Summary: A single-stage approach to revision ACL reconstruction is associated with excellent clinical results when an outside-in drilling technique is utilized. The presence of pre-operative tunnel widening does not significantly influence patient reported outcome measures, knee stability, graft rupture rates or non-graft rupture related re-operation rates.

Introduction

Pre-operative tunnel widening is a frequently reported indication for performing a two-stage revision anterior cruciate ligament reconstruction (R-ACLR) instead of a single-stage procedure. However, the strength of the available evidence to support a two-stage strategy is low. The main purpose of this study was to evaluate the clinical outcomes of a single-stage only approach to R-ACLR. It was hypothesized that this approach would be associated with significant improvements from baseline in patient reported outcome measures (PROMS) and knee stability, and also that there would be no significant differences in any post-operative outcomes between patients with and without pre-operative tunnel widening.

Methods

A retrospective analysis of a large series of consecutive patients undergoing R-ACLR, with a minimum follow-up of two years, was conducted. Pre-operative tunnel widening was assessed using digital radiographs. All patients underwent single-stage surgery, with an outside-in technique, even if they had tunnel widening. Clinical outcomes were compared according to whether tunnel widening was present (either tunnel = 12mm) or not (both tunnels <12mm). Comparisons between variables were assessed with the Chi-square or Fisher’s exact tests for categorical variables and the Student’s t test or Wilcoxon test for quantitative variables.

Results

409 consecutive patients with a mean follow-up of 69.6 ± 29.0 months were included in the study. At two years following R-ACLR, there was a significant reduction in the side-to-side AP laxity difference from 7.7 ± 2.2 mm pre-operatively to 1.2 ± 1.1 mm (p < .001). The mean IKDC and all KOOS subscales exceeded the patient acceptable symptom state (PASS) thresholds defined for primary ACLR. There were no significant differences between groups with respect to antero-posterior side-to side laxity difference, graft rupture rates, non-graft rupture related re-operations, or contralateral ACL injury rates. There was also no significant difference between groups, exceeding minimal detectable change thresholds, for any of the PROMS recorded (ACL-RSI, Lysholm, Tegner, IKDC, KOOS).

Conclusions

A single-stage approach to revision ACL reconstruction is associated with excellent clinical results when an outside-in drilling technique is utilized. The mean IKDC and all KOOS subscales exceeded the patient acceptable symptom state (PASS) thresholds defined for primary ACLR. The presence of pre-operative tunnel widening did not significantly influence PROMS, knee stability, graft rupture rates or non-graft rupture related re-operation rates. This suggests that two-stage R-ACLR is rarely warranted

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Acl - Pcl Fixation Sequence During Multi-Ligament Knee Reconstruction Does Not Affect Knee Laxity Abstract Presentation 6 minutes Carola F. van Eck, MD, PhD, FAAOS, UNITED STATES Aly Maher Fayed, MD, EGYPT Ryo Kanto, MD, JAPAN Taylor M. Price, MS, UNITED STATES Michael Dinenna, BS, UNITED STATES Monica A. Linde, MSIE, RN, UNITED STATES Patrick J. Smolinski, PhD, UNITED STATES
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Predicting Subsequent Revision ACL Reconstruction: A Machine Learning Analysis of the Norwegian Knee Ligament Register Abstract Presentation 5 minutes R. Kyle Martin, MD, FRCSC, UNITED STATES Solvejg Wastvedt, BA, UNITED STATES Ayoosh Pareek, MD, UNITED STATES Andreas Persson, MD, PhD, NORWAY Havard Visnes, MD, PT, PhD, NORWAY Anne Marie Fenstad, MSc, NORWAY Gilbert Moatshe, MD, PhD, NORWAY Julian Wolfson, PhD, UNITED STATES Lars Engebretsen, MD, PhD, NORWAY
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Contralateral versus ipsilateral quadriceps graft, for anterior cruciate ligament reconstruction. Abstract Presentation 6 minutes Franco Della Vedova, MD, ARGENTINA Hernan Galan, MD, ARGENTINA Daniel A. Slullitel, MD, Prof., ARGENTINA
Dynamic Radiostereometry Evaluation Of Two Different Anterior Cruciate Ligament Reconstruction Techniques: Does Single Bundle Reconstruction Plus Lateral Plasty Cause Knee Over-Constraint? Abstract Presentation 4 minutes Alberto Grassi, PhD, ITALY Stefano Di Paolo, Eng, ITALY Piero Agostinone, MD, ITALY Gian Andrea Lucidi, MD, ITALY Erika Pinelly, MsC, ITALY Marco Bontempi, ITALY Laura Bragonzoni, Prof., ITALY Stefano Zaffagnini, MD, Prof., ITALY
Validation of a Risk Calculator to Personalize Graft Choice and Reduce Rupture Rates for Anterior Cruciate Ligament Reconstruction Abstract Presentation 6 minutes Hana Marmura, BSc, CANADA Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, CANADA Kurt Paul Spindler, MD, UNITED STATES Michael W Kattan, PhD, UNITED STATES Isaac Briskin, MA, UNITED STATES Dianne M. Bryant, PhD, CANADA
PSM: Pivot Shift Meter Cellphone Application for Classifying ACL Injuries Abstract Presentation 5 minutes Edmundo Berumen Nafarrate, PhD, Prof., MEXICO Carlos Alejandro Vega Najera, MD, MEXICO Joel Alejandro Cabral, MD, MEXICO Luis Sigala Gonzalez, Eng, MEXICO Ivan Ramos Moctezuma, Eng, MEXICO Carlos Leal, MD, Prof., COLOMBIA Jesus Javier Tonche, MD, MEXICO Avril Pérez Fontes, MD, MEXICO Fatima Quintana Trejo, Eng, MEXICO
Negative Effects Of Delayed Anterior Cruciate Ligament Reconstruction On Associated Injuries And Knee Laxity Abstract Presentation 6 minutes Riccardo Cristiani, MD, PhD, SWEDEN Per-Mats Janarv, MD, Assist. Prof., SWEDEN Bjorn Engstrom, MD, PhD, Assoc. Prof., SWEDEN Gunnar Edman, MD, PhD, Prof., SWEDEN Magnus Forssblad, SWEDEN Anders Stalman, MD, PhD, associate professor, SWEDEN
Inter- and Intra-Rater Reliability of Measurenebt of ACL TUnnels with Radiographs, CT, and MRI Abstract Presentation 4 minutes Robert A Magnussen, MD, MPH, UNITED STATES Alexander Sparks, BS, UNITED STATES Jacy Leon, BS, UNITED STATES Matthew Colatruglio, BS, UNITED STATES Joshua Bowler, MD James Oosten, BS, UNITED STATES Alex C. Dibartola, MD, MPH, UNITED STATES Joshua Scott Everhart, MD, MPH, UNITED STATES Robert A. Duerr, MD, UNITED STATES Christopher C. Kaeding, MD, UNITED STATES David C. Flanigan, MD, UNITED STATES
Analysis Of The Blood Supply To The Femoral Attachment Of The Anterior Cruciate Ligament After Acl Injury Abstract Presentation 4 minutes Jedrzej Jerzy Lesman, PhD MD, POLAND Marcin E. Domzalski, MD, Prof., POLAND Krzysztof Nowak, MD, PhD, POLAND Sebastian Zygmunt Żabierek, PhD, POLAND Radoslaw Grabowski, MD, POLAND Ilona Wagner-Olszewska, MD, POLAND
Changes In Muscle Strength And Hop Performance After ACL Reconstruction. A Randomized Controlled Trial Comparing Patellar Tendon And Hamstring Tendon Autografts With Standard Or Accelerated Rehabilitation Abstract Presentation 6 minutes Riccardo Cristiani, MD, PhD, SWEDEN Christina Mikkelsen, PT, SWEDEN Peter Olov Wange, MD, SWEDEN Daniel Olsson, PhD, SWEDEN Anders Stalman, MD, PhD, associate professor, SWEDEN Bjorn Engstrom, MD, PhD, Assoc. Prof., SWEDEN
Return To Sports After Paediatric Anterior Cruciate Ligament Reconstruction (ACLR): Normal Population Vs An ACLR Cohort Abstract Presentation 6 minutes Alexander S. Nicholls, MSc, FRACS, AUSTRALIA Jillian Lee, BHB, MBChB, FRACS (Ortho), NEW ZEALAND Yoong Lim, BEng, PhD, AUSTRALIA Quang Dao, FRACS, AUSTRALIA
Acl Deficiency Influences Medio-Lateral Tibial Alignment And Knee Varus–Valgus During In Vivo Activities Abstract Presentation 3 minutes Piero Agostinone, MD, ITALY Stefano Di Paolo, Eng, ITALY Alberto Grassi, PhD, ITALY Marco Bontempi, ITALY Erika Pinelli, MsC, ITALY Laura Bragonzoni, Prof., ITALY Stefano Zaffagnini, MD, Prof., ITALY

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Pre-Operative Tunnel Widening Does Not Significantly Influence The Outcomes Of A Single-Stage Only Approach To Revision Acl Reconstruction: An Analysis Of 409 Consecutive Patients

Pre-Operative Tunnel Widening Does Not Significantly Influence The Outcomes Of A Single-Stage Only Approach To Revision Acl Reconstruction: An Analysis Of 409 Consecutive Patients

Introduction

Methods

Results

Conclusions

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Pre-Operative Tunnel Widening Does Not Significantly Influence The Outcomes Of A Single-Stage Only Approach To Revision Acl Reconstruction: An Analysis Of 409 Consecutive Patients

Pre-Operative Tunnel Widening Does Not Significantly Influence The Outcomes Of A Single-Stage Only Approach To Revision Acl Reconstruction: An Analysis Of 409 Consecutive Patients

Introduction

Methods

Results

Conclusions

More ISAKOS 2021: Global Content