Preoperative medial knee instability is an underestimated risk factor for failure of revision ACL reconstruction
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KNEE
Preoperative medial knee instability is an underestimated risk factor for failure of revision ACL reconstruction Lena Alm1,3 · Matthias Krause2 · Karl‑Heinz Frosch1,2 · Ralph Akoto1,3,4 Received: 19 January 2020 / Accepted: 26 June 2020 © The Author(s) 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 III.
Introduction
* Ralph Akoto [email protected] 1
Department of Trauma and Orthopaedic Surgery, Sports Traumatology, BG Hospital Hamburg, Bergedorfer Str. 10, 21033 Hamburg, Germany
2
Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
3
Asklepios Clinic St. Georg, Department of Trauma and Reconstructive Surgery with Division of Knee and Shoulder Surgery, Sports Traumatology, Hamburg, Germany
4
Department of Orthopaedics, Trauma Surgery and Sports Medicine, Cologne Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany
Results following revision anterior cruciate ligament reconstruction (ACLR) are commonly known to be less favourable than those following primary ACLR, as failure rates of 3.5–33% for revision and 5–25% for primary ACLR have been reported [9]. Re
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