title: Repeat revision of anterior cruciate ligament reconstruction: a retrospective review of management and outcome of 10 patients with an average 3-year follow-up.
abstract: BACKGROUND
  To the authors' knowledge, no previous published study has focused on management and outcome of repeat revision of anterior cruciate ligament reconstruction in terms of functional result and meniscus and articular cartilage status.
  
  
  OBJECTIVE
  Repeat revision of anterior cruciate ligament reconstruction improves knee stability, but with inferior results for functional outcome compared with primary anterior cruciate ligament reconstruction. Meniscal tears and subsequent articular cartilage degeneration are more prevalent with successive revisions due to recurrent laxity.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Between February 2003 and November 2006, a consecutive series of 10 patients with an average age at 30 years (range, 17-48) were operated on for a repeat revision of anterior cruciate ligament reconstruction (2 revisions after a primary reconstruction) with arthroscopic procedures. A clinical and a radiographic evaluation were performed to assess anterior cruciate ligament reconstruction failures, outcome of revisions, and causes of failures. Meniscal tears and articular cartilage lesions were analyzed.
  
  
  RESULTS
  The average follow-up of the second revision was 38 months (range, 12-61). At latest follow-up, final International Knee Documentation Committee assessment was excellent or good in 7 cases. Postoperatively, only 2 patients recovered to the same sports activity level they had before their first anterior cruciate ligament reconstruction. Four had a lower level, and 4 discontinued sports activity. The postoperative average side-to-side KT-1000 arthrometer maximum manual difference was 1.3 +/- 1.9 mm. Nine patients had meniscal tears and 7 had articular cartilage lesions. Meniscal tears, meniscectomies, and articular cartilage degeneration increased after the second revision (P = .016, P = .0098, and P = .0197, respectively). Severe articular cartilage degeneration (International Cartilage Repair Society grade III and IV lesions) was found in patients with bad functional outcome (final International Knee Documentation Committee assessment C or D) (P = .0472). Incidence of articular cartilage degeneration was found to be more prevalent in cases of meniscal tears and partial meniscectomy at the same tibiofemoral compartment (P = .0157). Index anterior cruciate ligament reconstruction and first revision failures were caused by recurrent trauma (60% and 70%, respectively) or a surgical technical error with tunnel malpositioning (40% and 10%, respectively).
  
  
  CONCLUSIONS
  Outcome of repeat revision of anterior cruciate ligament reconstruction was excellent or good in 70% of the cases, although decreased after the second revision, in relation to the occurrence of meniscal tears and articular cartilage lesions. Meniscal and articular cartilage lesions were more frequent and more severe with recurrent laxity. The cause of failures was mainly recurrent trauma, followed by surgical technical errors.
authors.affiliation: Department of Orthopedic Surgery and Sports Medicine, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France. julien.wegrzyn@chu-lyon.fr
authors.forename: Julien
authors.initials: J
authors.lastname: Wegrzyn
authors.forename: Julien
authors.initials: J
authors.lastname: Chouteau
authors.forename: Rémi
authors.initials: R
authors.lastname: Philippot
authors.forename: Michel-Henri
authors.initials: MH
authors.lastname: Fessy
authors.forename: Bernard
authors.initials: B
authors.lastname: Moyen