Revision Anterior Cruciate Ligament Reconstruction Using a 2-Stage Technique With Bone Grafting of the Tibial Tunnel
Background: Revision anterior cruciate ligament surgery is often considered a salvage procedure with limited goals. However, this limitation need not be the case. Similar to primary reconstruction, the goal should be to choose an appropriate graft and place it in an anatomical position in a good qua...
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creator | Thomas, Neil P. Kankate, Raghu Wandless, Felicity Pandit, Hemant |
description | Background: Revision anterior cruciate ligament surgery is often considered a salvage procedure with limited goals. However, this limitation
need not be the case. Similar to primary reconstruction, the goal should be to choose an appropriate graft and place it in
an anatomical position in a good quality bone. The issue of good quality bone seems to have been ignored.
Hypothesis: A 2-stage anterior cruciate ligament revision reconstruction with bone grafting of the tibial tunnel and the use of a different
femoral tunnel will produce measured knee laxity and International Knee Documentation Committee scores similar to a primary
anterior cruciate ligament reconstruction.
Study Design: Case control study; Level of evidence, 3.
Methods: This prospective study involved 49 consecutive 2-stage anterior cruciate ligament revisions (group R) performed by a single
surgeon from 1993 to 2000. Two-stage revision surgery was performed if the tibial tunnel from a previous reconstruction surgery
would overlap (either partially or fully) the correctly placed revision tunnel. The first stage consisted of removal of the
old graft and interfering metalwork, together with bone grafting of the tibial tunnel. After ensuring adequate bone graft
incorporation using computed tomography scan, the second stage revision was undertaken. This stage comprised harvesting the
autograft, its anatomical placement, and its adequate fixation. The results were compared with the results of a matched group
of patients with primary anterior cruciate ligament reconstruction (group P).
Results: In group R, as meniscal and chondral lesions were more common, the International Knee Documentation Committee scores were
lower than those of group P (61.2 for group R and 72.8 for group P; P = .006). Objective laxity measurement was similar in both groups (1.36 mm for group R and 1.2 mm for group P; P = .25).
Conclusion: This study establishes that the laxity measurements achieved with a 2-stage revision anterior cruciate ligament reconstruction
can be similar to those achieved after primary anterior cruciate ligament reconstruction, although the International Knee
Documentation Committee rating is lower.
Keywords:
revision anterior cruciate ligament (ACL) reconstruction
bone grafting
clinical outcome |
doi_str_mv | 10.1177/0363546505276759 |
format | Article |
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need not be the case. Similar to primary reconstruction, the goal should be to choose an appropriate graft and place it in
an anatomical position in a good quality bone. The issue of good quality bone seems to have been ignored.
Hypothesis: A 2-stage anterior cruciate ligament revision reconstruction with bone grafting of the tibial tunnel and the use of a different
femoral tunnel will produce measured knee laxity and International Knee Documentation Committee scores similar to a primary
anterior cruciate ligament reconstruction.
Study Design: Case control study; Level of evidence, 3.
Methods: This prospective study involved 49 consecutive 2-stage anterior cruciate ligament revisions (group R) performed by a single
surgeon from 1993 to 2000. Two-stage revision surgery was performed if the tibial tunnel from a previous reconstruction surgery
would overlap (either partially or fully) the correctly placed revision tunnel. The first stage consisted of removal of the
old graft and interfering metalwork, together with bone grafting of the tibial tunnel. After ensuring adequate bone graft
incorporation using computed tomography scan, the second stage revision was undertaken. This stage comprised harvesting the
autograft, its anatomical placement, and its adequate fixation. The results were compared with the results of a matched group
of patients with primary anterior cruciate ligament reconstruction (group P).
Results: In group R, as meniscal and chondral lesions were more common, the International Knee Documentation Committee scores were
lower than those of group P (61.2 for group R and 72.8 for group P; P = .006). Objective laxity measurement was similar in both groups (1.36 mm for group R and 1.2 mm for group P; P = .25).
Conclusion: This study establishes that the laxity measurements achieved with a 2-stage revision anterior cruciate ligament reconstruction
can be similar to those achieved after primary anterior cruciate ligament reconstruction, although the International Knee
Documentation Committee rating is lower.
Keywords:
revision anterior cruciate ligament (ACL) reconstruction
bone grafting
clinical outcome</description><identifier>ISSN: 0363-5465</identifier><identifier>EISSN: 1552-3365</identifier><identifier>DOI: 10.1177/0363546505276759</identifier><identifier>PMID: 16093534</identifier><identifier>CODEN: AJSMDO</identifier><language>eng</language><publisher>Los Angeles, CA: American Orthopaedic Society for Sports Medicine</publisher><subject>Adult ; Anterior cruciate ligament ; Anterior Cruciate Ligament - surgery ; Anterior Cruciate Ligament Injuries ; Biological and medical sciences ; Bone transplantation ; Bone-grafting ; Care and treatment ; Case-Control Studies ; Clinical trials ; Documentation ; Female ; Femur - surgery ; Fundamental and applied biological sciences. Psychology ; Health aspects ; Humans ; Injuries ; Joint Instability ; Knee ; Ligaments ; Male ; Medical sciences ; Orthopedic Procedures - methods ; Prospective Studies ; Reconstructive Surgical Procedures - methods ; Reoperation ; Skin & tissue grafts ; Sport (general aspects) ; Sports injuries ; Sports medicine ; Studies ; Surgery ; Tibia - surgery ; Tibia - transplantation ; Traumas. Diseases due to physical agents ; Treatment Outcome ; Vertebrates: body movement. Posture. Locomotion. Flight. Swimming. Physical exercise. Rest. Sports</subject><ispartof>The American journal of sports medicine, 2005-11, Vol.33 (11), p.1701-1709</ispartof><rights>2005 American Orthopaedic Society for Sports Medicine</rights><rights>2005 INIST-CNRS</rights><rights>COPYRIGHT 2005 Sage Publications, Inc.</rights><rights>Copyright Sage Publications Ltd. Nov 2005</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c594t-181c63628645004f9353cbf1e233eb4cba295e4f2e1911d62a72bd4155cf782b3</citedby><cites>FETCH-LOGICAL-c594t-181c63628645004f9353cbf1e233eb4cba295e4f2e1911d62a72bd4155cf782b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0363546505276759$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0363546505276759$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17213709$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16093534$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Thomas, Neil P.</creatorcontrib><creatorcontrib>Kankate, Raghu</creatorcontrib><creatorcontrib>Wandless, Felicity</creatorcontrib><creatorcontrib>Pandit, Hemant</creatorcontrib><title>Revision Anterior Cruciate Ligament Reconstruction Using a 2-Stage Technique With Bone Grafting of the Tibial Tunnel</title><title>The American journal of sports medicine</title><addtitle>Am J Sports Med</addtitle><description>Background: Revision anterior cruciate ligament surgery is often considered a salvage procedure with limited goals. However, this limitation
need not be the case. Similar to primary reconstruction, the goal should be to choose an appropriate graft and place it in
an anatomical position in a good quality bone. The issue of good quality bone seems to have been ignored.
Hypothesis: A 2-stage anterior cruciate ligament revision reconstruction with bone grafting of the tibial tunnel and the use of a different
femoral tunnel will produce measured knee laxity and International Knee Documentation Committee scores similar to a primary
anterior cruciate ligament reconstruction.
Study Design: Case control study; Level of evidence, 3.
Methods: This prospective study involved 49 consecutive 2-stage anterior cruciate ligament revisions (group R) performed by a single
surgeon from 1993 to 2000. Two-stage revision surgery was performed if the tibial tunnel from a previous reconstruction surgery
would overlap (either partially or fully) the correctly placed revision tunnel. The first stage consisted of removal of the
old graft and interfering metalwork, together with bone grafting of the tibial tunnel. After ensuring adequate bone graft
incorporation using computed tomography scan, the second stage revision was undertaken. This stage comprised harvesting the
autograft, its anatomical placement, and its adequate fixation. The results were compared with the results of a matched group
of patients with primary anterior cruciate ligament reconstruction (group P).
Results: In group R, as meniscal and chondral lesions were more common, the International Knee Documentation Committee scores were
lower than those of group P (61.2 for group R and 72.8 for group P; P = .006). Objective laxity measurement was similar in both groups (1.36 mm for group R and 1.2 mm for group P; P = .25).
Conclusion: This study establishes that the laxity measurements achieved with a 2-stage revision anterior cruciate ligament reconstruction
can be similar to those achieved after primary anterior cruciate ligament reconstruction, although the International Knee
Documentation Committee rating is lower.
Keywords:
revision anterior cruciate ligament (ACL) reconstruction
bone grafting
clinical outcome</description><subject>Adult</subject><subject>Anterior cruciate ligament</subject><subject>Anterior Cruciate Ligament - surgery</subject><subject>Anterior Cruciate Ligament Injuries</subject><subject>Biological and medical sciences</subject><subject>Bone transplantation</subject><subject>Bone-grafting</subject><subject>Care and treatment</subject><subject>Case-Control Studies</subject><subject>Clinical trials</subject><subject>Documentation</subject><subject>Female</subject><subject>Femur - surgery</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Injuries</subject><subject>Joint Instability</subject><subject>Knee</subject><subject>Ligaments</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Orthopedic Procedures - methods</subject><subject>Prospective Studies</subject><subject>Reconstructive Surgical Procedures - methods</subject><subject>Reoperation</subject><subject>Skin & tissue grafts</subject><subject>Sport (general aspects)</subject><subject>Sports injuries</subject><subject>Sports medicine</subject><subject>Studies</subject><subject>Surgery</subject><subject>Tibia - surgery</subject><subject>Tibia - transplantation</subject><subject>Traumas. Diseases due to physical agents</subject><subject>Treatment Outcome</subject><subject>Vertebrates: body movement. Posture. Locomotion. Flight. Swimming. Physical exercise. Rest. Sports</subject><issn>0363-5465</issn><issn>1552-3365</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqF0s1r2zAUAHAzNta0232nITa6sYM7fViSfczClg0ChS5lRyErz46CLbeSvI__fjIJtCkrQweB9HtPT4-XZa8IviBEyo-YCcYLwTGnUkhePclmhHOaMyb402w2XefT_Ul2GsIOY0ykKJ9nJ0TginFWzLJ4BT9tsINDcxfB28GjhR-N1RHQyra6BxfRFZjBhZjO4ySvg3Ut0ojm36NuAa3BbJ29HQH9sHGLPg0O0NLrJk5saFDcJmNrqzu0Hp2D7kX2rNFdgJeH_Sy7_vJ5vfiary6X3xbzVW54VcSclMQIJmgpCo5x0Uwlm7ohQBmDujC1phWHoqFAKkI2gmpJ602ROmAaWdKanWXv9nlv_JDKC1H1NhjoOu1gGIMSpahEUYn_QiJZRUkhE3zzAO6G0bv0CUWJxJIxShJ6-xgilSz5lAgndbFXre5AWdcM0WuT1gZ6m_oNjU3nc8JKwYuSVSngw1FAMhF-x1aPIahyuTq2-b-sGboOWlCpy4vLY4_33vghBA-NuvG21_6PIlhNo6YejloKeX345Vj3sLkLOMxWAucHoIPRXeO1MzbcOZlaJfG9WkMapnutevzh93u_te32l_WgQq-7LpXBlN4FxlJcyo4J-wvb-vBc</recordid><startdate>20051101</startdate><enddate>20051101</enddate><creator>Thomas, Neil P.</creator><creator>Kankate, Raghu</creator><creator>Wandless, Felicity</creator><creator>Pandit, Hemant</creator><general>American Orthopaedic Society for Sports Medicine</general><general>SAGE Publications</general><general>Sage Publications, Inc</general><general>Sage Publications Ltd</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>8GL</scope><scope>7TS</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>20051101</creationdate><title>Revision Anterior Cruciate Ligament Reconstruction Using a 2-Stage Technique With Bone Grafting of the Tibial Tunnel</title><author>Thomas, Neil P. ; Kankate, Raghu ; Wandless, Felicity ; Pandit, Hemant</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c594t-181c63628645004f9353cbf1e233eb4cba295e4f2e1911d62a72bd4155cf782b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Adult</topic><topic>Anterior cruciate ligament</topic><topic>Anterior Cruciate Ligament - surgery</topic><topic>Anterior Cruciate Ligament Injuries</topic><topic>Biological and medical sciences</topic><topic>Bone transplantation</topic><topic>Bone-grafting</topic><topic>Care and treatment</topic><topic>Case-Control Studies</topic><topic>Clinical trials</topic><topic>Documentation</topic><topic>Female</topic><topic>Femur - surgery</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Health aspects</topic><topic>Humans</topic><topic>Injuries</topic><topic>Joint Instability</topic><topic>Knee</topic><topic>Ligaments</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Orthopedic Procedures - methods</topic><topic>Prospective Studies</topic><topic>Reconstructive Surgical Procedures - methods</topic><topic>Reoperation</topic><topic>Skin & tissue grafts</topic><topic>Sport (general aspects)</topic><topic>Sports injuries</topic><topic>Sports medicine</topic><topic>Studies</topic><topic>Surgery</topic><topic>Tibia - surgery</topic><topic>Tibia - transplantation</topic><topic>Traumas. Diseases due to physical agents</topic><topic>Treatment Outcome</topic><topic>Vertebrates: body movement. Posture. Locomotion. Flight. Swimming. Physical exercise. Rest. Sports</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Thomas, Neil P.</creatorcontrib><creatorcontrib>Kankate, Raghu</creatorcontrib><creatorcontrib>Wandless, Felicity</creatorcontrib><creatorcontrib>Pandit, Hemant</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: High School</collection><collection>Physical Education Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of sports medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Thomas, Neil P.</au><au>Kankate, Raghu</au><au>Wandless, Felicity</au><au>Pandit, Hemant</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Revision Anterior Cruciate Ligament Reconstruction Using a 2-Stage Technique With Bone Grafting of the Tibial Tunnel</atitle><jtitle>The American journal of sports medicine</jtitle><addtitle>Am J Sports Med</addtitle><date>2005-11-01</date><risdate>2005</risdate><volume>33</volume><issue>11</issue><spage>1701</spage><epage>1709</epage><pages>1701-1709</pages><issn>0363-5465</issn><eissn>1552-3365</eissn><coden>AJSMDO</coden><abstract>Background: Revision anterior cruciate ligament surgery is often considered a salvage procedure with limited goals. However, this limitation
need not be the case. Similar to primary reconstruction, the goal should be to choose an appropriate graft and place it in
an anatomical position in a good quality bone. The issue of good quality bone seems to have been ignored.
Hypothesis: A 2-stage anterior cruciate ligament revision reconstruction with bone grafting of the tibial tunnel and the use of a different
femoral tunnel will produce measured knee laxity and International Knee Documentation Committee scores similar to a primary
anterior cruciate ligament reconstruction.
Study Design: Case control study; Level of evidence, 3.
Methods: This prospective study involved 49 consecutive 2-stage anterior cruciate ligament revisions (group R) performed by a single
surgeon from 1993 to 2000. Two-stage revision surgery was performed if the tibial tunnel from a previous reconstruction surgery
would overlap (either partially or fully) the correctly placed revision tunnel. The first stage consisted of removal of the
old graft and interfering metalwork, together with bone grafting of the tibial tunnel. After ensuring adequate bone graft
incorporation using computed tomography scan, the second stage revision was undertaken. This stage comprised harvesting the
autograft, its anatomical placement, and its adequate fixation. The results were compared with the results of a matched group
of patients with primary anterior cruciate ligament reconstruction (group P).
Results: In group R, as meniscal and chondral lesions were more common, the International Knee Documentation Committee scores were
lower than those of group P (61.2 for group R and 72.8 for group P; P = .006). Objective laxity measurement was similar in both groups (1.36 mm for group R and 1.2 mm for group P; P = .25).
Conclusion: This study establishes that the laxity measurements achieved with a 2-stage revision anterior cruciate ligament reconstruction
can be similar to those achieved after primary anterior cruciate ligament reconstruction, although the International Knee
Documentation Committee rating is lower.
Keywords:
revision anterior cruciate ligament (ACL) reconstruction
bone grafting
clinical outcome</abstract><cop>Los Angeles, CA</cop><pub>American Orthopaedic Society for Sports Medicine</pub><pmid>16093534</pmid><doi>10.1177/0363546505276759</doi><tpages>9</tpages></addata></record> |
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subjects | Adult Anterior cruciate ligament Anterior Cruciate Ligament - surgery Anterior Cruciate Ligament Injuries Biological and medical sciences Bone transplantation Bone-grafting Care and treatment Case-Control Studies Clinical trials Documentation Female Femur - surgery Fundamental and applied biological sciences. Psychology Health aspects Humans Injuries Joint Instability Knee Ligaments Male Medical sciences Orthopedic Procedures - methods Prospective Studies Reconstructive Surgical Procedures - methods Reoperation Skin & tissue grafts Sport (general aspects) Sports injuries Sports medicine Studies Surgery Tibia - surgery Tibia - transplantation Traumas. Diseases due to physical agents Treatment Outcome Vertebrates: body movement. Posture. Locomotion. Flight. Swimming. Physical exercise. Rest. Sports |
title | Revision Anterior Cruciate Ligament Reconstruction Using a 2-Stage Technique With Bone Grafting of the Tibial Tunnel |
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