Revisional ACL reconstruction

failure of ACL reconstruction
Revisional ACL reconstruction
Revisional ACL reconstruction
Revisional ACL reconstruction
Revisional ACL reconstruction planning
Revisional ACL reconstruction planning

 Failure of ACL reconstruction

Factors

Surgical technique

Graft selection

Condition of articular & meniscal cartilage

Post op Rehabilitation


Early failure (<6 months)

Technical errors

Incorrect rehab

Premature return to sports

Later failure (>1 year)

Recurrent injury


The most avoidable & common cause : Surgical technique

Revision ACL reconstruction

Continued symptomatic and functional instability

Radiographs, 3D-CT, MRI


Pre op planning with 3D-CT

Tunnel position

Tunnel widening

Hardware position

Revision ACL reconstruction

Continued symptomatic and functional instability

Radiographs, 3D-CT, MRI


Pre op planning with 3D-CT

Tunnel position

Non-anatomic : completely outside of the anatomic footprints

Anatomic : completely within the anatomic footprints

Semi-anatomic : partially overlapping the anatomic footprints

Revision ACL reconstruction

Continued symptomatic and functional instability

Radiographs, 3D-CT, MRI


Pre op planning with 3D-CT

Tunnel position

Non-anatomic : completely outside of the anatomic footprints

Technique of primary anatomic ACL reconstruction can be employed

Adequate bony bridge between tunnels


Revision ACL reconstruction

Continued symptomatic and functional instability

Radiographs, 3D-CT, MRI


Pre op planning with 3D-CT

Tunnel position

(2) Anatomic  tunnel widening consideration

Absence of widening 

Reuse

Widening or osteolysis exists(>16mm) 

Staged revision

allograft or autograft bone


Revision ACL reconstruction

Continued symptomatic and functional instability

Radiographs, 3D-CT, MRI


Pre op planning with 3D-CT

Tunnel position

(3) Semi-anatomic : partially overlapping the anatomic footprints

One-stage

Eccentric drilling of the previous tunnel

Diverging tunnel creation

Using large bone blocks

Staged revision


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