Abstract
Purpose of the study: Failure of anterior cruciate ligament (ACL) ligamentoplasty is a major surgical challenge. Over the last decade, failures have been related to the use of synthetic material, but at the present time, most of the failures observed are related to an inappropriate position for the graft. The purpose of this work was to report a prospective cohort of 44 consecutive patients where the objective and subjective results of revision surgery were recorded.
Material and methods: Between January 2000 and January 2004, 44 patients with a healthy contralateral knee were included in this study: 26 males and 18 females, mean age 30 years (range 20–53 years). The majority of the initial grafts were patellar (57%), hamstring tendons had been used for 26%. The time from the first ligamentoplasty to revision reconstruction was 38.7±28.3 months. This was a first revision for 38 patients and six patients had had multiple revisions. The preoperative IKDC scores were: subjective 51.7±16.2; overall: 1B, 19C, 24D. The maximal manual differential laxity measured with KT1000 was 8.6±3.1 mm. In 70% of cases, the cause of failure was related to an inadapted position of the graft. At revision, grade 2 or 3 cartilage lesions were observed in 50% of knees. Reconstructions were performed with autografts: patellar tendon (39%), hamstring tendons (31%), or quadricipital tendon (29%), combined with lateral ligamentoplasty in 78% of the cases.
Results: Mean follow-up in this series was 14.7 months, minimum 12 months. At last follow-up, the IKDC scores were: 73.8±13.9 for the subjective assessment and 9A, 12B, 17C, 6D for the overall assessment. 67.7% of patients were satisfied or very satisfied. The maximal manual differential laxity measured with KT1000 was 4.3±3.5 mm. All variables exhibited statistically significant improvement. Grade B or C radiologial modifications were noted in 32% of cases.
Discussion and conclusion: Complete analysis of the clinical findings searching for combined laxity as well as a precise preoperative radiological work-up is the key to a successful operative strategy. Data provided by this series confirmed that outcome is less satisfactory after revision reconstruction of the ACL than first-intention ligamentoplasty. Most of the knees involved however present cartilaginous and meniscal lesions with associated peripheral injuries. Short-term cartilage degradation is a worrisome problem and emphasizes the importance of correctly positioning the ACL graft at the primary surgery.
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