Location of the graft tear was determined from both the operative report and from intra-operative photographs. Patient demographics, surgical details of the primary ACL reconstruction, time from reconstruction to re-injury, activity at re-injury, time from re-injury to revision reconstruction, and location of graft tear were collected from the medical record. After obtaining approval from our institutional review board, the medical records of these patients were reviewed to verify the diagnosis. These 10 patients were excluded, leaving 34 patients for this analysis. Of these 44 patients, 10 reported no re-injury to their knee prior to the revision ACL reconstruction. We hypothesize that autograft ACL reconstructions will fail near their femoral origin, similar to native ligament tear locations, while allograft reconstructions will fail in other locations.īetween February 28, 2006, and March 25, 2010, the two senior authors performed 370 ACL reconstructions, including 44 revision cases. However, we are unable to locate any reports in the literature detailing the location of failure of ACL grafts in the case of traumatic re-injury. An understanding of how grafts fail is critical in assessing the reasons for these failures and ultimately in decreasing failure rates. Animal studies have demonstrated slower incorporation of allograft tissue and demonstrated decreased failure loads for allografts up to one year following reconstruction. Increased activity level and the use of allograft tissue in ACL reconstruction have been associated with increased graft failure rates. Traumatic re-injuries may be more common in younger, more active patient populations. Traumatic re-injury has been reported in 22-28% of patients in several large series. classified the etiology of post-operative instability as technical error, failure of graft incorporation, or recurrent trauma. Although failure of ACL reconstruction is not limited to cases of persistent or recurrent instability, instability is the most frequent reason for revision ACL reconstruction. Modern intra-articular reconstructive techniques allow clinically stable ligament reconstruction in the majority of cases however, failed reconstruction continues to be a problem.įailure rates of ACL reconstruction are difficult to assess because the definition of failure is not absolute, but many clinical outcome studies place the failure rate between 5 and 20%. Reconstructive techniques have evolved over time with variable results.
The anterior cruciate ligament (ACL) is commonly injured and is the most frequently reconstructed ligament of the knee. When ACL autografts fail traumatically, they frequently fail near their femoral origin, while allograft reconstructions that fail are more likely to fail in other locations or stretch. In the autograft group 14 of 19 grafts failed near their femoral attachment, while in the allograft group 2 of 11 grafts failed near their femoral attachment (p < 0.02). Failure location could be determined in 30 patients. The median time from re-injury to revision reconstruction was 10.4 weeks (range, 1 to 241 weeks). The median time from primary reconstruction to re-injury was 1.2 years (range, 0.4 – 17.6 years).
The primary reconstructions included 20 autografts (13 hamstrings, 6 patellar tendons, 1 iliotibial band), 12 allografts (5 patellar tendon, 5 tibialis anterior tendons, 2 achilles tendons), and 2 unknown. Median patient age at primary ACL reconstruction was 18.5 years (range, 13–39 years). Graft utilized in the primary reconstruction, time from initial reconstruction to re-injury, activity at re-injury, time to revision reconstruction, and location of ACL graft tear were recorded. The medical records of 34 consecutive patients at our center undergoing revision ACL reconstruction following a documented traumatic re-injury were reviewed. The purpose of this study is to determine the location of traumatic graft failure following ACL reconstruction and investigate differences in failure patterns between autografts and allografts. Animal studies have demonstrated slower incorporation of allograft tissue, which may affect the mechanism of graft failure. Between 5 and 20% of patients undergoing ACL reconstruction fail and require revision.
0 kommentar(er)
