How to Perform ACL Revision Surgery
Thus, the work-up 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. Soft tissue ACL reconstruction grafts often cause graft reconstruction tunnel enlargement over time and a careful assessment for this must be performed.
When all factors have been evaluated, an assessment can then be made if a one stage or two stage reconstructions are necessary. There are certain times when trying to perform a one stage ACL reconstruction may significantly increase the risk of failure of the revision graft. Possible treatment scenarios include patients undergoing an autograft or allograft revision reconstruction, either as a first stage or as a second stage surgery after bone grafting the tunnels first and/or a combined proximal tibial osteotomy. Concurrent procedures with the revision ACL reconstruction could include meniscal repairs, meniscal transplants, posterolateral corner or medial knee reconstructions.
It is very rare that the evaluation of a failed ACL reconstruction graft is easy. There is usually a reason why the graft failed and a very careful assessment must be performed including long leg alignment x-rays, possible varus/valgus stress x-rays, a Rosenberg view to look at joint space narrowing and an MRI scan to look at the location, size and position of the previous ACL reconstruction graft tunnels as well as the status of the meniscus and articular cartilage of the joint.
A very thorough physical exam is necessary but these secondary studies are often required to choose the best plan of treatment for a revision ACL reconstruction. In general, the success rates in the literature for ACL revision surgery are approximately 75%. A very careful assessment of the cause of the graft failure is necessary to try to maximize an individual patient’s outcome with an ACL revision surgery.