[Results after anterior cruciate ligament revision surgery].
Revision surgery after failed anterior cruciate ligament reconstructions has increased tremendously. Reasons for revisions are persistent loss of motion, recurrent joint laxity, a painful knee or joint infections. In a retrospective study with a mean follow-up of 35.2 months 82 patients were examined after revision surgery. Time interval between primary and revision surgery, causes of revisions and treatment modalities were evaluated and compared to subjective, clinical and radiological parameters. In all cases a clinical improvement could be achieved. But results after revision operations are inferior to first reconstructions. The mean Tegner score improved after revision surgery from 2.4 to 4.6 points. The mean Lysholm score increased after secondary surgery from 54 to 76 points. The overall IKDC results of follow-up showed category A - 35.4 %, B - 39 %, C - 13.4 % and D - 12.2 % of the patients. A distinction between patients with preoperative isolated loss of motion and patients with isolated joint laxity seems useful. Revision operations with an improvement of joint mobility showed a higher subjective satisfaction, a lower rate of joint instability and better overall IKDC result compared to those with a high grade of preoperative joint laxity. Better results could be also achieved for early revision compared to late revisions and also for autologous grafts compared to alloplastic revision plasty. Transplant retaining procedures are only possible in selected cases and showed no clinical benefit compared to second revision of cruciate replacements. As a result of this study we conclude that early revision operation and the use of an autologous graft can be recommended but the surgeon has to be prepared to encounter many demanding technical problems.
Labs
K
K
Orthopädische Universitätsklinik der Humboldt-Universität zu Berlin, Campus Charité Mitte, Germany. karsten.labs@charite.de
Hasart
O
O
Perka
C
C
D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000000981:diagnostic imaging / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D003286:Contracture / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery; D007718:Knee Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012086:Reoperation; D013530:Surgical Wound Infection / Q000000981:diagnostic imaging / Q000601:surgery; D013709:Tendon Transfer