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Knee News

Report on Results of ACL Revision Surgery

Many studies report on the results of anterior cruciate ligament (ACL) repairs. In this study from the Sports Injury Center in Rome, Italy, the results of ACL revision are reported.

Thirty patients who had a primary or first ACL repair had to have a second (revision) operation when the ACL repair failed. All revisions were done using a hamstring tendon graft. The surgeon also used a fixation (holding) device. The same surgeon performed all revision operations.

The hamstring muscle is made up of several major muscles and tendons. Two of those tendons (gracilis and semitendinosus) were folded over and used together to replace the primary repair.

The tibial fixation device used to hold the soft tissues in place is made up of three parts. These include a screw, a coil that goes inside a tunnel in the bone, and a washer to hold it against the bone.

There was significant improvement in joint laxity after revision surgery. Patients had full joint motion and all were able to squat fully. Thigh muscle size and strength were still less on the operative side compared to the uninvolved side at the time of testing. Almost all patients had full return of function. Three patients (10 per cent) had a failed revision surgery.

The authors report that not all patients with failed ACL repair need revision surgery. A second operation should be considered when there is knee pain and instability during daily activities or sports.

We can expect to see an increase in ACL injuries as the number of people participating in sports increases. This increase goes along with more failed repairs and failed revisions. The most common cause of failed ACL repair is surgical error.

This study reports on one method to revise the repair. Other surgeons will explore different methods to treat this problem. The authors say that although the patient will have a stable knee, they should be warned that degenerative joint disease is common.

Andrea Ferretti, MD, et al. Revision Anterior Cruciate Ligament Reconstruction with Doubled Semitendinosus and Gracilis Tendons and Lateral Extra-Articular Reconstruction. In The Journal of Bone and Joint Surgery. November 2006. Vol. 88-A. No. 11. Pp. 2373-2379.


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