REVISION ANTERIOR CRUCIATE LIGAMENT SURGERY - EXPERIENCE FROM MIAMI

Failed anterior cruciate ligament reconstitution as defined by recurre nt patholaxity is increasingly commonplace. This report presents the f indings of 54 patients wire had unsuccessful intraarticular anterior c ruciate Ligament reconstruction to correct persistent instability and who subsequently underwent revision anterior cruciate ligament surgery . Before revision, patients were evaluated by clinical examination, KT -1000 arthrometer, radiographs, Lysholm knee score, Tegner activity sc ale, and subjective questionnaire. The results were compared at a mean of 32 months following revision surgery. There was an average of 16 m onths from index procedure to the time of revision. Autogenous patella r tendon grafts were used in 61% of the cases with 30% of these harves ted from the contralateral knee. Fresh frozen patellar tendon was used in 35% and autogenous hamstring tendons in 4%. Revision was successfu l in objectively improving stability in all patients with an average K T-000 of 2.8 mm. Autogenous tissue grafts provided greater objective s tability when compared with allograft tissue with average KT-1000 of 2 .2 and 3.3, respectively. Functionally, however, there was no signific ant difference in outcome between the 2 groups. Harvesting of the cont ralateral patellar tendon was found to have no adverse long term effec t. Subjectively, the results were significantly worse depending on the degree of articular cartilage degeneration. Only 54% of patients retu rned to their preanterior cruciate ligament injury activity level. Com petence in various anterior cruciate Ligament reconstruction technique s will facilitate revision surgery especially in avoiding preexisting tunnels and hardware. Correct graft placement and addressing the secon dary restraints are critical to successful revision surgery.