix and Endobutton/Biosure PEEK implant combinations exhibited a significantly higher risk of revision. For PT grafts, Atlantech metal screw/metal screw and Softsilk/Softsilk exhibited a significantly lower risk of revision.
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Kaeding, Christopher C., Kurt P. Spindler, Laura J. Huston, and Alex Zajichek. "ACL Reconstruction In High School and College-aged Athletes: Does Autograft Choice Affect Recurrent ACL Revision Rates?" Orthopaedic Journal of Sports Medicine 7, no. 7_suppl5 (July 2019): 2325967119S0028. http://dx.doi.org/10.1177/2325967119s00282.
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Objectives: Physicians’ and patients’ decision-making process between bone-patellar tendon-bone (BTB) versus hamstring autografts for ACL reconstruction (ACLR) may be influenced by a patient’s gender, laxity level, sport played, and/or competition level in the young, active athlete. The purpose of this study was to determine the incidence of subsequent ligament disruption for high school and college-aged athletes between autograft BTB versus hamstring grafts for ACLRs. Our hypothesis is there would be no recurrent ligament failure differences between autograft types at 6-year follow-up. Methods: Our inclusion criteria were patients aged 14-22 who were injured in sport (basketball, football, soccer, other), had a contralateral normal knee, and were due to have a unilateral primary ACLR with either a BTB or hamstring autograft. All patients were prospectively followed at two and six years and contacted by phone and/or email to determine whether any subsequent surgery had occurred to either knee since their initial ACLR. If so, operative reports were obtained, whenever possible, in order to document pathology and treatment. Multivariable regression modeling controlled for age, gender, ethnicity/race, body mass index, sport and competition level, activity level, knee laxity, and graft type. The six-year outcomes of interest were the incidence of subsequent ACL reconstruction to either knee. Results: Eight hundred thirty-nine (839) patients were eligible, of which 770 (92%) had 6-year follow-up for subsequent surgery outcomes. The median age was 17, with 48% females, and the distribution of BTB to hamstring was 492 (64%) and 278 (36%) respectively. Thirty-three percent (33%) of the cohort was classified as having “high grade” knee laxity preoperatively. The overall ACL revision rate was 9.2% in the ipsilateral knee, 11.2% in the contralateral normal ACL, and 19.7% had one or the other within 6 years of the index ACLR surgery. High-grade laxity (OR: 2.4; 95% CI: 1.4, 3.9; p=0.001), autograft type (OR: 2.1; 95% CI: 1.3, 3.5; p=0.004), and age (OR: 0.8; 95% CI: 0.7, 0.96; p=0.009) were the 3 most influential predictors of a recurrent ACL graft revision on the ipsilateral knee, respectively, whereas the sport of the index injury (OR: 0.3; 95% CI: 0.2, 0.7; p=0.002) was the most influential predictor of a subsequent primary ACL reconstruction on the contralateral knee. The odds of a recurrent ACL graft revision on the ipsilateral knee for patients receiving a hamstring autograft were 2.1 times the odds of a patient receiving a BTB autograft (95% CI: 1.3, 3.5). For low-risk patients (5% incidence of graft failure), a hamstring graft can increase the risk of recurrent ACL graft revision by 5 percentage points, from 5% to 10%. For high-risk patients (35% incidence of graft failure), a hamstring graft can increase the risk of recurrent ACL graft revision by 15 percentage points, from 35% to ˜ 50%. An individual prediction risk calculator for a subsequent ACL graft revision can be determined by the nomogram in Figure 1. Conclusion: There is a high rate of subsequent ACL tears in both the ipsilateral and contralateral knees in this young athletic cohort, with evidence suggesting that incidence of ACL graft revisions at 6 years following index surgery is significantly higher in hamstring autograft compared to BTB autograft. [Figure: see text]
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Estves, Joao, Joao Maia Rosa, Luis Barros, Ana Ribau, Paulo Pereira, and Adelio Vilaça. "How to repair an immediately post-operative anterior cruciate ligament reconstruction failure? About a clinical case." International Journal of Research in Orthopaedics 5, no. 6 (October 22, 2019): 1219. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20194834.
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<p class="abstract">We present a 23-year-old male with an early anterior cruciate ligament (ACL) reconstruction failure due to lateral wall blow-out, diagnosed on day one post-op. We were able to perform the revision using the original graft, and maintaining the initial tibial fixation, revising only the femoral fixation. At 1-year follow-up the patient is asymptomatic. In the early ACL reconstruction failures due to femoral wall blowout, it is possible to perform the revision surgery using the same graft and maintaining the same tibial fixation. This avoids de morbidity of a new graft harvest and the need for a new tibial tunnel.</p>
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Rahardja, R., H. Love, M. G. Clatworthy, and S. W. Young. "LOWER RISK OF REVISION WITH SUSPENSORY TIBIAL FIXATION VERSUS INTERFERENCE TIBIAL FIXATION OF HAMSTRING TENDON AUTOGRAFTS IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION." Orthopaedic Proceedings 105-B, SUPP_3 (February 2023): 58. http://dx.doi.org/10.1302/1358-992x.2023.3.058.
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The optimal method of tibial fixation when using a hamstring tendon autograft in anterior cruciate ligament (ACL) reconstruction is unclear. This study aimed to compare the risk of revision ACL reconstruction between suspensory and interference devices on the tibial side.Prospective data on primary ACL reconstructions recorded in the New Zealand ACL Registry between April 2014 and December 2019 were analyzed. Only patients with a hamstring tendon autograft fixed with a suspensory device on the femoral side were included. The rate of revision ACL reconstruction was compared between suspensory and interference devices on the tibial side. Univariate Chi-Square test and multivariate Cox regression was performed to compute hazard ratios (HR) and 95% confidence intervals (CI) with adjustment for age, gender, time-to-surgery, activity at the time of injury, number of graft strands and graft diameter.6145 cases were analyzed, of which 59.6% were fixed with a suspensory device on the tibial side (n = 3662), 17.6% fixed with an interference screw with a sheath (n = 1079) and 22.8% fixed with an interference screw without a sheath (n = 1404). When compared to suspensory devices (revision rate = 3.4%), a higher risk of revision was observed when using an interference screw with a sheath (revision rate = 6.2%, adjusted HR = 2.05, 95% CI 1.20 – 3.52, p = 0.009) and without a sheath (revision rate = 4.6%, adjusted HR = 1.81, 95% CI 1.02 – 3.23, p = 0.044). The number of graft strands and a graft diameter of ≥8 mm did not influence the risk of revision.When reconstructing the ACL with a hamstring tendon autograft, the use of an interference screw, with or without a sheath, on the tibial side has a higher risk of revision when compared to a suspensory device.
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Magnussen, Robert A., James R. Borchers, Angela D. Pedroza, Laura J. Huston, Amanda K. Haas, Kurt P. Spindler, Rick W. Wright, et al. "Risk Factors and Predictors of Significant Chondral Surface Change From Primary to Revision Anterior Cruciate Ligament Reconstruction: A MOON and MARS Cohort Study." American Journal of Sports Medicine 46, no. 3 (December 15, 2017): 557–64. http://dx.doi.org/10.1177/0363546517741484.
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Background: Articular cartilage health is an important issue following anterior cruciate ligament (ACL) injury and primary ACL reconstruction. Factors present at the time of primary ACL reconstruction may influence the subsequent progression of articular cartilage damage. Hypothesis: Larger meniscus resection at primary ACL reconstruction, increased patient age, and increased body mass index (BMI) are associated with increased odds of worsened articular cartilage damage at the time of revision ACL reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: Subjects who had primary and revision data in the databases of the Multicenter Orthopaedics Outcomes Network (MOON) and Multicenter ACL Revision Study (MARS) were included. Reviewed data included chondral surface status at the time of primary and revision surgery, meniscus status at the time of primary reconstruction, primary reconstruction graft type, time from primary to revision ACL surgery, as well as demographics and Marx activity score at the time of revision. Significant progression of articular cartilage damage was defined in each compartment according to progression on the modified Outerbridge scale (increase ≥1 grade) or >25% enlargement in any area of damage. Logistic regression identified predictors of significant chondral surface change in each compartment from primary to revision surgery. Results: A total of 134 patients were included, with a median age of 19.5 years at revision surgery. Progression of articular cartilage damage was noted in 34 patients (25.4%) in the lateral compartment, 32 (23.9%) in the medial compartment, and 31 (23.1%) in the patellofemoral compartment. For the lateral compartment, patients who had >33% of the lateral meniscus excised at primary reconstruction had 16.9-times greater odds of progression of articular cartilage injury than those with an intact lateral meniscus ( P < .001). For the medial compartment, patients who had <33% of the medial meniscus excised at the time of the primary reconstruction had 4.8-times greater odds of progression of articular cartilage injury than those with an intact medial meniscus ( P = .02). Odds of significant chondral surface change increased by 5% in the lateral compartment and 6% in the medial compartment for each increased year of age ( P ≤ .02). For the patellofemoral compartment, the use of allograft in primary reconstruction was associated with a 15-fold increased odds of progression of articular cartilage damage relative to a patellar tendon autograft ( P < .001). Each 1-unit increase in BMI at the time of revision surgery was associated with a 10% increase in the odds of progression of articular cartilage damage ( P = .046) in the patellofemoral compartment. Conclusion: Excision of the medial and lateral meniscus at primary ACL reconstruction increases the odds of articular cartilage damage in the corresponding compartment at the time of revision ACL reconstruction. Increased age is a risk factor for deterioration of articular cartilage in both tibiofemoral compartments, while increased BMI and the use of allograft for primary ACL reconstruction are associated with an increased risk of progression in the patellofemoral compartment.
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DePhillipo, Nicholas N., Travis J. Dekker, Zachary S. Aman, David Bernholt, W. Jeffrey Grantham, and Robert F. LaPrade. "Incidence and Healing Rates of Meniscal Tears in Patients Undergoing Repair During the First Stage of 2-Stage Revision Anterior Cruciate Ligament Reconstruction." American Journal of Sports Medicine 47, no. 14 (November 6, 2019): 3389–95. http://dx.doi.org/10.1177/0363546519878421.
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Background: Meniscal tears, including tears at the root attachment, have been associated with tears of the anterior cruciate ligament (ACL) in both primary and revision settings. However, there is a paucity of literature reporting the healing rates of meniscal repair during 2-stage revision ACL reconstruction (ACLR). Purpose: To evaluate the healing rates of meniscal repairs performed during 2-stage revision ACLR in ACL-deficient knees and to report the incidence of meniscus root tears in patients undergoing primary ACLR as compared with revision ACLR. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent primary and revision ACLR by a single surgeon were retrospectively identified. Revision ACLRs were grouped according to 1- or 2-stage ACLR. Meniscal tears were grouped according to laterality (medial, lateral) and location of tears. Meniscal repair technique was recorded, including transtibial or inside-out. Meniscal repair healing was assessed via second-look arthroscopy at the time of second-stage revision ACLR. Results: There were 1168 patients identified who underwent ACLR: 851 primary and 317 revision procedures. Sixty-four patients underwent meniscal repair during first-stage bone grafting in ACL-deficient knees, with an overall healing rate of 86%. The healing rates were 82.3% for meniscus root tears via the transtibial repair technique and 92.4% for meniscal peripheral tears via the inside-out repair technique. Meniscus root tears had overall incidences of 15.5% and 26.2% in primary and revision ACLRs, respectively. The incidence of lateral meniscus posterior root tears was approximately 4 times higher than of medial meniscus posterior root tears in both primary (12.2% vs 3.2%) and revision (20.5% vs 5.6%) ACLRs. Conclusion: A high incidence of meniscus root tears was found in patients undergoing revision ACLRs as compared with primary ACLRs. Meniscal repairs have a high rate of healing and success when performed during the first stage of revision ACLR in ACL-deficient knees.