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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIX | Pages 14 - 14
1 Jul 2012
Bhattacharya R Akhtar M Keating J
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Purpose. The aim of the present study was to investigate the relationship between generalised ligament laxity and requirement for revision ACL reconstruction. Materials and methods. 126 patients undergoing primary ACL reconstruction were included in the study along with 35 patients undergoing revision ACL surgery. 62 patients without any knee ligament injury formed an age and sex matched the control group. The Beighton score was used to quantify the ligamentous laxity in all cases with a score more than 4 classified as having generalised ligamentous laxity. The revision ACL patients were evaluated to identify technical errors at the time of the primary procedure or subsequent traumatic injury that could have contributed to primary graft failure. Results. The primary ACL surgery group was associated with an increased generalised ligamentous laxity compared to the control group and this was statistically significant (p < 0.05). Similarly the revision surgery group was also associated with increased generalised ligamentous laxity compared to the control group (p < 0.05). The revision ACL surgery group was also associated with increased generalised ligamentous laxity when compared to the primary ACL surgery group but this did not quite achieve statistical significance (p = 0.058). There was a subgroup within the revision cohort, who had a failure of the original surgery due to biological failure of the primary graft. The incidence of generalised ligament laxity in this group was significantly higher than the primary surgery group (p < 0.05). Conclusion. The findings of the study suggest a clear relationship between generalised ligamentous laxity and ACL injury. The study also highlights a link between generalised ligamentous laxity and requirement for revision ACL surgery. Based on the results of our study we feel that in the presence of GLL an autogenous graft may not be the best mode of reconstruction for either primary of revision ACL reconstruction. A case could be made for preferring allografts over autografts for these patients to reduce the rate of graft failure. Further prospective studies comparing allograft and autorgraft failure rates in patients undergoing primary and revision ACL are required to confirm our observations


The Bone & Joint Journal
Vol. 99-B, Issue 3 | Pages 337 - 343
1 Mar 2017
Ahmed I Salmon L Roe J Pinczewski L

Aims

The aim of this study was to investigate the long-term clinical and radiological outcome of patients who suffer recurrent injuries to the anterior cruciate ligament (ACL) after reconstruction and require revision surgery.

Patients and Methods

From a consecutive series of 200 patients who underwent primary reconstruction following rupture of the ACL, we identified 36 who sustained a further rupture, 29 of whom underwent revision surgery. Patients were reviewed prospectively at one, two, seven, 15 and about 20 years after their original surgery. Primary outcome measures were the number of further ruptures, the posterior tibial slope (PTS), and functional and radiological outcomes. These were compared with a gender and age matched cohort of patients who underwent primary ACL reconstruction only.


The Bone & Joint Journal
Vol. 99-B, Issue 6 | Pages 714 - 723
1 Jun 2017
Grassi A Nitri M Moulton SG Marcheggiani Muccioli GM Bondi A Romagnoli M Zaffagnini S

Aims

Our aim was to perform a meta-analysis of the outcomes of revision anterior cruciate ligament (ACL) reconstruction, comparing the use of different types of graft.

Materials and Methods

A search was performed of Medline and Pubmed using the terms “Anterior Cruciate Ligament” and “ACL” combined with “revision”, “re-operation” and “failure”. Only studies that reported the outcome at a minimum follow-up of two years were included. Two authors reviewed the papers, and outcomes were subdivided into autograft and allograft. Autograft was subdivided into hamstring (HS) and bone-patellar tendon-bone (BPTB). Subjective and objective outcome measures were analysed and odds ratios with confidence intervals were calculated.


The Bone & Joint Journal
Vol. 100-B, Issue 3 | Pages 285 - 293
1 Mar 2018
Nakamae A Adachi N Deie M Ishikawa M Nakasa T Ikuta Y Ochi M

Aims

To investigate the risk factors for progression of articular cartilage damage after anatomical anterior cruciate ligament (ACL) reconstruction.

Patients and Methods

A total of 174 patients who underwent second-look arthroscopic evaluation after anatomical ACL reconstruction were enrolled in this study. The graded condition of the articular cartilage at the time of ACL reconstruction was compared with that at second-look arthroscopy. Age, gender, body mass index (BMI), ACL reconstruction technique, meniscal conditions, and other variables were assessed by regression analysis as risk factors for progression of damage to the articular cartilage.