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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Dynamic Radiostereometry Evaluation Of Two Different Anterior Cruciate Ligament Reconstruction Techniques: Does Single Bundle Reconstruction Plus Lateral Plasty Cause Knee Over-Constraint? Abstract Presentation 4 minutes Alberto Grassi, PhD, ITALY Stefano Di Paolo, Eng, PhD, ITALY Piero Agostinone, MD, QATAR Gian Andrea Lucidi, MD, ITALY Erika Pinelly, MsC, ITALY Marco Bontempi, PhD, ITALY Laura Bragonzoni, Prof., ITALY Stefano Zaffagnini, MD, Prof., ITALY
Lower Socioeconomic Status Adversely Affects Access To Care And The Rate Of Instability Events And Bucket Handle Meniscus Tears Following Anterior Cruciate Ligament Tears Abstract Presentation 6 minutes Edward S. Chang, MD, UNITED STATES Blake M. Bodendorfer, MD, UNITED STATES Andrew Curley, MD, UNITED STATES David X. Wang, MD, UNITED STATES Christine Conroy, MD, UNITED STATES Mark Hopkins, MD, UNITED STATES Brian McCormick, MD, UNITED STATES Caroline Fryar, MD, UNITED STATES
Quantitative Evaluation of Lateral Articular Cartilage Quality on Magnetic Resonance Imaging at 2-years following Anterior Cruciate Ligament Reconstruction With Or Without A Lateral Extra-Articular Tenodesis Abstract Presentation 6 minutes Andrew Firth, PhD, CANADA Dianne M. Bryant, PhD, CANADA Jaques Milner , CANADA Stephany Pritchett, MD, FRCPC, DABR, CANADA David Holdsworth, PhD, Canada Stability Study Group, CANADA Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, QATAR
Acl - Pcl Fixation Sequence During Multi-Ligament Knee Reconstruction Does Not Affect Knee Laxity Abstract Presentation 6 minutes Carola F. van Eck, MD, PhD, FAAOS, UNITED STATES Aly Maher Fayed, MD, EGYPT Ryo Kanto, MD, JAPAN Taylor M. Price, MS, UNITED STATES Michael Dinenna, BS, UNITED STATES Monica A. Linde, MSIE, RN, UNITED STATES Patrick J. Smolinski, PhD, UNITED STATES
Coach Education Improves Implementation Of ACL Injury Prevention Programs: A Cluster-Randomized Controlled Trial Abstract Presentation 5 minutes Daphne Ling, PhD, MPH, TAIWAN Caroline Boyle, UNITED STATES Brandon Schneider, MS, UNITED STATES Joseph Janosky, DrPHc, MS, PT, ATC, UNITED STATES James Kinderknecht, UNITED STATES Robert G. Marx, MD, UNITED STATES
Predicting Patient Lost to Follow-up in the STABILITY 1 Study: A Multi-centre, International, Randomized Controlled Trial of Young, Active Patients Undergoing Anterior Cruciate Ligament Reconstruction Abstract Presentation 6 minutes Andrew Firth, PhD, CANADA Dianne M. Bryant, PhD, CANADA Andrew Johnson, PhD, CANADA Stability Study Group, CANADA Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, QATAR
A Comparison of Lower Limb Strength and Plyometric Ability in Athletes who underwent ACLR with Lateral Extra-Articular Ilio-Tibial Band Tenodesis when compared with Isolated ACLR Surgery. A Biomechanical Study. Abstract Presentation 7 minutes Bláithín Brady, BSc MSc , IRELAND Sarah Crosbie, BSc, IRELAND Neil Welch, BSc MSc PhD, IRELAND Mihai Vioreanu, MD, MCh, FFSEM, FRCSI(Tr&Orth), IRELAND
Risk Factor Analysis for Graft Failure after Anterior Cruciate Ligament Reconstruction with or without mLET Abstract Presentation 7 minutes Filip R Hendrikx, MD, BELGIUM Koen Lagae, MD, BELGIUM Annemieke Van Haver, PhD, MSc, BELGIUM Peter Verdonk, MD, PhD, BELGIUM
Tranexamic Acid Has No Effect On Post-Operative Hemarthrosis Or Pain Control Following Acl Reconstruction Using Bone Patella Tendon Bone Autograft: A Double-Blinded Randomized Control Trial Abstract Presentation 5 minutes Jordan W Fried, BM, UNITED STATES David Bloom, BA, UNITED STATES Eoghan T. Hurley, MB, BCh, MCh, IRELAND Samuel Baron, MD, UNITED STATES Kirk Anthony Campbell, MD, UNITED STATES Eric Jason Strauss, MD Laith M. Jazrawi, MD, UNITED STATES Michael J Alaia, MD, UNITED STATES

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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

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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