Revision anterior cruciate ligament surgery

Anterior cruciate ligament (ACL) reconstruction surgery is one of the most frequently performed operative procedures in orthopaedic surgery. There are estimates that 100,000 new ACL injuries occur annually. Marked improvements have occurred in the last 15 years with regard to graft selection, tunnel placement, graft fixation, and rehabilitation that have resulted in predictable outcomes for ACL surgery using patellar tendon, hamstring, quadriceps tendon, autograft, and allograft tissues. Nevertheless, most studies report a clinical failure rate of between 10% and 15% at short- and intermediate-term follow-ups. 1 Bach Jr, B.R. Jones G.T. Sweet F.A. Hager C.A. Arthroscopy-assisted anterior cruciate ligament reconstruction using patellar tendon substitution. Two- to four-year follow-up results. Am J Sports Med. 1994; 22: 758-767 Crossref PubMed Scopus (176) Google Scholar , 2 Bach Jr, B.R. Levy M.E. Bojchuk J. Tradonsky S. Bush-Joseph C.A. Khan N.H. Single-incision endoscopic anterior cruciate ligament reconstruction using patellar tendon autograft. Minimum two-year follow-up evaluation. Am J Sports Med. 1998; 26: 30-40 PubMed Google Scholar , 3 Bach Jr, B.R. Tradonsky S. Bojchuk J. Levy M.E. Bush-Joseph C.A. Khan N.H. Arthroscopically assisted anterior cruciate ligament reconstruction using patellar tendon autograft. Five- to nine-year follow-up evaluation. Am J Sports Med. 1998; 26: 20-29 PubMed Google Scholar Increasing numbers of ACL reconstruction failures are being seen. 4 Williams III, R.J. Warren R.F. Carson E.W. Wickiewicz T.L. Revision anterior cruciate ligament reconstruction The Hospital for Special Surgery experience. Tech Orthop. 1998; 13: 375-383 Crossref Scopus (7) Google Scholar , 5 Steadman J.R. Saterbak A.M. Revision anterior cruciate ligament reconstruction Techniques and tips—The Vail experience. Tech Orthop. 1998; 13: 384-390 Crossref Scopus (6) Google Scholar , 6 Clancy Jr, W.G. Pietropaoli M.P. Revision anterior cruciate ligament reconstruction using the “anatomic-endoscopic” method. Tech Orthop. 1998; 13: 391-410 Crossref Scopus (7) Google Scholar , 7 Bach Jr, B.R. Mazzocca A. Fox J.A. Revision anterior cruciate ligament surgery. in: Grana W.A. Orthopaedic knowledge online. American Academy of Orthopaedic Surgeons, Rosemont, IL2003 Google Scholar , 8 Brown Jr, C.H. Carson E.W. Revision anterior cruciate ligament surgery. Clin Sports Med. 1999; 18: 109-171 Abstract Full Text Full Text PDF PubMed Scopus (192) Google Scholar , 9 Barber F.A. McGuire D.A. Johnson D.H. Should allografts be used for routine anterior cruciate ligament reconstructions?. Arthroscopy. 2003; 19: 421-425 Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar , 10 Noyes F.R. Barber-Westin S.D. Revision anterior cruciate ligament reconstruction Report of 11-year experience and results in 114 consecutive patients. Instr Course Lect. 2001; 50: 451-461 PubMed Google Scholar , 11 Uribe J.W. Hechtman K.S. Zvijac J.E. Tjin A.T.E.W. Revision anterior cruciate ligament surgery Experience from Miami. Clin Orthop. 1996; 325: 91-99 Crossref PubMed Scopus (134) Google Scholar The purpose of this article is to discuss the etiology of failure, approaches to the failed ACL patient, surgical technique issues, and results of revision ACL surgery. 7 Bach Jr, B.R. Mazzocca A. Fox J.A. Revision anterior cruciate ligament surgery. in: Grana W.A. Orthopaedic knowledge online. American Academy of Orthopaedic Surgeons, Rosemont, IL2003 Google Scholar