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Revision ACL Reconstruction

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Home > Orthopedic Surgery > Arthroscopy > Revision ACL Reconstruction

Overview

Revision ACL Surgery


After you have an ACL reconstruction you lead a normal injury free return to all activities. It is an unfortunate fact that sometimes even after you have your ACL reconstructed, that you can do something to re-injure the ligament and require another reconstructive surgery.

Many times if you re-injure your ACL, another reconstruction is needed. If this is the case, well over 50% of the time the reconstruction requires two surgeries. The first surgery requires doctor to remove the old screws from the tunnels (figure 1), repair any damage that occurred to the other structures of the knee and to use donor bone plugs (figure 3) to graft into the tunnels (figure 2). After a sufficient period of time to allow for proper healing of the bone grafting, Doctor will then perform the second phase of the reconstruction. This surgery consists of drilling new tunnels and then reconstructing the ACL again.

In a few cases the doctor is able to remove the hardware and use those tunnels to reconstruct the ACL. This is not a common occurrence since the stresses that tear the ligament also tend to widen out the tunnels. If the tunnels are too big, there is no way to secure the new graft properly and bone grafting will be required.

There will be a period of rehabilitation required after each surgery. Once the ACL reconstruction has been completed, another full course of rehabilitation to strengthen the knee will once again be required.
Anterior Cruciate Ligament, ACL Reconstruction Surgery, ACL
Figure 1 : - Hardware Removal

Revision ACL Reconstruction Surgery, ACL Reconstruction Surgery, Ligament Reconstruction                ACL Reconstruction Surgery, ACL, Anterior Cruciate, Ligament Reconstruction

            Figure 2 : - Old Tunnel                         Figure 3 : - Bone Plug


Causes of Failure of ACL Reconstruction


  • Incorrect Technique
  • Incorrect tunnel Placement
  • Graft fixed in lax position
  • Synthetics
  • Failure of Graft Incorporation
  • Host Factors
  • Missed Associated Instabilities
  • Re-Injury
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Steps in Planning ACL Revision : -
  • Determine the cause of Failure
  • Choose the appropriate graft
  • Autograft
    1. Quadriceps tendon
    2. Patellar tendon - same or opposite side
    3. Semi-t opposite side
  • Allograft
    1. Patellar tendon
    2. Achilles tendon
  • synthetic
  • Plan the hardware removal
  • Plan tunnel placement
  • Large tunnel


Revision anterior cruciate ligament (ACL) reconstruction is indicated for selected patients with recurrent instability after a failed primary procedure. The cause of the failure must be carefully identified to avoid pitfalls that may cause the revision to fail as well. Associated instability patterns must be recognized and corrected to achieve a successful result. The choice of graft, the problem of retained hardware, and tunnel placement are the major challenges of revision ACL reconstruction.

The patient must have reasonable expectations and understand that the primary goal of surgery is restoration of the ability to perform activities of daily living, rather than a return to competitive athletics. The results of revision ACL reconstructions are not as good as those after primary reconstructions; however, the procedure appears to be beneficial for most patients.


The list of of Orthopedic Surgery in India is as follows : -


Apollo Hospitals Bangalore Apollo Hospitals, Bangalore, India
Apollo Hospital Chennai Apollo Hospital, Chennai, India
Apollo Hospitals Hyderabad Apollo Hospitals, Hyderabad, India
Apollo Hospitals Delhi Indraprastha Apollo Hospital, Delhi, India
Apollo Hospitals Kolkata Apollo Gleneagles Hospital, Kolkata, India
Apollo Hospital, Goa, India Apollo Hospital, Goa, India
Wockhardt Hospital Bangalore India Wockhardt Hospital, Bangalore India
Wockhardt Hospital Mumbai, India Wockhardt Hospital, Mumbai, India
Fortis Hospital, Delhi, India Fortis Hospital, Delhi, India
Fortis Hospital Mohali, India Fortis Hospital, Mohali, India
Fortis Hospital Noida, India Fortis Hospital, Noida, India
Manipal Hospital, Bangalore, India Manipal Hospital, Bangalore, India
MIOT Hospital, Chennai, India MIOT Hospital, Chennai, India
Sparsh Hospital, Bangalore, India Sparsh Hospital, Bangalore, India
Sparsh Hospital, Bangalore, India Sparsh Hospital, Bangalore, India
Artemis Hospital, Gurgaon ( Delhi ) , India Artemis Hospital, Gurgaon ( Delhi ) , India
Max Devki Devi Heart and Vascular  hospital,  Delhi, India Max Devki Devi Heart and Vascular hospital, Delhi, India
BGS Global Hospital Bangalore, India BGS Global Hospital, Bangalore, India
BGS Global Hospital Chennai, India BGS Global Hospital, Chennai, India
BGS Global Hospital Hyderabad, India BGS Global Hospital, Hyderabad, India



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