ISAKOS: 2019 Congress in Cancun, Mexico
ISAKOS

2019 ISAKOS Biennial Congress ePoster #810

 

Outcomes of Single Stage Revision ACL Reconstruction Using Autograft

Abdelaleem Ragab, MBBCh, MCh, MRCS, Cardiff, Wales UNITED KINGDOM
Vinayak D. Ghanate, DOrtho, DNB(Orth), Mumbai, Maharashtra INDIA
Sasan Dehbozorgi, MBBS, BSc, Cardiff UNITED KINGDOM
Omar Elalfy, Cardiff UNITED KINGDOM
Randy Guro, BSc, Bridgend UNITED KINGDOM
Rahul Kotwal, FRCS(Ortho), Bridgend UNITED KINGDOM
Amit P. Chandratreya, FRCS(Tr&Orth), MS(Orth), MCh(Orth), Cardiff, South Glamorgan UNITED KINGDOM

Princess Of Wales Hospital, Bridgend, Wales, UNITED KINGDOM

FDA Status Not Applicable

Summary

Pragmatic review of single stage revision ACL reconstruction outcomes and reasons of failure in primary surgery.

Abstract

Introduction

ACL reconstruction is a common orthopaedic procedure, hence there is an increased potential for ACL reconstruction revision surgeries.

Aim

Pragmatic review of single stage revision ACL reconstruction outcomes and reasons of failure in primary surgery.

Methods

Retrospective analysis of prospectively collected data for 59 patients with revision ACL reconstructions done by the senior author from 2007 to 2017. The data collected included demographic details, type of graft used in primary and revision ACL reconstruction and possible cause of failure of the primary ACL reconstruction. Pre operative xrays were reviewed to assess position of tunnel after primary surgery and if there is widening of the tunnel. Tunnel positions were also assessed in post revision xrays. Oxford knee scores (OKS), Tegner Scores and Leysholm scores were collected pre and post revision surgeries.

Results

Fifty-nine patients operated on by one surgeon were assessed. Mean age was 32.56+/- 8.75 years with 48 males. Three patients underwent more than one revision surgeries. 36 patients had their primary surgery done by the senior author who did 489 primary ACL reconstructions over this period (rate of revision 7.4%).

In primary reconstruction, hamstrings grafts were the most common used in 40(67.8%) patients, followed by patellar tendon grafts (BTB) in 13(22%) patients. 1(1.7%) patient had reconstruction with quadriceps tendon, 3(5.1%) patients with carbon fibre and 2 (3.4%) patients with LARS ligament.

Mechanical cause of failure was recorded in 26(44.1%) patients after primary reconstruction, improper tunnel position in 18(30.5%) patients and biological failure in 15(25.4%) patients.

All ACL revisions were done using autografts with independent femoral tunnel technique. In revision surgery, the most common used grafts were BTB grafts in 33(55.9%) patients, followed by ipsilateral hamstrings in 12(20.3%) patients, contralateral hamstrings grafts in 9(15.3%) patients and quadriceps tendons grafts in 5(8.5%) revisions. The type of graft used was decided as per the surgeon’s clinical judgment.

Associated procedures with revision surgeries included 9 antero-lateral ligament (ALL) reconstructions, 7 postero-lateral corner (PLC) reconstructions, 1 medial collateral ligament (MCL) reconstruction and 13 meniscal surgeries. One patient could have more than on associated procedure)

There was an average 18 point improvement in OKS post-operatively, 1.6 point improvement in Tegner scores and a 30 point improvement in Leysholm scoring.
After revision surgery, 1(1.7%) patient developed septic arthritis, 4(6.8%) patients had superficial infection, whilst 6(10.2%) patients suffered from residual instability after revision but did not have further surgery. There was a lack of full extension in 4(6.8%) patients. In BTB grafts, 2(6.1%) patients sustained a post-traumatic patellar fracture.

Discussion

Technical difficulty in single stage ACL revision is mainly about tunnel positioning. Both anatomical and completely non-anatomical tunnels could be revised with single stage revision using same tunnel or new tunnel respectively. Widened tunnel or tunnels between anatomical and non-anatomical positions could be managed with single stage revision in our series as bone block with screw was used. Our results are comparable to other studies.

Conclusion

Good outcomes of single stage revision ACL reconstruction surgery are achievable as being successful in our centre.