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