Abstract
Purpose: Failed anterior cruciate ligament reconstruction as defined by recurrent pathologic laxity, is increasingly commonplace. We reviewed 77 patients who had undergone unsuccesful anterior cruciate ligament surgery to correct persisting instability, and who underwent revision surgery.
Material and Methods: During the first operative treatment, were used synthetic ligament in 18 cases, autograft in 54 cases, extra-articular plasty in 4 cases, allograft in 1 case and primary repair in 1 case. For revision, we used autograft in all cases according to differents anatomicals factors: 41 patellar tendons, 15 quadriceps tendons and 17 hamstring tendons. 46 patients had meniscectomy during one of the two surgeries ; 19 patients had cartilage lesions (grade 3 or 4).
For clinical evaluation, we used the IKDC score (1999), and laxity measurement with the KT-1000 arthrometer and stress X-rays.
The mean follow-up was 24 months.
Results The mean IKDC subjective score was 71,5 and 75% of knee were considered as normal or nearly normal. The surgery was successfull in objectively improving the stability in most of patients with a KT-1000 differential maxi-manual of 2 1,7 mm.
We found no statistical difference between the three groups of graft used for revision. The results are a trend toward less good results, when patients had a meniscec-tomy. Subjectively the result were worse in cases of cartilage lesion. In fact, no patient who had grade IV lesion returned to there previous level activity (pre-operative level activity). The worse results are in the group of failed synthetic ligaments.
Conclusion ACL revision surgery leads to poorer results than primary surgery.
There was no clinical difference for the revision, whether we used autograft of patellar tendon, quadriceps tendon or hamstring tendon with an adapted fixation device.
On the other hand, meniscal or cartilage lesion or the use of synthetic grafts are factors of poor clinical outcome.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
