PDF herunterladen
J Knee Surg 2012; 25(02): 143-150
DOI: 10.1055/s-0031-1286196
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

An Institution-Specific Analysis of ACL Reconstruction Failure

Rachel M. Frank
1   Division of Sports Medicine, Department of Orthopedics, Rush University Medical Center, Chicago, Illinois
,
Kevin C. McGill
1   Division of Sports Medicine, Department of Orthopedics, Rush University Medical Center, Chicago, Illinois
,
Brian J. Cole
1   Division of Sports Medicine, Department of Orthopedics, Rush University Medical Center, Chicago, Illinois
,
Charles A. Bush-Joseph
1   Division of Sports Medicine, Department of Orthopedics, Rush University Medical Center, Chicago, Illinois
,
Bernard R. Bach
1   Division of Sports Medicine, Department of Orthopedics, Rush University Medical Center, Chicago, Illinois
,
Nikhil N. Verma
1   Division of Sports Medicine, Department of Orthopedics, Rush University Medical Center, Chicago, Illinois
,
Mark A. Slabaugh
1   Division of Sports Medicine, Department of Orthopedics, Rush University Medical Center, Chicago, Illinois
› Institutsangaben
Weitere Informationen

Publikationsverlauf

02. März 2011

18. Juni 2011

Publikationsdatum:
05. Oktober 2011 (online)

    Lizenzen und Reprints

Abstract

The purpose of this study was to determine the most common causes of failed anterior cruciate ligament reconstruction (ACLR) using modern reconstructive techniques at a single, high-volume institution. In addition, the clinical outcomes of patients undergoing revision ACLR will be reported. The surgical logs of four senior knee surgeons were retrospectively reviewed for all patients who had undergone ACLR between 2002 and 2009. Patients were excluded if they did not have both the primary and revision surgery on the same knee with the same surgeon. Out of 1944 ACL reconstructions, 28 patients (56 reconstructions) were included in the study. Radiographic studies, operative reports, KT-1000 scores, and chart notes were used to identify all potential factors that may have led to failure. All patients were invited to return for a follow-up examination and survey. Of the 28 patients, the mean age at the index and revision procedure was 22 ± 11 (range, 12 to 50) and 24 ± 11 (range, 14 to 57), respectively. In 20 cases, the cause of failure was determined to be acute trauma (sports, work, or accident); in 1 case, the cause was biologic failure; while in 7 cases, the cause was technical error. During the study period the surgeons performed a combined total of 1944 procedures, for an overall failure rate of 1.8%. Twenty patients (71%) were available for follow-up at a mean 30.2 ± 17.7 months. The overall postrevision outcomes were good to excellent for a majority of patients, with an average Lysholm score of 84 ± 15.5 and International Knee Documentation Committee score of 77.2 ± 13.8. The pre- and postoperative KT-1000 scores were 12.1 ± 2.8 and 6.7 ± 2.8, respectively. The results from this study suggest that traumatic re-injury, and not surgical/surgeon error, is the most common cause of ACLR failure using anatomic reconstructive principles and strong fixation. In addition, good to excellent outcomes following revision ACLR can be expected in the majority of patients.

Keywords

anterior cruciate ligament reconstruction - revision - failure - bone tunnel
 

  • References

  • 1 Owings MF, Kozak LJ. Ambulatory and inpatient procedures in the United States, 1996. Vital Health Stat 13 1998; (139) 1-119
    PubMedGoogle Scholar
  • 2 Brown Jr CH, Carson EW. Revision anterior cruciate ligament surgery. Clin Sports Med 1999; 18 (1) 109-171
    CrossrefPubMedGoogle Scholar
  • 3 Snook GA. A short history of the anterior cruciate ligament and the treatment of tears. Clin Orthop Relat Res 1983; (172) 11-13
    PubMedGoogle Scholar
  • 4 Bach Jr BR. Revision anterior cruciate ligament surgery. Arthroscopy 2003; 19 (Suppl. 01) 14-29
    PubMedGoogle Scholar
  • 5 Friedman MJ, Sherman OH, Fox JM, Del Pizzo W, Snyder SJ, Ferkel RJ. Autogeneic anterior cruciate ligament (ACL) anterior reconstruction of the knee. A review. Clin Orthop Relat Res 1985; (196) 9-14
    PubMedGoogle Scholar
  • 6 Johnson RJ, Eriksson E, Haggmark T, Pope MH. Five- to ten-year follow-up evaluation after reconstruction of the anterior cruciate ligament. Clin Orthop Relat Res 1984; (183) 122-140
    PubMedGoogle Scholar
  • 7 Yunes M, Richmond JC, Engels EA, Pinczewski LA. Patellar versus hamstring tendons in anterior cruciate ligament reconstruction: A meta-analysis. Arthroscopy 2001; 17 (3) 248-257
    CrossrefPubMedGoogle Scholar
  • 8 Pinczewski LA, Lyman J, Salmon LJ, Russell VJ, Roe J, Linklater J. A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Am J Sports Med 2007; 35 (4) 564-574
    CrossrefPubMedGoogle Scholar
  • 9 Jones AP, Sidhom S, Sefton G. Long-term clinical review (10–20 years) after reconstruction of the anterior cruciate ligament using the Leeds-Keio synthetic ligament. J Long Term Eff Med Implants 2007; 17 (1) 59-69
    CrossrefPubMedGoogle Scholar
  • 10 Johnson DL, Fu FH. Anterior cruciate ligament reconstruction: why do failures occur?. Instr Course Lect 1995; 44: 391-406
    PubMedGoogle Scholar
  • 11 Diamantopoulos AP, Lorbach O, Paessler HH. Anterior cruciate ligament revision reconstruction: results in 107 patients. Am J Sports Med 2008; 36 (5) 851-860
    CrossrefPubMedGoogle Scholar
  • 12 Carlisle JC, Parker RD, Matava MJ. Technical considerations in revision anterior cruciate ligament surgery. J Knee Surg 2007; 20 (4) 312-322
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 13 George MS, Dunn WR, Spindler KP. Current concepts review: revision anterior cruciate ligament reconstruction. Am J Sports Med 2006; 34 (12) 2026-2037
    CrossrefPubMedGoogle Scholar
  • 14 Kamath GV, Redfern JC, Greis PE, Burks RT. Revision anterior cruciate ligament reconstruction. Am J Sports Med 2011; 39 (1) 199-217
    CrossrefPubMedGoogle Scholar
  • 15 Grossman MG, ElAttrache NS, Shields CL, Glousman RE. Revision anterior cruciate ligament reconstruction: three- to nine-year follow-up. Arthroscopy 2005; 21 (4) 418-423
    CrossrefPubMedGoogle Scholar
  • 16 Weiler A, Schmeling A, Stöhr I, Kääb MJ, Wagner M. Primary versus single-stage revision anterior cruciate ligament reconstruction using autologous hamstring tendon grafts: a prospective matched-group analysis. Am J Sports Med 2007; 35 (10) 1643-1652
    CrossrefPubMedGoogle Scholar
  • 17 Johnson DL, Coen MJ. Revision ACL surgery. Etiology, indications, techniques, and results. Am J Knee Surg 1995; 8 (4) 155-167
    PubMedGoogle Scholar
  • 18 Noyes FR, Barber-Westin SD. Revision anterior cruciate ligament surgery: experience from Cincinnati. Clin Orthop Relat Res 1996; (325) 116-129
    PubMedGoogle Scholar
  • 19 Behrend H, Stutz G, Kessler MA, Rukavina A, Giesinger K, Kuster MS. Tunnel placement in anterior cruciate ligament (ACL) reconstruction: quality control in a teaching hospital. Knee Surg Sports Traumatol Arthrosc 2006; 14 (11) 1159-1165
    CrossrefPubMedGoogle Scholar
  • 20 Morgan CD, Kalman VR, Grawl DM. Definitive landmarks for reproducible tibial tunnel placement in anterior cruciate ligament reconstruction. Arthroscopy 1995; 11 (3) 275-288
    CrossrefPubMedGoogle Scholar
  • 21 Gougoulias N, Khanna A, Griffiths D, Maffulli N. ACL reconstruction: Can the transtibial technique achieve optimal tunnel positioning? A radiographic study. Knee 2008; 15 (6) 486-490
    CrossrefPubMedGoogle Scholar
  • 22 Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957; 16 (4) 494-502
    CrossrefPubMedGoogle Scholar
  • 23 Bach Jr BR, Jones GT, Hager CA, Sweet FA, Luergans S. Arthrometric results of arthroscopically assisted anterior cruciate ligament reconstruction using autograft patellar tendon substitution. Am J Sports Med 1995; 23 (2) 179-185
    CrossrefPubMedGoogle Scholar
  • 24 Daniel DM, Malcom LL, Losse G, Stone ML, Sachs R, Burks R. Instrumented measurement of anterior laxity of the knee. J Bone Joint Surg Am 1985; 67 (5) 720-726
    CrossrefPubMedGoogle Scholar
  • 25 Daniel DM, Stone ML, Sachs R, Malcom L. Instrumented measurement of anterior knee laxity in patients with acute anterior cruciate ligament disruption. Am J Sports Med 1985; 13 (6) 401-407
    CrossrefPubMedGoogle Scholar
  • 26 Uribe JW, Hechtman KS, Zvijac JE, Tjin-A-Tsoi EW. Revision anterior cruciate ligament surgery: experience from Miami. Clin Orthop Relat Res 1996; (325) 91-99
    PubMedGoogle Scholar
  • 27 Johnson DL, Swenson TM, Irrgang JJ, Fu FH, Harner CD. Revision anterior cruciate ligament surgery: experience from Pittsburgh. Clin Orthop Relat Res 1996; (325) 100-109
    PubMedGoogle Scholar
  • 28 Getelman MH, Schepsis AA, Zimmer J. Revision ACL Reconstruction: Autograft verusus Allograft [abstract]. Arthroscopy 1995; 11: 378
    PubMedGoogle Scholar
  • 29 Denti M, Lo Vetere D, Bait C, Schönhuber H, Melegati G, Volpi P. Revision anterior cruciate ligament reconstruction: causes of failure, surgical technique, and clinical results. Am J Sports Med 2008; 36 (10) 1896-1902
    CrossrefPubMedGoogle Scholar
  • 30 Salmon LJ, Pinczewski LA, Russell VJ, Refshauge K. Revision anterior cruciate ligament reconstruction with hamstring tendon autograft: 5- to 9-year follow-up. Am J Sports Med 2006; 34 (10) 1604-1614
    CrossrefPubMedGoogle Scholar