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Knee Surgery, Sports Traumatology, Arthroscopy

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Open Access 01-08-2020 | KNEE

Preoperative medial knee instability is an underestimated risk factor for failure of revision ACL reconstruction

Authors: Lena Alm, Matthias Krause, Karl-Heinz Frosch, Ralph Akoto

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 8/2020

Abstract

Purpose

The purpose of this study was to carefully analyse the reasons for revision ACLR failure to optimize the surgical revision technique and minimize the risk of recurrent re-rupture. Large studies with a minimum of 2 years of follow-up that clinically examine patients with revision ACLR are rare.

Methods

Between 2013 and 2016, 111 patients who underwent revision ACLR were included in the retrospective study. All patients were examined for a minimum of 2 years after revision surgery (35 ± 3.4 months, mean ± STD) and identified as “failed revision ACLR” (side-to-side difference ≥ 5 mm and pivot-shift grade 2/3) or “stable revision ACLR”.

Results

Failure after revision ACLR occurred in 14.5% (n = 16) of the cases. Preoperative medial knee instability (n = 36) was associated with failure; thus, patients had a 17 times greater risk of failure when medial knee instability was diagnosed (p = 0.015). The risk of failure was reduced when patients had medial stabilization (n = 24, p = 0.034) and extra-articular lateral tenodesis during revision surgery (n = 51, p = 0.028). Increased posterior tibial slope (n = 11 ≥ 12°, p = 0.046) and high-grade anterior knee laxity (side-to-side difference > 6 mm and pivot-shift grade 3, n = 41, p = 0.034) were associated with increased failure of revision ACLR. Obese patients had a 9 times greater risk of failure (p = 0.008, n = 30).

Conclusion

This study demonstrates the largest revision ACLR patient group with pre- and postoperative clinical examination data and a follow-up of 2 years published to date. Preoperative medial knee instability is an underestimated risk factor for revision ACLR failure. Additionally, high-grade anterior knee laxity, increased PTS and high BMI are risk factors for failure of revision ACLR, while additional medial stabilization and lateral extra-articular tenodesis reduce the risk of failure.

Level of evidence

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Title: Preoperative medial knee instability is an underestimated risk factor for failure of revision ACL reconstruction
Authors: Lena Alm
Matthias Krause
Karl-Heinz Frosch
Ralph Akoto
Publication date: 01-08-2020
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 8/2020
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-020-06133-y

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Springer Medicine

Preoperative medial knee instability is an underestimated risk factor for failure of revision ACL reconstruction

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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