title: Anatomic double-bundle anterior cruciate ligament reconstruction revision surgery.
abstract: With the increasing number of double-bundle anterior cruciate ligament (ACL) reconstructions being performed, revision cases are expected. This report describes the first 3 cases of revision double-bundle ACL surgeries performed at our institution. In 3 athletes in whom the ACL was previously reconstructed with an anatomic double-bundle technique, new traumatic events occurred and an ACL retear was diagnosed. In cases 1 and 2 the anteromedial (AM) bundle was completely torn and the posterolateral (PL) bundle was stretched and nonfunctional. In case 1 both bundles were reconstructed via the previous tunnels, and the AM and PL grafts were tensioned at 60 degrees of flexion and full extension, respectively. In case 2 the PL femoral tunnel was posterosuperior to the PL anatomic position. Therefore we drilled a third femoral tunnel and used the previous PL tunnel as our new AM tunnel. In case 3 the rupture pattern presented an intact and functional PL bundle and a midsubstance AM tear. We decided to revise only the AM bundle using the previous AM tunnels, which were anatomically positioned. This report shows that revision of anatomic double-bundle ACL reconstruction is reasonable to accomplish and that the principles of anatomy are essential as a guide to approaching each case.
authors.affiliation: Department of Orthopaedics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Kaz
authors.forename: James S
authors.initials: JS
authors.lastname: Starman
authors.forename: Freddie H
authors.initials: FH
authors.lastname: Fu
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001182:Arthroscopy; D001265:Athletic Injuries / Q000601:surgery; D005538:Football / Q000293:injuries; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures; D012008:Recurrence; D012086:Reoperation