Description
Purpose: When anterior cruciate ligament (ACL) reconstruction fails, a revision procedure may be performed to improve knee function, correct instability, and allow return to activities. Previous studies have shown that primary ACL reconstruction with a rectangular tunnel can restore the ACL footprint more anatomically, and produce better clinical outcomes than those achieved via a conventional round tunnel. The purpose of this study is to focused on the results of revision ACL reconstruction using the rectangular tunnel technique.
Methods: This study included the revision ACL reconstructions using the rectangular tunnel technique from 2017 to 2020. The exclusion criteria were combined fractures and multiligament injuries other than MCL injury. Intraoperative findings and postoperative knee laxity and clinical outcomes were assessed after 2 years follow up. Cause of failure after primary ACL reconstruction was collected. Failure was defined as symptomatic rotatory knee laxity with a positive pivot shift test graded as 2 or 3, or anterior knee laxity with a positive lachman test graded as 2 or 3 or more than 5mm anterior translation on stress radiography.
Results: Twenty-six patients were included after ACL revision surgery using rectangular tunnel technique. Causes of failure after primary ACL reconstruction were new trauma in 12 knees, femoral tunnel malposition in nine knees, and objective clinical failures in pivot shift or lachman test, as well as stress radiograph. The IKDC subjective scores were improved from 42.6± 6.3 to 82.3 ± 7.1.(p<0.05) The Tegner scores were improved from 2.8± 1.6 to 5.2 ± 1.5. (p<0.05) The positive pivot shift on postoperative follow up period was 1/26 (3.8%). There were no complications after surgery, as well as femoral condyle blow out. There was no patient who was converted to secondary ACL revision.
Conclusion: Revision ACL reconstruction with a rectangular tunnel could be considered as a reliable, safe technique.
