Anterior Cruciate Ligament Revision Reconstruction

Abstract

Background Although techniques and options for suitable graft substitutes for anterior cruciate ligament surgery continue to improve, failures occur because of many reasons. Errors in surgical techniques seem to be important reasons. Hypothesis Inappropriate positioning of the tunnels may be the most important reason for these failures. Anatomical anterior cruciate ligament revision reconstruction, using autografts, may yield acceptable outcomes. Study Design Case series; Level of evidence, 4. Methods This retrospective study involved 148 anterior cruciate ligament revision reconstructions performed in our hospital using autografts. One hundred and seven patients were followed up at a mean of 72.9 ± 20.6 months. Clinical evaluation was performed using the Lysholm score, the Tegner rating system, the International Knee Documentation Committee evaluation form, and the KT-1000 arthrometer. Radiographs were evaluated for signs of osteoarthritis according to the Jaeger and Wirth classification. Results Inappropriate positioning of the tunnels was the most important reason (63.5%) for anterior cruciate ligament reconstruction failure. The average Lysholm score improved significantly at the follow-up (88.5±12.4 vs 51.5±24.9; P < .001). Moreover, the average Tegner activity score improved significantly compared with the activity score before revision surgery (6.3±1.8 vs 2.8±1.8; P < .001). The International Knee Documentation Committee score was A in 17 cases, B in 45, C in 37, and D in 8. Radiographic evaluation revealed that 33 patients had degenerative findings of grade I, 35 of grade li, 16 of grade III, and 2 of grade IV. Conclusion Anatomical anterior cruciate ligament revision reconstruction provides satisfactory midterm results as far as stability and function of the knee are concerned. In spite of these favorable subjective and objective results, the radiological evaluation revealed a significant progression of osteoarthritis.