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Revision Anterior Cruciate Ligament Reconstruction

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Arthroscopy

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Abstract

Revision ACL (R-ACL) surgery is a complex procedure that requires a rigorous and meticulous approach.

R-ACL is mainly indicated in cases of graft failure resulting in functional instability.

The causes of graft failure can be separated into four categories: technical errors, trauma, biological failure and rehabilitation problems. Technical errors are the most frequent cause of graft failure. The most common technical or diagnostic error is related to tunnel placement, then undetected secondary restraint injuries and lastly inadequate primary graft fixation.

Pre-operative evaluation is crucial. We propose here our comprehensive check list for diagnosis and pre-op evaluation of R-ACL. Pre-operative evaluation is composed by a clinical evaluation and paraclinical tests.

Revision surgery is contraindicated after inadequate rehabilitation including insufficient neuromuscular control, loss of range of motion, uncorrected severe malalignment, diffuse osteoarthritis and inflammatory or septic arthritis.

Surgical procedure starts with a precise evaluation of the different structures. This evaluation is both clinical (secondary restraints) and arthroscopic. The key point is the management of tunnels; it could be done in one or two stage. There is no gold-standard graft for R-ACL. Options for graft fixation include ignoring previous fixation devices, removing them and removing and reusing the same fixation technique, which depends upon primary tunnel placement and bone loss.

Results of R-ACL are comparable to primary ACL reconstruction in terms of stability measured by anterior-posterior translation and rotatory stability. However, subjective outcome scores for International Knee Documentation Committee (IKDC) and Lysholm score are significantly lower after multiple ACL reconstructions.

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Authors and Affiliations

  1. Unité d’Orthopédie et Traumatologie du Sport, Service de chirurgie orthopédique et traumatologie de l’appareil moteur, Swiss Olympic Medical Center, University Hospital of Geneva, Genève, Switzerland

    Etienne Cavaignac MD, Philippe Tscholl MD & Jacques Menetrey MD, PhD

  2. Faculty of Medicine, University of Geneva, 4, Rue Gabrielle-Perret-Gentil, Genève 4, CH-1211, Switzerland

    Philippe Tscholl MD & Jacques Menetrey MD, PhD

  3. Lyon-Ortho-Clinic, 29 Avenue des Sources, Lyon, 69009, France

    Marco Valoroso MD

Authors
  1. Etienne Cavaignac MD
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  2. Philippe Tscholl MD
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  3. Marco Valoroso MD
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  4. Jacques Menetrey MD, PhD
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Correspondence to Etienne Cavaignac MD .

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Editors and Affiliations

  1. San Donato Milanese, Milano, Italy

    Pietro Randelli

  2. Lyon, France

    David Dejour

  3. Academic Med Ctr, Orthopedic Surger, Univ of Amsterdam, Amsterdam, The Netherlands

    C. Niek van Dijk

  4. Istituto Clinico Humanitas, Rozzano, Milan, Italy

    Matteo Denti

  5. Dept Orthopedic Surgery & Sports Meds, Ctr Hospitalier Clinique d’Eich, Luxemburg, Luxembourg

    Romain Seil

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Cavaignac, E., Tscholl, P., Valoroso, M., Menetrey, J. (2016). Revision Anterior Cruciate Ligament Reconstruction. In: Randelli, P., Dejour, D., van Dijk, C., Denti, M., Seil, R. (eds) Arthroscopy. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-49376-2_25

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