Introduction. Multiple ACL revisions represent an extremely demanding surgery, due to the presence of enlarged or malpositioned tunnels, hardware, injuries to the secondary stabilizers and difficulties in retrieving autologous tendons. An anatomical ACL reconstruction is not always possible. We analyzed the results in a series of patients operated with over the top reconstruction (OTTR) and lateral extra-articular plasty to the Gerdy's tubercle (LP) using Achilles (AT) or tibialis posterior tendon (TPT) allografts. Methods. From 2002 to 2008, twenty-four male athletes with a mean age of 30.8 years were operated. 20 of the patients had two, while four patients had three previous reconstructions. IKDC score and KT evaluation were used at a mean 3.3 years follow-up (2–7 years). Results. The mean IKDC subjective score at follow-up was 81.3. The IKDC objective score rated A or B in 84% of the patients. Of the 20 good results, 17 patients resumed sport activity at the pre-injury level. KT side-to-side difference averaged 3.5 mm in the TPT, versus 3.2 mm in the AT group. No significant differences were noted between the AT and TPT group. Conclusions. Multiple ACL revision surgery is a salvage procedure, with average good results, but not equivalent to primary ACL reconstruction. Patients should be advised that a return to sports may not be feasible. OTTR+LP is an established technique that permits to overcome difficult anatomical situations, with cortical fixation providing good immediate stability and avoiding tunnel fixation and bone grafting. Long tendon grafts as AT and TPT are needed

Background. Acquired flatfoot deformity goes ahead with a partial or complete rupture and thus insufficiency of the tibialis posterior tendon. We present the results of flexor digitorum longus transfer and medial displacement calcaneal osteotomy to reconstruct the acquired deformity. Material & Methods. Twenty two patients (24 feet) with an average age of 58 (36–75) years were operated on for acquired flexible flatfoot deformity. Two patients had a bilateral procedure. Patients were seen pre-and postoperatively in order to evaluate following parameters: AOFAS hindfoot score, visual analogue scale for pain (0–10), the tarsometatarsal angle on lateral and ap standing x-rays, the cuneiform heights and talocalcaneal angle on lateral standing x-rays and subjective postoperative satisfaction score (1-worst to 5-best). Average time of follow-up was 24.7 months (12–48). Results. The AOFAS hindfoot score could be increased from 46.4 to 89.5 points, the visual analogue scale for pain decreased from 6.6 to 1.1. The average satisfaction score was 4.5 points with one patient scoring 2 and another one scoring 3. All the other patients scored either 4 or 5. All radiological parameters could be improved. Following complications were seen: one recurrence, two patients with irritation of the sural nerve, one patient with hypesthesia of the big toe. The calcaneal screws had to be removed in 3 patients. Conclusion. Flexor digitorum longus transfer together with medial displacement calcaneal osteotomy gave satisfactory results for the treatment of acquired flatfoot deformity. All radiologic parameters were improved