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Anterior Cruciate Ligament Revision Surgery


Approximately 10% of patients who undergo anterior cruciate ligament (ACL) surgery experience graft failure, where the tendon graft placed in the location of the ACL tears for various reasons.


The most common reason is technical errors in the initial ACL surgery. The angles and placements of the tunnels opened in the shin (tibia) and thigh (femur) bones are crucial for a successful ACL surgery. If the tunnel in the shin bone is too far back or the one in the thigh bone is too far forward, the graft placed during the surgery may loosen and eventually tear during knee bending movements.


The second most common cause of failed ACL surgery is overlooking another injury during the initial trauma. If injuries such as posterolateral corner injuries, meniscus root injuries, and posterior horn injuries of the inner meniscus are missed, meaning they are not treated during the ACL surgery, excessive stress on the graft can lead to eventual tearing. It is also possible for the reconstructed ACL to tear again due to another trauma.


How is the Planning Done for Anterior Cruciate Ligament Revision Surgery?

For the revision surgery to be successful, it is essential to identify why the initial surgery failed and plan the revision accordingly. X-rays of the patient's knee and leg are taken to check for any alignment abnormalities. If there is a misalignment, corrective bone surgeries may be necessary, and these surgeries are performed during the ACL reconstruction surgery. An MRI is used to check for any additional injuries. If there is a meniscus tear, repair is planned. Particularly, the inner meniscus should be examined for posterior root and ramp tears.


Before the surgery, a CT scan of the knee is taken to determine whether the revision surgery will be done in one or two stages by examining the angles and widths of the tunnels opened in the previous surgery. Tunnel widening is a common issue, and if the tunnel diameter is greater than 12 mm, two surgeries may be required. In the first surgery, the tunnels are filled with bone tissues taken from the patient's pelvic bone. The ACL revision surgery is then performed 4-6 months later. The reason for the waiting period is the time required for the bone tissues placed in the tunnels to fuse.



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