How is revision ACL reconstruction performed?
Before revision ACL reconstruction surgery is performed, patients meet with Dr. Williams to discuss the cause of the ACL graft failure. A full understanding of the graft failure is needed so that the risk of repeat failure the revision surgery is minimized. Revision ACL reconstruction is a similar procedure to primary ACL reconstruction. Dr. Williams prefers the use of the patient’s tissue (autograft) for revision ACL reconstruction as these tissues are very strong and heal quickly and predictably.
During the first reconstruction, tunnels were created in the tibia and femur bones to facilitate ACL graft placement. If these tunnels have been damaged or expanded, bone graft may be used to repair the bone defect so the new tendon graft can be secured in place. In some cases, the original ACL graft may have been placed in the wrong footprint; if this is the case, the bony portion of the original graft may be left in place. Dr. Williams will do that which is necessary to place the revised ACL ligament graft into the proper location within the knee joint.
Sometimes, revision ACL reconstruction requires two separate surgeries. The first operation is performed to restore the bony integrity of the knee joint. Bone plugs and bone graft are used to restore the bony anatomy of the tibia and femur. Reconstitution of the tibia and femur allows for the placement of the revision ACL graft in the correct anatomic location. After about 3-6 months, Dr. Williams will check the graft procedure using a CT or MRI scan. Once the bony repair is physiologically complete, Dr. Williams will perform a second surgery to place the new ACL graft. During this operation, Dr. Williams creates new tunnels in the tibia and femur to secure the graft. He takes care to ensure that the new grafts are in the correct anatomical position and will allow the optimal range of motion and stability.
Revision ACL graft sources include use of a hamstring tendon autograft, quadriceps tendon autograft, and contralateral patellar tendon graft. The patient’s own tissue is Dr. Williams’ preferred revision graft of choice. In some cases, donor tissue (allograft) may be indicated. Dr. Williams will discuss all these options with the patient prior to performing the revision ACL procedure.
In addition, adjunctive procedures such as a lateral extra-articular tenodesis, iliotibial band tenodesis, or anterior lateral ligament (ALL) may be recommended by Dr. Williams to increase the likelihood of clinical success of revision ACL reconstruction.