RETROSPECTIVE ANALYSIS OF 40 REPEATED LIGAMENTOPLASTIES OF THE ANTERIOR CRUCIATE LIGAMENT

Abstract

Purpose: We reviewed retrospectively 40 ligamentoplasties of the anterior cruciate ligament in patients who had undergone several prior reconstructions (1 to 6). The initial operation had used a synthetic ligament in 13 cases, patellar tendon in 23 and divers implants in four.

Material and methods: Forty patients, 12 women and 28 men, with recurrent ligament tears where reoperated by the same surgeon. Mean age was 28.5 years (16–51). Mean follow-up after the last operation was 27 months. All patients were reviewed (history, physical examinatin and KT 1000); 20 of them responded to a self-administered questionnaire using the IKDC chart later after the clinical review, and 23 of the 40 had radiographs to measure laxity. Arthroscopic reconstruction was used in 33 cases. A surgical procedure was necessary on a peripheral ligament in six cases and osteotomy for tibial valgisation in one. Reconstruction was achieved with the quadriceps tendon in 11 cases, the patellar tendon in 18, the hamstrings in eight and Mac in Jones in three. The IKDC score was used for clinical assessment with manual arthrometric measurement of laxity. Radiographs were obtained to measure the anterior drawer of the medial and lateral compartments of both knees for right-left and pre-postoperative comparisons.

Results: The initial handicap was marked (IKDC: 18 D, 21 C, 1 B). Reconstruction was good or very good in 72.5% of the knees (IKCD: 2 A, 27 B, 10 C, 1 D). Self-evaluation revealed 25% painful knees for intense activities. Laxity was improved with a mean differential gain of 5.35 mm of the maximal pre- and postoperative KT 100 (7.24 versus 1.89). Among the 24 knees with radiographic assessment, the mean differential preoperative was 9.14 mm preoperatively and 4.69 mm at last follow-up giving a gain of 4.45 mm. One athlete was able to resume sports activities at the same or higher level and others at a lower level.

Discussion, conclusion: This study confirms that the results obtained after revision repair are less satisfactory than after primary repair. This homogeneous (one operator) and large series with a sufficient follow-up can be compared with the rare published series. Each ligament reconstruction is specific and warrants a specific surgical approach adapted to each individual case.