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Published in: International Orthopaedics 7/2013

01-07-2013 | Original Article

Two-stage procedure in anterior cruciate ligament revision surgery: a five-year follow-up prospective study

Authors: Francesco Franceschi, Rocco Papalia, Angelo Del Buono, Biagio Zampogna, Lorenzo Diaz Balzani, Nicola Maffulli, Vincenzo Denaro

Published in: International Orthopaedics | Issue 7/2013

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Abstract

Purpose

The purpose of this study was to show that this two-stage procedure for ACL (anterior cruciate ligament) revision surgery could be straight-forward and provide satisfactory clinical and functional outcomes.

Materials

This is a five-year prospective analysis of clinical and functional data on 30 patients (19 men and 11 women; average age 29.1 ± 5.4) who underwent a two-stage ACL revision procedure after traumatic re-rupture of the ACL. Diagnosis was on Lachman and pivot-shift tests, arthrometer 30-lb KT-1000 side-to-side findings, and on MRI and arthroscopic assessments.

Results

Postoperative IKDC and Lysholm scores were significantly improved compared to baseline values (P < 0.001). At the last follow up, 20 of 30 patients (66.7 %) had returned to preoperative sport activity level (nine elite athletes, 11 county level), seven had changed to lower sport levels, and three had given up any sport activity. At the same appointment, 11 patients had degenerative changes. All these patients reported significantly lower Lysholm scores compared to patients without any degenerative change (p < 0.001).

Conclusions

In ACL revision surgery, when the first femoral tunnel has been correctly placed, this procedure allows safe filling of large bony defects, with no donor site comorbidities. It provides comfortable clinical, functional and imaging outcomes.
Literature
1.
go back to reference Ramjug S, Ghosh S, Walley G, Maffulli N (2008) Isolated anterior cruciate ligament deficiency, knee scores and function. Acta Orthop Belg 74:643–651PubMed Ramjug S, Ghosh S, Walley G, Maffulli N (2008) Isolated anterior cruciate ligament deficiency, knee scores and function. Acta Orthop Belg 74:643–651PubMed
2.
go back to reference Lovric V, Kanazawa T, Nakamura Y, Oliver R, Yu Y, Walsh WR (2011) Effects of gaps induced into the ACL tendon graft on tendon-bone healing in a rodent ACL reconstruction model muscles. Ligaments Tendons J I:91–99 Lovric V, Kanazawa T, Nakamura Y, Oliver R, Yu Y, Walsh WR (2011) Effects of gaps induced into the ACL tendon graft on tendon-bone healing in a rodent ACL reconstruction model muscles. Ligaments Tendons J I:91–99
3.
go back to reference Franceschi F, Papalia R, Di Martino A, Rizzello G, Allaire R, Denaro V (2007) A new harvest site for bone graft in anterior cruciate ligament revision surgery. Arthroscopy 23(558):e551–e554 Franceschi F, Papalia R, Di Martino A, Rizzello G, Allaire R, Denaro V (2007) A new harvest site for bone graft in anterior cruciate ligament revision surgery. Arthroscopy 23(558):e551–e554
4.
go back to reference Johnson DL, Fu FH (1995) Anterior cruciate ligament reconstruction: why do failures occur? Instr Course Lect 44:391–406PubMed Johnson DL, Fu FH (1995) Anterior cruciate ligament reconstruction: why do failures occur? Instr Course Lect 44:391–406PubMed
5.
go back to reference Felmet G (2011) Anatomic double bundle single tunnel foreign material free ACL-reconstruction—a technical note. Muscle Ligaments Tendons J 1:147–151 Felmet G (2011) Anatomic double bundle single tunnel foreign material free ACL-reconstruction—a technical note. Muscle Ligaments Tendons J 1:147–151
6.
go back to reference Dhillon MS, Ball K, Prabhakar S (2012) Differences among mechanoreceptors in healthy and injured anterior cruciate ligaments and their clinical importance. Muscle Ligaments Tendons J 2:38–43 Dhillon MS, Ball K, Prabhakar S (2012) Differences among mechanoreceptors in healthy and injured anterior cruciate ligaments and their clinical importance. Muscle Ligaments Tendons J 2:38–43
7.
go back to reference Tornetta P, Riina J, Geller J, Purban W (1999) Intraarticular anatomic risks of tibial nailing. J Orthop Trauma 13:247–251PubMedCrossRef Tornetta P, Riina J, Geller J, Purban W (1999) Intraarticular anatomic risks of tibial nailing. J Orthop Trauma 13:247–251PubMedCrossRef
8.
go back to reference Cameron ML, Briggs KK, Steadman JR (2003) Reproducibility and reliability of the outerbridge classification for grading chondral lesions of the knee arthroscopically. Am J Sports Med 31:83–86PubMed Cameron ML, Briggs KK, Steadman JR (2003) Reproducibility and reliability of the outerbridge classification for grading chondral lesions of the knee arthroscopically. Am J Sports Med 31:83–86PubMed
9.
go back to reference Kartus J, Ejerhed L, Sernert N, Brandsson S, Karlsson J (2000) Comparison of traditional and subcutaneous patellar tendon harvest. A prospective study of donor site-related problems after anterior cruciate ligament reconstruction using different graft harvesting techniques. Am J Sports Med 28:328–335PubMed Kartus J, Ejerhed L, Sernert N, Brandsson S, Karlsson J (2000) Comparison of traditional and subcutaneous patellar tendon harvest. A prospective study of donor site-related problems after anterior cruciate ligament reconstruction using different graft harvesting techniques. Am J Sports Med 28:328–335PubMed
11.
go back to reference Bernard M, Hertel P, Hornung H, Cierpinski T (1997) Femoral insertion of the ACL. Radiographic quadrant method. Am J Knee Surg 10:14–21PubMed Bernard M, Hertel P, Hornung H, Cierpinski T (1997) Femoral insertion of the ACL. Radiographic quadrant method. Am J Knee Surg 10:14–21PubMed
12.
go back to reference Osti L, Papalia R, Del Buono A, Merlo F, Denaro V, Maffulli N (2010) Simultaneous surgical management of chronic grade-2 valgus instability of the knee and anterior cruciate ligament deficiency in athletes. Knee Surg Sports Traumatol Arthrosc 18:312–316PubMedCrossRef Osti L, Papalia R, Del Buono A, Merlo F, Denaro V, Maffulli N (2010) Simultaneous surgical management of chronic grade-2 valgus instability of the knee and anterior cruciate ligament deficiency in athletes. Knee Surg Sports Traumatol Arthrosc 18:312–316PubMedCrossRef
13.
go back to reference Weiler A, Schmeling A, Stohr I, Kaab MJ, Wagner M (2007) Primary versus single-stage revision anterior cruciate ligament reconstruction using autologous hamstring tendon grafts: a prospective matched-group analysis. Am J Sports Med 35:1643–1652PubMedCrossRef Weiler A, Schmeling A, Stohr I, Kaab MJ, Wagner M (2007) Primary versus single-stage revision anterior cruciate ligament reconstruction using autologous hamstring tendon grafts: a prospective matched-group analysis. Am J Sports Med 35:1643–1652PubMedCrossRef
14.
go back to reference Brown CH Jr, Carson EW (1999) Revision anterior cruciate ligament surgery. Clin Sports Med 18:109–171PubMedCrossRef Brown CH Jr, Carson EW (1999) Revision anterior cruciate ligament surgery. Clin Sports Med 18:109–171PubMedCrossRef
15.
go back to reference Fukubayashi T, Kurosawa H (1980) The contact area and pressure distribution pattern of the knee. A study of normal and osteoarthrotic knee joints. Acta Orthop Scand 51:871–879PubMedCrossRef Fukubayashi T, Kurosawa H (1980) The contact area and pressure distribution pattern of the knee. A study of normal and osteoarthrotic knee joints. Acta Orthop Scand 51:871–879PubMedCrossRef
16.
go back to reference Streich NA, Reichenbacher S, Barié A, Buchner M, Schmitt H (2012) Long-term outcome of anterior cruciate ligament reconstruction with an autologous four-strand semitendinosus tendon autograft. Int Orthop 37:279–284CrossRef Streich NA, Reichenbacher S, Barié A, Buchner M, Schmitt H (2012) Long-term outcome of anterior cruciate ligament reconstruction with an autologous four-strand semitendinosus tendon autograft. Int Orthop 37:279–284CrossRef
17.
go back to reference Choi JY, Ha JK, Kim YW, Shim JC, Yang SJ, Kim JG (2012) Relationships among tendon regeneration on MRI, flexor strength, and functional performance after anterior cruciate ligament reconstruction with hamstring autograft. Am J Sports Med 40:152–162PubMedCrossRef Choi JY, Ha JK, Kim YW, Shim JC, Yang SJ, Kim JG (2012) Relationships among tendon regeneration on MRI, flexor strength, and functional performance after anterior cruciate ligament reconstruction with hamstring autograft. Am J Sports Med 40:152–162PubMedCrossRef
18.
go back to reference Kartus J, Stener S, Lindahl S, Eriksson BI, Karlsson J (1998) Ipsi- or contralateral patellar tendon graft in anterior cruciate ligament revision surgery. A comparison of two methods. Am J Sports Med 26:499–504PubMed Kartus J, Stener S, Lindahl S, Eriksson BI, Karlsson J (1998) Ipsi- or contralateral patellar tendon graft in anterior cruciate ligament revision surgery. A comparison of two methods. Am J Sports Med 26:499–504PubMed
19.
go back to reference Dargel J, Schmidt-Wiethoff R, Fischer S, Mader K, Koebke J, Schneider T (2009) Femoral bone tunnel placement using the transtibial tunnel or the anteromedial portal in ACL reconstruction: a radiographic evaluation. Knee Surg Sports Traumatol Arthrosc 17:220–227PubMedCrossRef Dargel J, Schmidt-Wiethoff R, Fischer S, Mader K, Koebke J, Schneider T (2009) Femoral bone tunnel placement using the transtibial tunnel or the anteromedial portal in ACL reconstruction: a radiographic evaluation. Knee Surg Sports Traumatol Arthrosc 17:220–227PubMedCrossRef
20.
go back to reference Brown CH, Spalding T, Robb C (2013) Medial portal technique for single-bundle anatomical anterior cruciate ligament (ACL) reconstruction. Int Orthop 37:253–269PubMedCrossRef Brown CH, Spalding T, Robb C (2013) Medial portal technique for single-bundle anatomical anterior cruciate ligament (ACL) reconstruction. Int Orthop 37:253–269PubMedCrossRef
21.
go back to reference Ristanis S, Stergiou N, Siarava E, Ntoulia A, Mitsionis G, Georgoulis AD (2009) Effect of femoral tunnel placement for reconstruction of the anterior cruciate ligament on tibial rotation. J Bone Joint Surg Am 91:2151–2158PubMedCrossRef Ristanis S, Stergiou N, Siarava E, Ntoulia A, Mitsionis G, Georgoulis AD (2009) Effect of femoral tunnel placement for reconstruction of the anterior cruciate ligament on tibial rotation. J Bone Joint Surg Am 91:2151–2158PubMedCrossRef
22.
go back to reference Papalia R, Del Buono A, Osti L, Denaro V, Maffulli N (2011) Meniscectomy as a risk factor for knee osteoarthritis: a systematic review. Br Med Bull 99:89–106PubMedCrossRef Papalia R, Del Buono A, Osti L, Denaro V, Maffulli N (2011) Meniscectomy as a risk factor for knee osteoarthritis: a systematic review. Br Med Bull 99:89–106PubMedCrossRef
23.
go back to reference Garofalo R, Djahangiri A, Siegrist O (2006) Revision anterior cruciate ligament reconstruction with quadriceps tendon-patellar bone autograft. Arthroscopy 22:205–214PubMedCrossRef Garofalo R, Djahangiri A, Siegrist O (2006) Revision anterior cruciate ligament reconstruction with quadriceps tendon-patellar bone autograft. Arthroscopy 22:205–214PubMedCrossRef
24.
go back to reference Struewer J, Ziring E, Frangen TM, Efe T, Meissner S, Buecking B, Bliemel C, Ishaque B (2013) Clinical outcome and prevalence of osteoarthritis after isolated anterior cruciate ligament reconstruction using hamstring graft: follow-up after two and ten years. Int Orthop 37:271–277PubMedCrossRef Struewer J, Ziring E, Frangen TM, Efe T, Meissner S, Buecking B, Bliemel C, Ishaque B (2013) Clinical outcome and prevalence of osteoarthritis after isolated anterior cruciate ligament reconstruction using hamstring graft: follow-up after two and ten years. Int Orthop 37:271–277PubMedCrossRef
Metadata
Title
Two-stage procedure in anterior cruciate ligament revision surgery: a five-year follow-up prospective study
Authors
Francesco Franceschi
Rocco Papalia
Angelo Del Buono
Biagio Zampogna
Lorenzo Diaz Balzani
Nicola Maffulli
Vincenzo Denaro
Publication date
01-07-2013
Publisher
Springer-Verlag
Published in
International Orthopaedics / Issue 7/2013
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-013-1886-5

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