The analysis of anterior cruciate ligament reconstruction failure and strategies of arthroscopic anterior cruciate ligament revison surgery

Zheng Xiaofei; Huang Huayang; Zhang Yu; Ding huanwen; Yin Qingshui

doi:10.3969/j.issn.1674-666X.2013.05.003

Abstract：Objective To analyze the failure reasons of arthroscopic anterior cruciate ligament (ACL) reconstruction, and to summarize surgical strategies for the ACL revision surgery. Methods From February 2005 to January 2008, a total of 14 patients who were suffered from ACL reconstruction failures underwent ACL revision surgery, including reinjury in 4 cases, graft tension-losing and laxity in 7 cases, knee joint adhesion with restricted activities in 2 cases, and infection in 1 case. Eleven patients with ACL complete rupture or graft tension loss and laxity were treated by one-stage ACL reconstruction, in which for 8 cases with correct bone tunnel, hollow drilling was passed through the original absorbable screws and bone tunnel was rebuilt; while for other 3 patients whose bone tunnel placement was incorrect, femoral and tibial tunnels were repositioned. Two patients with knee joint adhesion underwent arthroscopic adhesion release. Infection in 1 case was cured by arthroscopic debridement, irrigation, drainage and antibiotics therapy. Results All patients had no complications such as further joint adhesion, wound infection, graft rupture and so on. According to IKDC score, there were A grade in 11 cases, B grade in 2 cases and C grade in 1 case at postoperation, while there were C grade in 4 cases and D grade in 10 cases at preoperation.; Lysholm score was improved from preoperative (62 ± 10) to postoperative (89 ± 8.7), the difference between preoperation and postoperation had statistical significance (P <0.05). Conclusions The failure reasons of ACL reconstruction were complex with high difficulty of revision surgery. Detailed preoperative evaluation and procedure design is very important to safeguard the success of ACL revision operation.