Primary revision after failure of anterior cruciate ligament reconstruction

doi:10.3969/j.issn.2095-4344.2014.46.016

Abstract

Abstract:

BACKGROUND: Failure of anterior cruciate ligament reconstruction can be caused by multiple factors, which requires a revision surgery. However, there are few studies about the revision of anterior cruciate ligament.

OBJECTIVE: To investigate the primary cause, indication, methods and effectiveness of revision after the failure of anterior cruciate ligament reconstruction.

METHODS: Thirty patients with instability undergoing anterior cruciate ligament reconstructions were subjected to revision under arthroscopy. After revision, a systemic analysis was performed based on KT-2000 examination, the International Knee Documentation Committee (IKDC) scale, Lysholm and Tegner scores.

RESULTS AND CONCLUSION: Of the 30 cases, 9 cases were reconstructed with bone-patellar tendon-bone autograft, 14 cases with hamstring tendon autograft, 7 cases with hamstring tendon allograft. Twelve cases had a femoral tunnel in the front of the predicted one, 1 case had knee stiffness, 8 cases had a tibial tunnel in the front of the predicted one, and 8 cases had both the femoral and tibial tunnels in the front of the predicted ones. One case had a malposited interference screw which reconstructed with bone-patellar tendon-bone autograft; one case complicated by posteromedial corner injury was not reconstructed. The reconstructed anterior cruciate ligament was absolutely ruptured and absorbed in 12 cases, and 18 cases had obviously loosen but still partly linked reconstructed ligament. None had severe incompletion of spongy bone. All cases received primary revision. Ten cases reconstructed with ipsilateral hamstring tendon, 14 cases reconstructed with contralateral hamstring tendon, and 6 cases with LARS ligament. The mean side-to-side difference of KT-2000 examination at 90° and 30°, the mean IKDC, Tegner and Lysholm scores were significantly improved after revision. There were many reasons leading to failure of anterior cruciate ligament reconstruction, such as malposition of the bone tunnel, invalid fixation, adhesion, compound ligament injuries, and ankylosis. The functional results and objective stability could be obtained through revision following anterior cruciate ligament reconstruction.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

全文链接：

Key words: anterior cruciate ligament, arthroscopes, bone-patellar tendon-bone graft

CLC Number:

R318

Kong Ying, Wang Guo-dong, Zhang Yuan-min, Zhao Xiao-wei, Zhang Yu-ge . Primary revision after failure of anterior cruciate ligament reconstruction [J]. Chinese Journal of Tissue Engineering Research, 2014, 18(46): 7458-7462.

Figures/Tables 1

References

[1] Sherman OH, Banfy MB. Anterior cruciate ligament reconstruction: Which graft is best. Arthroscopy.2004;20(9): 974-980.
[2] 黄迅悟,常青,白一冰,等.关节镜下应用深低温冷冻异体跟腱重建后交叉韧带[J].骨与关节损伤杂志,2003,18(2):91-93.
[3] 张春礼,樊宏斌,吕荣,等.自体和异体肌腱移植重建前十字韧带后止点转归的组织学研究[J].中华骨科杂志,2004,24(3):146-149.
[4] Persson A, Fjeldsgaard K, Gjertsen JE, et al. Increased Risk of Revision With Hamstring Tendon Grafts Compared With Patellar Tendon Grafts After Anterior Cruciate Ligament Reconstruction: A Study of 12,643 Patients From the Norwegian Cruciate Ligament Registry, 2004-2012. Am J Sports Med. 2014;42(2):285-291.
[5] Mariscalco MW, Flanigan DC, Mitchell J, et al. The influence of hamstring autograft size on patient-reported outcomes and risk of revision after anterior cruciate ligament reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) Cohort Study. Arthroscopy.2013;29(12):1948-1953.
[6] Maletis GB, Inacio MC, Desmond JL, et al. Reconstruction of the anterior cruciate ligament: association of graft choice with increased risk of early revision. Bone Joint J. 2013;95-B(5): 623-628.
[7] Ventura A, Legnani C, Terzaghi C, et al. Revision surgery after failed ACL reconstruction with artificial ligaments: clinical, histologic and radiographic evaluation. Eur J Orthop Surg Traumatol. 2014;24(1):93-98.
[8] 马勇,敖英芳,崔国庆,等.前交叉韧带重建后翻修的临床研究[J].中华外科杂志,2008,46(9:650-653.
[9] 敖英芳,马勇,崔国庆,等.前交叉韧带重建失败的原因分析[J].中华外科杂志,2007,45(2):86-89.
[10] Song EK,Oh LS,Gill TJ,et al. Prospective comparative study of anterior cruciate ligament reconstruction using the double-bundle and single-bun- dle techniques. Am J Sports Med.2009;37(9):1705-1711.
[11] Lee S, Kim H, JalIg J, et al. Comparison of anterior and rotatory Laxity using navigation between single- and double-bundle ACL reconstruction：prospective randomized trial. Knee Surg Sports Traumatol Arthrosc.2012;20(4): 752-761.
[12] 张辉,冯华,洪雷,等.导航辅助下前十字韧带单束与双束重建的比较研究[J].中华骨科杂志,2012,32(6):557-564.
[13] Song EK, Seon JK, Yim JH, et al．Progression of osteoarthritis after double- and single-bundle anterior cruciate ligament reconstruction. Am J Sports Med. 2013;41(10):2340-2346.
[14] Taketomi S,Inui H, Nakamura K, et al. Three-dimensional fluoroscopic navigation guidance for femoral tunnel creation in revision anterior cruciate ligament reconstruction. Arthrosc Tech.2012;1(1):e95-99.
[15] Hofbauer M, Muller B, Murawski CD, et al. Strategies for revision surgery after primary double-bundle anterior cruciate ligament (ACL) reconstruction. Knee Surg Sports Traumatol Arthrosc. 2013;21(9):2072-2080.
[16] 陈百成.合理选择单束和双束移植物重建前交叉韧带[J].中华关节外科杂志:电子版, 2009, 3(2): 137-140.
[17] Chen JL, Allen CR, Stephens TE, et al. Differences in mechanisms of failure, intraoperative findings, and surgical characteristics between single- and multiple-revision ACL reconstructions: a MARS cohort study.Am J Sports Med. 2013;41(7):1571-1578.
[18] Behrens SB, Lee BJ, Paller D, et al. Mechanical Properties of Revision ACL Reconstruction.J Knee Surg. 2014;27(2): 119-124.
[19] Ra HJ,Ha JK,Kim JG.One-stage revision anterior cruciate ligament reconstruction with impacted bone graft after failed primary reconstruction. Orthopedics. 2013;36(11):860-863.
[20] Buda R, Ruffilli A, Di Caprio F, et al. Allograft salvage procedure in multiple-revision anterior cruciate ligament reconstruction.Am J Sports Med. 2013;41(2):402-410.
[21] Kievit AJ, Jonkers FJ, Barentsz JH, et al. A cross-sectional study comparing the rates of osteoarthritis, laxity, and quality of life in primary and revision anterior cruciate ligament reconstructions. Arthroscopy.2013;29(5):898-905.
[22] Griffith TB, Allen BJ, Levy BA, et al. Outcomes of repeat revision anterior cruciate ligament reconstruction. Am J Sports Med.2013;41(6):1296-1301.