Review of Literature: Revision Anterior Cruciate Ligament Reconstruction

Abstract

There has been an increasing number of primary Anterior Cruciate Ligament (ACL) reconstructions in the past two-three decades leading to increasing need of revision ACL reconstructions as well. The exact etiology and pathophysiology of the failure of ACL reconstruction is multifactorial and still unclear. Poor surgical technique, 'biological failure' of the graft, injury and patient's factors like smoking have been attributed as the few leading causes responsible for unsuccessful outcome. Improper tunnel placement is the cause of 70 80% of ACL reconstruction failures and the most common error is malpositioning of the femoral tunnel3. Elaborate history taking and careful preoperative planning is of paramount importance for successful revision surgery. Over the past 15 years there has been a lot of published studies about primary ACL reconstruction, however there is relatively little literature on revision ACL reconstruction. The majority of these authors concluded that revision ACL reconstruction has a worse outcome than primary ACL reconstruction. Revision reconstruction has been described as a 'salvage procedure' 16and it has been suggested that significant time should be spent counselling patients and discussing their expectations prior to surgery.