One-stage revision reconstruction of the anterior cruciate ligament using autograft: retrospective cohort study

BACKGROUND: Revision reconstruction of the anterior cruciate ligament (ACL) is a technically more complex procedure than primary reconstruction. Recurrence of anterior instability is most often associated with a technical error during the primary operation. The primary task of revision reconstruction is to identify the cause of recurrence of anterior instability and careful preoperative planning. Thus, the principles of ACL anatomical location to be essential restore stability. This paper discusses options for revision anatomical reconstruction of the ACL, including surgical technique, preoperative preparation, and choice of autograft material.

AIM: This study aimed to evaluate the results of a one-stage revision reconstruction of the ACL and show that this method can be performed in one stage, rather than in two stages, which will lead to a reduction in the patient’s recovery time and return to usual physical activity.

MATERIALS AND METHODS: To monitor the long-term treatment results, 50 of 92 patients with revision through one-stage ACL reconstruction, who were examined 9, and 12 months after surgery, were enrolled. All patients were young, who were working from age 18 to 42 years. The mean age was 29 years. This group included only male patients. As a graft material, all patients underwent sampling of the tendons of the fine and semitendinous muscles from the diseased or the contralateral limb. To assess the treatment results, the IKDC scale, Lysholm scale, arthrometric testing on KT-1000, and functional tests were conducted.

RESULTS: The use of developed surgical approaches made it possible to obtain good treatment results in patients with recurrences of anterior instability according to the Lysholm score of 82 points. Grade II residual lateral instability was observed in two (4%) patients in the observed group and in seven (14%) patients in the control group. According to the subjective assessment of treatment outcomes, 19 patients (38%) remained satisfied with them.

CONCLUSION: The practical application of the proposed options for the location of the channels and methods for fixing the autograft in the intraosseous channels make it possible to perform revision arthroscopic reconstruction of the ACL in one stage, without additional bone grafting of the channels, which in turn reduces the treatment and recovery time of patients, as evidenced by the results.