Summary: A single-stage approach to revision ACL reconstruction is associated with excellent clinical results when an outside-in drilling technique is utilized. The presence of pre-operative tunnel widening does not significantly influence patient reported outcome measures, knee stability, graft rupture rates or non-graft rupture related re-operation rates.

Introduction

Pre-operative tunnel widening is a frequently reported indication for performing a two-stage revision anterior cruciate ligament reconstruction (R-ACLR) instead of a single-stage procedure. However, the strength of the available evidence to support a two-stage strategy is low. The main purpose of this study was to evaluate the clinical outcomes of a single-stage only approach to R-ACLR. It was hypothesized that this approach would be associated with significant improvements from baseline in patient reported outcome measures (PROMS) and knee stability, and also that there would be no significant differences in any post-operative outcomes between patients with and without pre-operative tunnel widening.

Methods

A retrospective analysis of a large series of consecutive patients undergoing R-ACLR, with a minimum follow-up of two years, was conducted. Pre-operative tunnel widening was assessed using digital radiographs. All patients underwent single-stage surgery, with an outside-in technique, even if they had tunnel widening. Clinical outcomes were compared according to whether tunnel widening was present (either tunnel = 12mm) or not (both tunnels <12mm). Comparisons between variables were assessed with the Chi-square or Fisher’s exact tests for categorical variables and the Student’s t test or Wilcoxon test for quantitative variables.

Results

409 consecutive patients with a mean follow-up of 69.6 ± 29.0 months were included in the study. At two years following R-ACLR, there was a significant reduction in the side-to-side AP laxity difference from 7.7 ± 2.2 mm pre-operatively to 1.2 ± 1.1 mm (p < .001). The mean IKDC and all KOOS subscales exceeded the patient acceptable symptom state (PASS) thresholds defined for primary ACLR. There were no significant differences between groups with respect to antero-posterior side-to side laxity difference, graft rupture rates, non-graft rupture related re-operations, or contralateral ACL injury rates. There was also no significant difference between groups, exceeding minimal detectable change thresholds, for any of the PROMS recorded (ACL-RSI, Lysholm, Tegner, IKDC, KOOS).

Conclusions

A single-stage approach to revision ACL reconstruction is associated with excellent clinical results when an outside-in drilling technique is utilized. The mean IKDC and all KOOS subscales exceeded the patient acceptable symptom state (PASS) thresholds defined for primary ACLR. The presence of pre-operative tunnel widening did not significantly influence PROMS, knee stability, graft rupture rates or non-graft rupture related re-operation rates. This suggests that two-stage R-ACLR is rarely warranted

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Combined ACL and Anterolateral Ligament Reconstruction Confers Significantly Improved Long Term Outcomes when Compared to Isolated ACL Reconstruction: A Matched-Pair Analysis Abstract Presentation 5 minutes Adnan Saithna, MD, FRCS, UNITED STATES Ibrahim Haidar, MD, LEBANON Johnny Rayes, MD, MSc, FEBOT, CANADA Thomas Fradin, MD, FRANCE Cédric Ngbilo, MD, SWITZERLAND Benjamin Freychet, MD, FRANCE Thais Dutra Vieira, MD, FRANCE Herve Ouanezar, MD, UNITED ARAB EMIRATES Bertrand Sonnery-Cottet, MD, PhD, FRANCE
Second-Look Arthroscopic Evaluation And Clinical Outcomes After Anatomical Double-Bundle Anterior Cruciate Ligament Reconstruction With Generalized Joint Laxity Or Hyperextended Knee Abstract Presentation 6 minutes Yasunari Oniki, MD, PhD, JAPAN Taiki Murakami, JAPAN Eiichi Nakamura, MD, PhD, JAPAN
Comparison of three different Quadriceps Tendon ACL graft to BTB and Semi-T grafts: A biomechanical study ePoster Presentation Marc Jacob Strauss, MD, NORWAY Jonathan Miles, M.S, UNITED STATES Mitchell Iung Kennedy, BS, UNITED STATES Gilbert Moatshe, MD, PhD, NORWAY Grant J Dornan, MS, UNITED STATES Martin Lind, MD, PhD, Prof., DENMARK Lars Engebretsen, MD, PhD, NORWAY Robert F. LaPrade, MD, PhD, UNITED STATES
Changes In Muscle Strength And Hop Performance After ACL Reconstruction. A Randomized Controlled Trial Comparing Patellar Tendon And Hamstring Tendon Autografts With Standard Or Accelerated Rehabilitation Abstract Presentation 6 minutes Riccardo Cristiani, MD, PhD, SWEDEN Christina Mikkelsen, PT, SWEDEN Peter Olov Wange, MD, SWEDEN Daniel Olsson, PhD, SWEDEN Anders Stalman, MD, PhD, Associate Professor, SWEDEN Bjorn Engstrom, MD, PhD, Assoc. Prof., SWEDEN
Inter- and Intra-Rater Reliability of Measurenebt of ACL TUnnels with Radiographs, CT, and MRI Abstract Presentation 4 minutes Robert A Magnussen, MD, MPH, UNITED STATES Alexander Sparks, BS, UNITED STATES Jacy Leon, BS, UNITED STATES Matthew Colatruglio, BS, UNITED STATES Joshua Bowler, MD James Oosten, BS, UNITED STATES Alex C. Dibartola, MD, MPH, UNITED STATES Joshua Scott Everhart, MD, MPH, UNITED STATES Robert A. Duerr, MD, UNITED STATES Christopher C. Kaeding, MD, UNITED STATES David C. Flanigan, MD, UNITED STATES
The Effect Of Lateral Extraarticular Tenodesis On In Vivo Cartilage Contact In Combined Anterior Cruciate Ligament Reconstruction ePoster Presentation Kyohei Nishida , MD, PhD, JAPAN Tom Gale, MS, UNITED STATES Daisuke Chiba, MD, PhD, JAPAN Felipe Martin Suntaxi, MS, UNITED STATES Bryson P. Lesniak, MD, UNITED STATES Freddie H. Fu, MD, UNITED STATES William Anderst, PhD, UNITED STATES Volker Musahl, MD, Prof., UNITED STATES
Ligamentous Laxity, Male Sex, Chronicity, Meniscus Injury And Posterior Tibial Slope Are Associated With A High-Grade Pre-Operative Pivot Shift: A Post Hoc Analysis Of The Stability Study Abstract Presentation 6 minutes Lachlan Batty, FRACS, AUSTRALIA Andrew Firth, PhD, CANADA Gilbert Moatshe, MD, PhD, NORWAY Dianne M. Bryant, PhD, CANADA S. Mark A. Heard, MD, FRCS, CANADA Robert G. McCormack, MD, CANADA Alex Rezansoff, MD, FRCSC, CANADA Devin Clarke Peterson, MD, FRCSC, Dip Sport Med, CANADA Davide Bardana, MD, CANADA Peter B. MacDonald, MD, FRCS, Dip Sport Med, CANADA Tim Spalding, FRCS(Orth), UNITED KINGDOM Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, QATAR

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Pre-Operative Tunnel Widening Does Not Significantly Influence The Outcomes Of A Single-Stage Only Approach To Revision Acl Reconstruction: An Analysis Of 409 Consecutive Patients

Pre-Operative Tunnel Widening Does Not Significantly Influence The Outcomes Of A Single-Stage Only Approach To Revision Acl Reconstruction: An Analysis Of 409 Consecutive Patients

Introduction

Methods

Results

Conclusions

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Pre-Operative Tunnel Widening Does Not Significantly Influence The Outcomes Of A Single-Stage Only Approach To Revision Acl Reconstruction: An Analysis Of 409 Consecutive Patients

Pre-Operative Tunnel Widening Does Not Significantly Influence The Outcomes Of A Single-Stage Only Approach To Revision Acl Reconstruction: An Analysis Of 409 Consecutive Patients

Introduction

Methods

Results

Conclusions

More ISAKOS 2021: Global Content