Background

A 30 year old male patient presented with pain and giving away of the left knee. He sustained a twisting injury 2 years ago for which he underwent index arthroscopic.ACL reconstruction with hamstring grafts was done at an outside hospital. Ever since he has been having pain & instability in the left knee. Clinical examination showed grade 3 anterior drawer test & Lachman test positive

Diagnosis and Treatment

X-ray showed no fractures. The Femoral tunnel was noted to be in an abnormal position. MRI showed complete ACL and medial meniscus posterior horn tears. The patient was planned for revision arthroscopic anatomic ACL reconstruction +/- medial meniscus surgery. During arthroscopy, significant laxity of the ACL and partial tear of posterior horn of medial meniscus were noted. The hamstring graft was harvested from the contralateral knee, as the ipsilateral graft was harvested during the index surgery. The graft was augmented with FiberWire for internal bracing. Old ACL remnants were cleared with a shaver. Loose pieces of old femoral BioScrew were removed. Partial medial meniscectomy was done and trimmed to stable borders. New femoral and tibial tunnels were made. Anatomic ACL Reconstruction was done and stabilised with Arthrex Tightrope RT on femoral side and BioComposite screw on tibial side. Final stability showed negative anterior drawer test. The next day, he was mobilised with full weight-bearing walking. On follow-up, he achieved full range of movements and returned to normal sporting activities.

Discussion

Revision ACL reconstruction is technically challenging as we need to deal with tunnel widening, pre-existing hardware and injuries to concomitant structures. Recognizing and avoiding these pitfalls is crucial in obtaining a successful result after revision ACL reconstruction.

Pre-Op MRI showing Anterior cruciate ligament tear

New Anterior cruciate ligament Graf

About Author –

Dr. Sunil Dachepalli, Consultant Orthopedic Joint replacement & Arthroscopic Surgeon, Yashoda Hospitals – Hyderabad
MS ( Ortho), MBBS, MRCS, CCBST, MSc (Tr & Ortho), MCH (Ortho), FRCS ( Tr & Ortho)