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When revising reconstructed ACLs, identify cause of failure and select a reliable graft
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 Neil P. Thomas |
OSLO — Two-stage revisions that might involve an osteotomy or one-stage revisions preceded by an arthroscopy to examine the articular cartilage may be indicated when a high-level athlete’s reconstructed ACL fails, a British knee surgeon said at the 2010 ESSKA Congress, here.
“There is a bit of pressure here” to return the athlete to play, despite the fact this can be a career-stopping injury, Neil P. Thomas, FRCS, of the North Hampshire Hospital, Basingstoke, in Hampshire, United Kingdom, said during a lecture on effective strategies for such revisions.
He urged orthopedic surgeons to not succumb to the demands that coaches and players put on them to return an athlete with a failed ACL reconstruction in 3 months. “You must warn them there may be unexpected findings,” even during what might seem to be a straightforward one-stage revision, said Thomas, a past president of ESSKA, noting that returning to sports at 6 months is a much more realistic target.
Thomas made other key recommendations during his lecture that included clearly identifying what caused the failure. Frequently re-injury results from trauma or a misplaced tunnel, particularly in the femur, he noted.
“In these players we should use an autograft. We should do a one-stage procedure if our bone tunnels are wide. Even if they are not, there are techniques to … still do a one-stage reconstruction,” he said.
A two-stage revision may be indicated when it is unclear from tests and imaging why the original graft failed or when bone grafting could correct overlapping tunnels. With bone grafting, you are left with a “virgin-bone situation” in which performing a second-stage with a simple technique will achieve results with the same laxity as a primary procedure with no compromise on the rehabilitation, Thomas said.
In his experience, patellar tendon and hamstring autografts perform best in these patients, he said.
- Reference:
Thomas NP. ACL revision in high level athletes – strategy. Presented during SY55: Special concerns in ACL repair in high level athletes at the 2010 ESSKA Congress. June 9-12, 2010. Oslo.
