Revision ACL Reconstruction
Repeat ACL Reconstruction If You Initial ACL Surgery Has Failed
It has been estimated that the overall failure rate of ACL reconstruction is between 5% and 15%. Since there are over 100,000 ACL reconstructions performed annually in the USA, there will be at least 5,000 to 15,000 FAILED ACL reconstructions annually in the U.S. If the graft fails the knee will be subject to recurrent instability, cartilage damage, and degenerative arthritis as well as an inability to pursue an active lifestyle.
In a large published of ACL reconstructions performed by Dr. Prodromos there were no graft failures. But, while Dr. Prodromos’ own patients had no graft failures, he has substantial experience in re-repairing, i.e. revising, failed ACL reconstructions from patients referred to him.
These knees also often have severe cartilage damage. Dr Prodromos’ experience with cartilage regeneration provides the tools to simultaneously address these problems.
The Hamstring ACL reconstruction technique using extra-tunnel cortical fixation which Dr. Prodromos uses is particularly well suited for revision ACL reconstruction. The tunnels in the bones in which the graft lies are often used initially as the location at which the grafts are attached to the bone. However in revision ACL surgery these tunnels may be unusable. Thus fixation that relies on the integrity of these tunnels may not be suitable. In Dr. Prodromos’ technique the tunnels are left empty except for the graft. This is also believed to facilitate graft healing in the tunnel. Instead Dr. Prodromos fixates the graft by means of sutures and a small button on the femur and a screw on the tibia attached on the surfaces of the bone just outside the tunnels. This has two distinct advantages.
First, if the tunnel does not have structural integrity, which is often the case, this does not compromise the fixation of the revision graft. Second, by not putting hardware or other artificial devices inside the tunnel, the entire circumference of the tunnel is allowed to grow into the graft to promote faster more complete healing.
Dr Prodromos uses the hamstring tendon from either the affected leg, or if that tendon has already been used he uses the tendon from the opposite leg to reconstruct the ACL. He has had no failures of his technique in revision ACL reconstruction. In the few occasions in which he has had to take the tendon from the opposite leg, there have been no complications. In fact patients can walk immediately on the leg from which the hamstring tendon was harvested. Patients are discharged home on the day of surgery.
Click below to see an arthroscopic view of a revised ACL reconstruction.