Understanding Revision ACL Reconstruction

The anterior cruciate ligament (ACL) is the most commonly torn ligament in the knee, particularly among athletes. It plays a crucial role in providing stability during twisting and rotational movements and prevents the tibia (shinbone) from moving too far forward relative to the femur (thighbone). Due to its poor blood supply, the ACL does not heal on its own. Many athletes and active individuals undergo ACL reconstruction to restore knee function and stability. However, in some cases, a re-tear may occur, requiring a revision ACL reconstruction.

What Causes an ACL Reconstruction to Fail?

• Poorly positioned ACL graft from the initial surgery.
• Re-tear due to non-compliance with rehabilitation guidelines.
• Premature return to athletic activities.
• New trauma to the reconstructed ligament.
• Malalignment of the lower limb, such as knocked knees or bow legs, causing uneven stress loads.

When to Have Revision ACL Surgery

If revision ACL surgery is necessary, Dr. Khaleel, Senior Consultant Arthroscopic Knee and Sports Surgeon at Kims Alshifa, Perintalmanna, Kerala, India, will perform a detailed examination of the knee to determine the exact cause of failure. Diagnostic imaging such as X-rays and MRI will assess the bone and soft tissue structures before planning the surgery.

Revision ACL reconstruction is performed as soon as possible after a re-tear to restore function, mobility, and stability. Similar to the primary ACL surgery, either an autograft (patient’s tissue) or an allograft (donor tissue) is used for reconstruction, with the choice depending on the previous graft used.

How is Revision ACL Surgery Performed?

In cases where bone quality is compromised due to the previous surgery, Dr. Khaleel may need to perform staged revision ACL surgery.

Staged Revision ACL Reconstruction:

• Bone Grafting: If previous surgery has caused large tunnels in the bone, bone grafting is done to fill the damaged areas.
• Revision ACL Reconstruction: Performed 4-6 months after bone grafting, once the bone has healed.

Single-Stage Revision ACL Reconstruction:

If the previous tunnels are not too large, revision ACL reconstruction can be done in a single surgery without the need for bone grafting.

Correcting Knee Malalignment:

• If ACL failure is due to malalignment of the knee, corrective alignment surgeries may be required before ACL revision.
• Surgeries like High Tibial Osteotomy (HTO) or Distal Femoral Osteotomy (DFO) may be performed to improve knee biomechanics.

Success of Revision ACL Reconstruction

While primary ACL reconstruction has a high success rate, revision ACL surgery is more complex and may have a slightly lower success rate. However, with proper surgical planning, rehabilitation, and patient compliance, excellent results can be achieved.

Dr. Khaleel ensures comprehensive assessment and a personalized surgical approach to provide the best outcomes for patients undergoing ACL revision surgery.