The Role of Lateral Extra-articular Augmentation in Revision ACL Reconstruction

Background: Stacked screws is a commonly used technique in single-stage revision anterior cruciate ligament (ACL) reconstruction in the setting of bone loss, but there are limited data to support its use. Hypothesis: Two configurations of a biocomposite stacked screws construct have similar fixation strength and linear stiffness as a primary ACL reconstruction construct in a biomechanical model. Study Design: Controlled laboratory study. Methods: A total of 30 porcine legs were divided into 3 groups. Group 1 underwent primary ACL reconstruction with a patellar tendon graft fixed into the femur, with an 8-mm biocomposite interference screw of beta-tricalcium phosphate and poly lactide-co-glycolide. For a revision ACL reconstruction model, groups 2 and 3 had bone tunnels created and subsequently filled with 12-mm biocomposite screws. New bone tunnels were drilled through the filler screw and the surrounding bone, and the patellar bone plug was inserted. Group 2 was fixed with 8-mm biocomposite screws on the side of the graft opposite the filler screw, while group 3 had the interference screw interposed between the graft and the filler screw. The construct was loaded at 1.5 mm/s in line with the tunnel until failure. Load to failure, linear stiffness, and mode of failure were recorded. Results: The mean pullout strength for groups 1, 2, and 3 was 626 ± 145 N, 653 ± 152 N, and 720 ± 125 N, respectively ( P = .328). The mean linear stiffness of the construct in groups 1, 2, and 3 was 71.4 ± 9.9 N/mm, 84.1 ± 11.1 N/mm, and 82.0 ± 10.8 N/mm, respectively. Group 2 was significantly stiffer than group 1 ( P = .037). Conclusion: Two configurations of a biocomposite stacked screws construct for a single-stage revision ACL reconstruction in the setting of bone loss show a similar fixation strength and linear stiffness to a primary ACL reconstruction at time zero in a porcine model. Clinical Relevance: In the setting of bone loss from tunnel malpositioning, a single-stage revision ACL reconstruction using a stacked screws construct may provide adequate fixation strength and linear stiffness.

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Revision ACL Reconstruction: Principles and Practice

Indian Journal of Orthopaedics ◽

10.1007/s43465-020-00328-8 ◽

2021 ◽

Author(s):

Sachin Tapasvi ◽

Anshu Shekhar

Keyword(s):

Acl Reconstruction ◽

Revision Acl Reconstruction

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Lower Failure Rates and Improved Patient Outcome Due to Reconstruction of the MCL and Revision ACL Reconstruction in Chronic Medial Knee Instability

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121989312 ◽

2021 ◽

Vol 9 (3) ◽

pp. 232596712198931

Author(s):

Lena Alm ◽

Tobias Claus Drenck ◽

Jannik Frings ◽

Matthias Krause ◽

Alexander Korthaus ◽

...

Keyword(s):

Acl Reconstruction ◽

Lysholm Score ◽

Knee Instability ◽

Failure Rates ◽

Medial Knee ◽

Revision Acl Reconstruction ◽

Risk Of Failure ◽

Significant Difference ◽

Patient Reported ◽

Reconstruction Group

Background: Concomitant lesion of the medial collateral ligament (MCL) is associated with a greater risk of anterior cruciate ligament (ACL) graft failure. Purpose: The aim of this study was to compare two medial stabilization techniques in patients with revision ACL reconstruction (ACLR) and concomitant chronic medial knee instability. Study Design: Cohort study; Level of evidence, 3. Methods: In a retrospective study, we included 53 patients with revision ACLR and chronic grade 2 medial knee instability to compare medial surgical techniques (MCL reconstruction [n = 17] vs repair [n = 36]). Postoperative failure of the revision ACLR (primary aim) was defined as side-to-side difference in Rolimeter testing ≥5 mm or pivot-shift grade ≥2. Clinical parameters and postoperative functional scores (secondary aim) were evaluated with a mean ± SD follow-up of 28.8 ± 9 months (range, 24-69 months). Results: Revision ACLR was performed in 53 patients with additional grade 2 medial instability (men, n = 33; women, n = 20; mean age, 31.3 ± 12 years). Failure occurred in 5.9% (n = 1) in the MCL reconstruction group, whereas 36.1% (n = 13) of patients with MCL repair showed a failed revision ACLR ( P = .02). In the postoperative assessment, the anterior side-to-side difference in Rolimeter testing was significantly reduced (1.5 ± 1.9 mm vs 2.9 ± 2.3 mm; P = .037), and medial knee instability occurred significantly less (18% vs 50%; P = .025) in the MCL reconstruction group than in the MCL repair group. In the logistic regression, patients showed a 9-times elevated risk of failure when an MCL repair was performed ( P = .043). Patient-reported outcomes were increased in the MCL reconstruction group as compared with MCL repair, but only the Lysholm score showed a significant difference (Tegner, 5.6 ± 1.9 vs 5.3 ± 1.6; International Knee Documentation Committee, 80.3 ± 16.6 vs 73.6 ± 16.4; Lysholm, 82.9 ± 13.6 vs 75.1 ± 21.1 [ P = .047]). Conclusion: MCL reconstruction led to lower failure rates in patients with combined revision ACLR and chronic medial instability as compared with MCL repair. MCL reconstruction was superior to MCL repair, as lower postoperative anterior instability, an increased Lysholm score, and less medial instability were present after revision ACLR. MCL repair was associated with a 9-times greater risk of failure.

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Use of Supercritical Sterilized Bone Allograft in Two Stage Revision ACL Reconstruction

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967116s00024 ◽

2016 ◽

Vol 4 (2_suppl) ◽

pp. 2325967116S0002

Author(s):

Justin Roe ◽

Sjoerd Rutten ◽

Fiona Bonnar ◽

Lucy Salmon ◽

Leo Pinczewski

Keyword(s):

Acl Reconstruction ◽

Bone Allograft ◽

Two Stage ◽

Revision Acl Reconstruction

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Revision ACL Reconstruction in Skeletally Mature Athletes Younger Than 18 Years

Clinical Orthopaedics and Related Research ◽

10.1007/s11999-011-1956-1 ◽

2011 ◽

Vol 470 (3) ◽

pp. 835-842 ◽

Cited By ~ 25

Author(s):

Keith R. Reinhardt ◽

Sommer Hammoud ◽

Andrea L. Bowers ◽

Ben-Paul Umunna ◽

Frank A. Cordasco

Keyword(s):

Acl Reconstruction ◽

Revision Acl Reconstruction

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Revision ACL Reconstruction in Children and Adolescents

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2016.03.041 ◽

2016 ◽

Vol 32 (6) ◽

pp. e4-e5 ◽

Cited By ~ 1

Author(s):

Melissa Christino ◽

Frances Tepolt ◽

Lyle Micheli ◽

Mininder Kocher

Keyword(s):

Children And Adolescents ◽

Acl Reconstruction ◽

Revision Acl Reconstruction

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One-stage Revision ACL reconstruction with hamstring autograft results in satisfactory outcome

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117s00176 ◽

2017 ◽

Vol 5 (5_suppl5) ◽

pp. 2325967117S0017

Author(s):

Ritwik Kejriwal ◽

Jens Buelow

Keyword(s):

Acl Reconstruction ◽

Single Bundle ◽

Significant Heterogeneity ◽

Hamstring Autograft ◽

Rupture Rate ◽

One Stage ◽

Revision Acl Reconstruction ◽

Satisfactory Outcome ◽

Kt 1000

Objectives: Revision anterior cruciate ligament (ACL) reconstruction is associated with poorer outcomes and higher rerupture rates when compared to primary ACL reconstruction. There is also a significant heterogeneity in surgical technique, number of stages, and graft options. We report a large single surgeon case series with hamstring autograft as a graft option. Methods: Observational series of revision ACL reconstructions performed by the senior author between 2005 and 2015 was carried out. Chart reviews and clinic follow-ups were performed with the following recorded – re-rupture rate, radiographic grading of osteoarthritis, KT-1000 arthrometer test, IKDC outcome scores and knee range of motion. All patients underwent single bundle four-strand hamstring autograft performed in one stage with use of new tunnels in majority of the cases. Results: 66 patients underwent hamstring autograft one-stage revision ACL reconstruction by Dr Jens Buelow. Chart review was carried out on all patients, and 26 (39%) were followed up in clinic and/or by phone with a mean follow up of 4.7 years. Outcomes included re-rupture rate of 4.5%, reoperation rate of 12%, mean visual analogue scale score of 7.6, mean side-to-side difference of 2.6 mm for KT-1000 arthrometer test, and mean IKDC score of 79. Of the 17 patients with radiographs, 40% had moderate osteoarthritis (grade 2 or 3) at follow-up. Conclusion: Revision ACL reconstruction can result in a satisfactory outcome when performed with a hamstring autograft in one stage.

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