M-L Louis1, P D'ingrado2, F P Ehkirch3, S Bertiaux4, P Colombet5, B Sonnery-Cottet6, B Schlatterer7, R Pailhé8, J C Panisset9, C Steltzlen10, S Lustig11, C Lutz12, F Dalmay13, P Imbert14, D Saragaglia8. 1. Institut de chirurgie orthopédique et sportive, clinique Juge, 463, rue Paradis, 13008 Marseille, France. Electronic address: louis.marielaure@gmail.com. 2. Clinique du Parc, 155, boulevard de Stalingrad, 69006 Lyon, France. 3. Clinique Maussins-Nollet, 67, rue de Romainville, 75019 Paris, France. 4. Hôpital privé de l'Estuaire, 505, rue Irène-Joliot-Curie, 76620 le Havre, France. 5. Centre de chirurgie orthopédique et sportive, 2, rue Negrevergne, 33700 Mérignac, France. 6. Centre orthopédique Santy, 24, avenue Paul-Santy, 69008 Lyon, France. 7. Institut Monégasque de médecine du sport, 11, avenue d'Ostende, 98000, Monaco. 8. Clinique universitaire, hôpital Sud, CHU de Grenoble, avenue de Kimberley, 38130 Échirolles, France. 9. Clinique des cèdres, 21, rue Albert-Londres, 38432 Échirolles, France. 10. Centre hospitalier de Versailles André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France. 11. Centre Albert-Trillat, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France. 12. ICOSS, 50, avenue des Vosges, 67000 Strasbourg, France. 13. CEBIMER, faculté de médecine de Limoges, 2, rue du Docteur-Marcland, 87042 Limoges cedex, France. 14. Institut de chirurgie articulaire et des pathologies du sport, 87, avenue Archimède, 83700 St-Raphael, France.
Abstract
BACKGROUND: A careful analysis of the reasons for ACL reconstruction failure is essential to selection of the optimal surgical revision technique designed to ensure good rotational stability and to minimise the risk of re-rupture. OBJECTIVE: To evaluate anterolateral ligament (ALL) stabilisation during revision ACL reconstruction. HYPOTHESIS: ALL stabilisation during revision ACL reconstruction provides good rotational stability without increasing the risk of complications. MATERIAL AND METHODS: This multicentre study included 349 patients, 151 retrospectively and 198 prospectively. There were 283 males and 66 females. Inclusion criteria were an indication for revision ACL reconstruction surgery with combined intra-articular reconstruction and ALL stabilisation after failed autograft ACL reconstruction, and intact PCL. Exclusion criteria were primary ACL reconstruction and concomitant peripheral medial and/or lateral lesions. Each patient underwent a clinical and radiographic evaluation before and after revision surgery. Before revision surgery, the mean IKDC score was 56.5±15.5 and 96% of patients were IKDC C or D. RESULTS: Rates were 5.0% for early and 10.5% for late postoperative complications. Lachmann's test had a hard stop at last follow-up in 97% of patients. The pivot-shift test was positive in 1% of patients. The mean subjective IKDC score was 84.5±13.0 and 86.5% of patients were IKDC A or B. The proportions of patients with radiographic knee osteoarthritis at last follow-up was unchanged for the lateral tibio-femoral and patello-femoral compartments but increased by 9.7% to 21.2% for the medial tibio-femoral compartment. The re-rupture rate was 1.2% and the further surgical revision rate was 5.4%. CONCLUSION: Anterior laxity at last follow-up was consistent with previous studies of revision ACL reconstruction. However, rotational stability and the re-rupture risk were improved. ALL stabilisation is among the techniques that deserve consideration as part of the therapeutic options for revision ACL reconstruction. LEVEL OF EVIDENCE: IV, retrospective and prospective cohort study.
BACKGROUND: A careful analysis of the reasons for ACL reconstruction failure is essential to selection of the optimal surgical revision technique designed to ensure good rotational stability and to minimise the risk of re-rupture. OBJECTIVE: To evaluate anterolateral ligament (ALL) stabilisation during revision ACL reconstruction. HYPOTHESIS: ALL stabilisation during revision ACL reconstruction provides good rotational stability without increasing the risk of complications. MATERIAL AND METHODS: This multicentre study included 349 patients, 151 retrospectively and 198 prospectively. There were 283 males and 66 females. Inclusion criteria were an indication for revision ACL reconstruction surgery with combined intra-articular reconstruction and ALL stabilisation after failed autograft ACL reconstruction, and intact PCL. Exclusion criteria were primary ACL reconstruction and concomitant peripheral medial and/or lateral lesions. Each patient underwent a clinical and radiographic evaluation before and after revision surgery. Before revision surgery, the mean IKDC score was 56.5±15.5 and 96% of patients were IKDC C or D. RESULTS: Rates were 5.0% for early and 10.5% for late postoperative complications. Lachmann's test had a hard stop at last follow-up in 97% of patients. The pivot-shift test was positive in 1% of patients. The mean subjective IKDC score was 84.5±13.0 and 86.5% of patients were IKDC A or B. The proportions of patients with radiographic knee osteoarthritis at last follow-up was unchanged for the lateral tibio-femoral and patello-femoral compartments but increased by 9.7% to 21.2% for the medial tibio-femoral compartment. The re-rupture rate was 1.2% and the further surgical revision rate was 5.4%. CONCLUSION: Anterior laxity at last follow-up was consistent with previous studies of revision ACL reconstruction. However, rotational stability and the re-rupture risk were improved. ALL stabilisation is among the techniques that deserve consideration as part of the therapeutic options for revision ACL reconstruction. LEVEL OF EVIDENCE: IV, retrospective and prospective cohort study.
Authors: Danielle C Marshall; Flavio D Silva; Brandon T Goldenberg; Daniel Quintero; Michael G Baraga; Jean Jose Journal: Orthop J Sports Med Date: 2022-08-29