Revision anterior cruciate ligament reconstruction: causes of failure, surgical technique, and clinical results.

Denti M, Lo Vetere D, Bait C, Schönhuber H, Melegati G, Volpi P.

Abstract
BACKGROUND: Revision of an anterior cruciate ligament reconstruction is a complicated and delicate clinical procedure whose results, theoretically, are less satisfactory than those of the first operation...

HYPOTHESIS: The outcome of a revised anterior cruciate ligament surgery is comparable to primary anterior cruciate ligament reconstruction, with a rate of success around 70% to 80%. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 66 revisions of anterior cruciate ligament reconstructions were carried out from September 2000 to September 2004. Patients with concomitant instability and those with alterations in the weightbearing axis of the lower limbs were not included. Sixty patients were followed from 24 to 72 months: 50 clinically and 10 by a phone interview. Six patients were lost to follow-up due to changes of address. RESULTS: Lysholm scores were 57% excellent (95-100 points), 13% good (84-94 points), 22% fair (63-83 points), and 8% poor (<64 points). A total of 68% of patients had negative Lachman tests, 20% had positive tests with a hard end point, 10% had positive results, and 2% had very positive results. Stabilometric evaluation with the KT-1000 arthrometer at the maximum load showed that 56% of patients had <3 mm side-to-side difference, 34% had between 3 and 5 mm, and 10% had 6 to 10 mm. The International Knee Documentation Committee scores were 36% excellent (class A), 46% good (class B), and 18% fair (class C). The percentage of patients who resumed sport at the same level was 78%, compared with 58% after their primary reconstruction. CONCLUSION: The results of these anterior cruciate ligament reconstruction revision surgeries are close to those achieved by other series of primary reconstructions with a little less satisfactory results. We attribute the high success rate to the strict application of the same technique and the confinement of revision to motivated patients. It should be noted, however, that follow-up is only at the midterm stage (mean, 41.9 months).