One-stage Anterior Cruciate Ligament Revision Surgery After Primary Failed Double-bundle Reconstruction: a Systematic Review

Overview

Journal Arch Orthop Trauma Surg

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2023 Sep 5

PMID 37668660

Authors

Claudio Legnani

Timo Jarvela

Enrico Borgo

Vittorio Macchi

Alberto Ventura

Affiliations

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Abstract

Introduction: Anterior cruciate ligament (ACL) revision surgery after failed double-bundle (DB) reconstruction is a challenging procedure. This study aimed to systematically review the research on ACL revision surgery following failed DB reconstruction, providing an overview on indications, surgical techniques, clinical outcomes and potential pitfalls occurring while performing this therapeutic approach.

Materials And Methods: Literature published from exception to February 2023 was searched in the Pubmed/MEDLINE, Embase and CINAHL databases. Studies in English reporting on patients who underwent ACL revision surgery after prior failed DB reconstruction were considered. Review articles and expert opinion or editorial pieces were excluded. Outcomes of interest included indications and pre-operative planning, surgical technique and associated procedures, type of revision surgery (either one- or two-stage), graft choice, clinical and functional outcomes, rate of complications, failure rate.

Results: Overall, 4 studies met all the inclusion criteria for this review. All were published between 2007 and 2020. The search resulted in two retrospective comparative studies, one case series, and one case report. Average follow-up periods ranged from 24 to 45 months. From these studies, 66 patients (66 knees) were identified. One-stage revision surgery was performed in 64 on 66 patients (97%) with pathologic laxity following DB ACL reconstruction. Most frequently reported outcome was Lysholm score in five studies: average postoperative Lysholm score ranged from 90.5 to 91.0 while Tegner activity level ranged from 5.6 to 7.0. In 4 patients (6%) re-revision surgery was performed due to graft re-rupture.

Conclusions: One-stage ACL revision surgery following DB ACL reconstruction appears feasible providing satisfying outcomes and limited complications. The literature on this subject is limited and further comparative studies reporting long-term outcomes are needed, as high-level studies on this topic are still lacking.

Citing Articles

Over-the-Top Double-Bundle Revision Anterior Cruciate Ligament Reconstruction Technique With Hybrid Hamstring Tendon Autograft-Allograft and Associated Lateral Extra-articular Tenodesis.

Guo J, Zhang P, Lv M, Chen P, Li C, Jiang X Arthrosc Tech. 2024; 13(5):102944.

PMID: 38835449 PMC: 11144845. DOI: 10.1016/j.eats.2024.102944.

App-based analysis of the femoral tunnel position in ACL reconstruction using the quadrant method.

Mueller M, Tenfelde O, Hinz N, Pagenstert G, Frosch K, Hoeher J Arch Orthop Trauma Surg. 2024; 144(7):3137-3144.

PMID: 38795188 DOI: 10.1007/s00402-024-05380-9.

A novel surgical technique for revision anterior cruciate ligament reconstruction using an isolated rectus femoris tendon autograft.

Huber T, Fruhwirth M, Hartenbach F, Franzmair S, Ullmann D, Rath B Arch Orthop Trauma Surg. 2024; 144(6):2723-2730.

PMID: 38753014 DOI: 10.1007/s00402-024-05268-8.

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