74. MANAGEMENT PRACTICES AND RESULTS OF REPEATED REVISIONS FOR ANTERIOR CRUCIATE LIGAMENT

Abstract

Purpose of the study: Revision ligamentoplasty can improve function and laxity control but with a less satisfactory result than obtained after primary reconstruction. The purpose of this study was to report management practices and results of revision ACL reconstructions and to assess the course of meniscocartilage damage and determine causes of failures.

Material and method: This was a consecutive series of ten patients, mean age 30 years (range 17–48) who underwent arthroscopic reconstruction. The review was retrospective. Criteria for failure were redevelopment of instability and/or pain, objective laxity, and a KT-100 differential greater than 5 mm. The IKDC protocol was used for the clinical and radiographic assessment. Goniometry, arthroscan and MRI were also performed. The position of the tunnels was analysed according to the Aglietti criteria. The type of surgery, transplant used and status of the menisci and cartilage were analysed.

Results: Mean follow-up of the second revision was 38 months. At last follow-up, seven patients had a global IKDC score of A or B. Two patients had resumed regular sports activities at the same level as before the first tear, four at a lower level. Four had interrupted their sports activities. At the second revision, two patients exhibited medial femorotibial narrowing measured at less than 50%, three had a remodelled medial femorotibial compartment and one a remodelled lateral compartment. All had a partial homolateral meniscectomy and seven had cartilage injuries (3 ICRS III and 1 ICRS IV). At the successive interventions, the number of meniscal lesions, meniscetomies, and cartilage lesions increased (p=0.016, 00098 and 0.0197 respectively). ICRS grade II and IV cartilage lesions were associated with an overall C or D IKCD (p=0.0472). The cartilage lesions were more frequent in knees with meniscal lesions and meniscectomies. The causes of failure of the primary ligamentoplasty and of the first revision (six and seven patients respectively) were poor position of the tunnels (respectively 4 and 1 patients).

Discussion: In 70% of the patients outcome after repeated revision was good or excellent, although the quality declined with increasing number of revisions, in relation to the development of meniscal and cartilaginous lesions. These latter were more frequent and more severe, related to recurrent laxity. Failures were mainly due to recurrent trauma followed by technical errors.