Abstract
Anterior cruciate ligament (ACL) reconstruction represents one of the most successful
orthopedic surgical procedures. Nevertheless, ACL revisions are still very frequent,
with a small but relevant number of failures. The purpose of this study is to analyze
the failure causes and the clinical outcomes of patients who underwent a re-revision
ACL reconstruction. Between January 2009 and December 2017, 263 ACL revisions were
performed by a single senior surgeon. Seventeen patients (12 males and 5 females)
underwent re-revision ACL reconstruction meeting the inclusion criteria. The mean
age was 28.4 years (range, 19–41 years). Before the re-revision, the patients were
evaluated preoperatively and after a mean follow-up of 29 months (range, 13–58 months).
Assessment included subjective and objective evaluations (Lysholm and International
Knee Documentation Committee [IKDC]), KT-2000 arthrometer, radiographic study, and
preoperative computed tomography scan. Five patients showed a too anterior previous
femoral tunnel and seven a too vertical and posterior tibial tunnel; eight meniscal
tears were found. Five patients had grade III–IV according to Outerbridge cartilage
lesions. IKDC showed a statistically significant improvement (A + B 35%, C + D 65%
preop, A + B 82%, C + D 18% postop, odds ratio: 0.1169; p = 0.0083). The mean Lysholm score ranged from 43 ± 9 to 87 ± 7 (p < 0.001). The KT-2000 arthrometer showed a statistically significant improvement
from a mean of 5.8 ± 1.4 to 1.5 ± 1.1 (p < 0.001) at last follow-up. Out of 17 patients, only 4 returned to sports activity
at the same preinjury levels. Postoperatively at the last follow-up after last revision
surgery, no osteoarthritis evolution was observed. This study showed good clinical
and radiological results after the last revision ACL surgery in patients with multiple
failures of ACL reconstruction but only one-fourth of the patients returned to the
same preoperative sport level. Traumatic events, technical errors, and untreated peripheral
lesions are the main causes of multiple previous failures; the worst clinical outcomes
were found in the patients with high grade of chondral lesions.
Keywords
ACL - ACL revision - failure ACL reconstruction - return to sport
