Summary

Revision ACLR involves multiple concurrent procedure like Posterolateral corner reconstruction, HTO,Modified LeMaire anterolateral tenodesis and involves use of thicker autograft like quadriceps tendon and peroneus longus.

Abstract

Background

Early failures are typically associated with (1) technical error, (2) unrecognized associated ligamentous injuries (posterolateral corner, medial collateral ligament), (3) malalignment of the lower extremity, or (4) biological failure of graft incorporation. Other causes include fixation failure before graft incorporation resulting in graft laxity and recurrent instability.

Methods

This was a retrospective analyses of revision ACL reconstructions (ACLR) along with additional procedures, done in a tertiary level institute over last 5 years.. There were 32 patients out of which 24 patients (19 males and 5 females) were included as remaining refused follow up. Revision procedures involved re-reaming and utilising same femoral and tibial tunnels, using a larger reamer than native tunnels in 10 cases, using only native femoral tunnel re-reaming and preparing a more medialised new tibial tunnel in 8 cases, additional procedure of Posterolateral reconstruction in 4 cases and concurrent medial open wedge high tibial osteotomy (HTO) in 8 cases. In all cases except 2, additional procedure of Anterolateral tenodesis as per modified LeMaires procedure was added. Graft used was Quadriceps tendon in 8 cases and and tripled Peroneus longus tendon in 16 cases. Follow up assessment included Lysholm score, IKDC subjective score, Lachman test, Tegner Scoreand pivot shift test.

Results

Mean Lysholm score was 92, mean IKDC score showed excellent to good result, Lachman score was grade 1-2 in all cases, Pivot shift was negative in 19 patients. All patients returned to their pre injury activity levels at lower Tegner score by 20 % except 10 patients who left their sporting activity due to fear of reinjury.

Conclusion

– Revision ACLR involves multiple concurrent procedure like Posterolateral corner reconstruction, HTO,Modified LeMaire anterolateral tenodesis and involves use of thicker autograft like quadriceps tendon and peroneus longus.