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Chapter-166 Failed Anterior Cruciate Ligament Reconstruction and Revision Surgery

BOOK TITLE: Textbook of Orthopedics & Trauma (4 Volumes)

Author
1. Joshi Anant
2. Pardiwala Dinshaw
3. Kadrekar Sujit
4. BR Yathiraj
ISBN
9789385891052
DOI
10.5005/jp/books/12869_167
Edition
3/e
Publishing Year
2016
Pages
6
Author Affiliations
1. Bombay Hospital, Mumbai, Maharashtra, India, E-52,Lokmanya Nagar, Th Kataria Marg Mahim, Mumbai, Maharashtra, Sportsmed Mumbai, Parel ST Depot, Mumbai, Maharashtra, India, E-52, Lokmanya Nagar, Th Kataria Marg Mahim, Mumbai, Maharashtra, India
2. Jiwan-Flat. 7a, Ii LD Ruparel Marg Malabar Hill, Mumbai, Maharashtra, Arthroscopy and Joint Preservation Service; Center for Sports Medicine, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India, Jiwan-Flat. 7a, Ii LD Ruparel Marg, Malabar Hill, Mumbai, Maharashtra, India, Centre for Sports Medicine; Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra,
3. Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
4. Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, Inida
Chapter keywords
Anterior cruciate ligament, ACL reconstruction, recurrent instability, technical error, traumatic failure, biologic failure, graft selection, bone tunnel placement, rehabilitation, graft fixation

Abstract

The cause of the failure of anterior cruciate ligament (ACL) reconstruction must be carefully identified and associated instability patterns must be recognized and corrected to achieve a successful result. Failures following ACL reconstructive surgery can be divided into four groups which are failures due to technical errors, biologic factors, trauma and laxity in the secondary restraints. Revision surgery is complex and technically challenging. The choice of graft, the presence of previous implants and tunnel placement are important considerations in planning revision ACL reconstruction. There are three options in graft selection i.e. synthetic grafts, autografts and allografts. The preoperative evaluation should include a careful history assessing aspects, such as the primary procedure, postoperative rehabilitation, return to activity and the time at which recurrent instability was first noted. Instability, rather than pain, should be identified before considering a revision. Early revision surgery has better results than late revision due to secondary arthritis. Preventing ACL reconstruction failure is imperative. This can be achieved by improved surgical techniques such as correct tunnel placement, use of adequate grafts and metal free graft fixation.

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