Revision Anterior Cruciate Ligament (ACL) Reconstruction

The goal of an ACL reconstruction is to approximate the strength and characteristics of the native tissue. So, if the original ACL can rupture, it is logical to think that the reconstructed ligament can also tear. It is more difficult to deal with a revision case. Your decision what to do is dependent on what was done during the primary ACL reconstruction (ACLR). It is important to plan the surgery carefully and prepare for all possible scenarios intra-operatively. The three key questions you need to answer are the following? What was the GRAFT used? How were the TUNNELS made? What were the IMPLANTS used? It would be helpful to know who did the primary ACLR because you may be aware of some of the tendencies of that surgeon which may assist you in your surgery. There are seven situations that will be discussed: Bone-Patellar Tendon-Bone (BPTB) autograft using a trans-tibial technique Semitendinosus/Gracilis Tendon (ST/G) autograft using a trans-tibial technique With the advent of the medial portal technique, the position of the femoral tunnel changed dramatically. Five other circumstances arose from this: 3. ST/G autograft using endo-buttons 4. ST/G autograft using screws – femoral tunnel in ideal position 5. ST/G autograft using screws – femoral tunnel near where you want it to be 6. ST/G autograft using screws – femoral tunnel far from where you want it to be 7. Implant-less ACLR Always have a back-up plan when doing revisions. It is imperative that the rehabilitation program be delayed so as to give the graft more time to incorporate. Usually, twelve months before going back to sports is acceptable.