Abstract
The Multicenter Anterior Cruciate Ligament (ACL) Revision Study (MARS) group was formed
to study a large cohort of revision ACL reconstruction patients. The purpose of this
subset analysis study of the MARS database is to describe specific details of femoral
tunnel malposition and subsequent management strategies that surgeons chose in the
revision setting. The design of this study is a case series. The multicenter MARS
database is compiled from a questionnaire regarding 460 ACL reconstruction revision
cases returned by 87 surgeons. This subset analysis described technical aspects and
operative findings in specifically those cases in which femoral tunnel malposition
was cited as the cause of primary ACL reconstruction failure. Of the 460 revisions
included for study, 276 (60%) cases cited a specific “technical cause of failure.”
Femoral tunnel malposition was cited in 219 (47.6%) of 460 cases. Femoral tunnel malposition
was cited as the only cause of failure in 117 cases (25.4%). Surgeons judged the femoral
tunnel too vertical in 42 cases (35.9%), too anterior in 35 cases (29.9%), and too
vertical and anterior in 31 cases (26.5%). Revision reconstruction involved the drilling
of an entirely new femoral tunnel in 91 cases (82.1%). For primary reconstruction,
autograft tissue was used in 82 cases (70.1%). For revision reconstruction, autograft
tissue was used in 61 cases (52.1%) and allograft tissue in 56 cases (47.9%). Femoral
tunnel malposition in primary ACL reconstruction was the most commonly cited reason
for graft failure in this cohort. Graft selection is widely variable among surgeons.
Keywords
anterior cruciate ligament - reconstruction - revision - technique
