[One- and two-stage procedure for revision after failure of anterior cruciate ligament reconstruction]

Abstract

Aim: Most surgeons favour a one-stage procedure for ACL revision surgery. Tunnel widening, limited range of motion or existent hardware can make a two-stage procedure necessary. Studies evaluating the results between both procedures are still lacking. Thus, we performed a prospective preliminary study comparing early results after one- and two-stage procedures for ACL revision reconstruction.

Method: Between 1/2005 and 1/2006 21 patients were operated on for ACL revision. The follow-up period of the 4 women and 16 men was 12 months. One patient was excluded due to a juvenile osteoporosis. Median age was 34 years. All patients had a subjective instability, including 11 patients (55%) with a traumatic rerupture. The indication for a two-stage procedure depended on tunnel widening under consideration of tunnel placement, disturbing existing hardware and extension deficits. Eleven patients received a one-stage procedure while 9 patients were operated in a two-stage process. Seven received autogenous bone grafting.

Results: The preoperative tunnel diameter was for one-stage revisions (OS) femoral 7.9 +/- 1.8 mm and tibial 8.8 +/- 2.2 mm. For the two-stage (TS) procedure mean femoral tunnel was preoperatively 10.1 +/- 1.4 mm and tibial 12.1 +/- 1.4 mm. Femoral tunnel placement after revision (OS/TS) yielded a mean angle in anteroposterior view of 28.7 degrees /26.9 degrees and in the sagittal view most tunnels were placed in the dorsal quadrant. Tibial placement was in the sagittal view at 46.1%/46.9% in the anteroposterior direction and for mediolateral direction in the a. p. view at 44.2%/44.5%. Results for Lysholm score were 85.7/83.9 and for IKDC 73.6/76.4. The anterior tibial translation compared to the healthy side was 1.5 mm/1.8 mm. In one leg jumping patients obtained a distance of 83 %/86% of the healthy side and stated their pain on a VAS to be as low as 1.9/1.4 points. Both groups had similar ranges of motion as well.

Conclusion: The success of ACL revision surgery crucially depends on preoperative planning and analysis. No functional or radiological differences could be observed between one- and two-stage procedures. Although the one-stage procedure might be favourable because of faster convalescence and shorter work incapacity, it should not be enforced at the price of an insufficient ACL.