Dr Gardner is an expert at both primary (first-time) as well as revision (redo) ACL reconstruction. A revision reconstruction can be far more complicated than the initial procedure, due to the prior surgery and associated hardware/screws/buttons. As well, a different tendon graft must be used for the revision surgery. Before surgery, Dr Gardner will use Xrays, and MRI and often a CT scan to try to determine the cause of the prior ACL surgery – it is important to take the time to uncover this and that these be corrected the next time.
Additionally, Dr Gardner is a regional leader in the use of the lateral extra-articular tenodesis procedure, which is commonly advocated during revision ACL reconstruction, as a way to provide more rotational stability to the new ACL.
What is Revision ACL reconstruction?
Revision ACL (anterior cruciate ligament) reconstruction is a second surgery performed to correct a failed primary ACL reconstruction surgery. Causes of failure may include recurrent instability, loss of motion, infection, and hardware complications.
ACL reconstruction is a surgery to replace or repair a torn or damaged anterior cruciate ligament in your knee with a new ACL tissue graft obtained most commonly from your own body (autograft) or in rare cases from a deceased donor (allograft). Anterior cruciate ligament tears or injuries most often occur during sports activities that involve pivoting, cutting, and turning movements as in football, soccer, skiing, tennis, and basketball. Ligaments are tough bands of tissue that connect one bone to another bone.
Several options exist for revision ACL reconstruction, including utilizing one of the patient’s own tendons, including a hamstring tendon, patellar tendon, quadriceps tendon, or a donor tendon (allograft tissue) may be used as well. Tendons are cords of strong fibrous tissue that connect muscles to bones.
Indication for Revision ACL Reconstruction
You may need a revision ACL reconstruction surgery if the previous ACL reconstruction has failed due to the following conditions:
- The graft was not accepted by your body properly
- The graft was placed at an incorrect point in the bone
- Early return to high-level activities prior to graft acceptance
- Failure of the reconstructed ligament to heal properly
- Re-injury or re-rupture of the ACL
- Problems arising from the previous surgery
- Other causes of knee instabilities were not corrected during the original procedure
This failure would result in the return of ACL injury symptoms such as swelling, pain, and knee-buckling or giving way (knee instability), warranting a revision ACL reconstruction.
Risks and Complications
Revision ACL reconstruction surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Infection
- Bleeding
- Adverse reactions to anesthesia
- Blood clots or deep vein thrombosis
- Damage to adjacent soft tissue structures
- Arthrofibrosis
- Inferior surgical outcome compared to primary ACL reconstruction
