• Journal of Korean Orthopaedic Sports Medicine
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• v.2 no.1
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• pp.20-27
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• 2003

It is reported that approximately 100,000 anteior cruciate ligament (ACL) reconstructions are performed in the United States each year. Recurrent instability because of graft failure is estimated to occur in from 0.7$\%$ to 8$\%$ of reconstruction. Recently revision ACL reconstruction is likely to become more common as the number of primary reconstructions continues to increase. Arthroscopic revision ACL surgery with adequate graft for failed ACL reconstruction was successful in objectively and subjectively improving stability. However, considering the most common causes of failure after ACL reconstruction were errors in surgical technique, it is important that the primary ACL reconstruction should be performed with correct surgical technique. Therefore author reviewed the causes of failure of reconstruction to prevent the failure of reconstruction and described the surgical technique of revision ACL reconstruction.

• Journal of the Korean Arthroscopy Society
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• v.9 no.2
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• pp.115-122
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• 2005

With the increasing number of primary ACL reconstructions, revision surgery has become more frequent. Despite arthroscopic technique and treatment advancements, the current methods of reconstruction are far from perfect that a significant number of patients have an unsatisfactory. This article discusses the multiple mechanisms of failure of primary intra-articular ACL reconstruction and provides the orthopaedic surgeon with a systematic approach to the evaluation and treatment of failed ACL reconstructions.

• Journal of the Korean Arthroscopy Society
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• v.10 no.2
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• pp.159-164
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• 2006

Purpose: To evaluate the clinical stability and function after one-stage revision anterior cruciate ligament (ACL) reconstruction using fresh-frozen Achilles tendon allograft Materials and Methods: Thirteen patients who underwent one-stage revision ACL reconstruction using Achilles tendon allograft could be evaluated. The average time from primary procedure to revision surgery was 61.8 months. The mean follow-up period was 38.4 months. The bone defects of pre-constructed femoral and tibial tunnels were filled with calcaneal bone attached to Achilles tendon and the new femoral and tibial tunnels were created. Evaluations included the causes of failure of primary ACL reconstruction, Lysholm knee score, Lachman test, pivot shift test and KT-1000 arthrometer measurement. Results: The most common causes of failure of ACL reconstruction were poor surgical techniques in 10 cases (76.9%). Ten patients (76.9%) were good or excellent on the Lysholm score. Twelve patients (92.3%) had negative or 1+firm end Lachman test. Eleven patients (84.6%) had negative pivot shift test. Nine patients (69.2%) had less than 3 mm difference of manual maximum by KT-1000 arthrometer. Conclusion: One-stage revision ACL reconstruction with fresh-frozen Achilles tendon allograft, creating new tunnels after filling bone defects, resulted in a reliable and predictable outcome in terms of stability.

• Journal of the Korean Arthroscopy Society
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• v.12 no.3
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• pp.225-228
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• 2008

Pretibial cyst formation is a rare occurrence after anterior cruciate ligament (ACL) reconstruction. We report this complication after ACL revision surgery using tibialis anterior allograft. This complication seems to be the consequence of a direct communication between the joint and the cyst through the tibial tunnel. In the present study, the authors report that there is a pretibial cyst formation after a revisional ACL reconstruction.

• Journal of the Korean Arthroscopy Society
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• v.7 no.2
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• pp.183-188
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• 2003

Purpose : The purpose of this study is to evaluate the results of revision surgery for failed anterior cruciate ligament (ACL) reconstruction using quadruple hamstring tendon autograft. Materials and Methods : From May 2000 to July 2002, six patients received ACL revision surgery using quadruple hamstring autograft for failed ACL reconstruction. Femoral tunnels were made 40 mm in depth and fixed with a cross pin and a bioabsorbable interference screw to fill the bone defect. In tibial tunnels, the grafts were fixed with Intrafix(Mitek, Norwood, MA). In case of tibial tunnel widening, additional screw-washer fixation was done. Follow up was at least 12 months postoperatively. Clinical assessments consisted of Lysholm knee scores, International Knee Documentation Committee(IKDC) evaluation form and manual maximal side to side difference using KT-2000 arthrometer. Results : The average Lysholm knee score improved from 77.2 preoperatively to 87.7 postoperatively. At the final IKDC evaluation, 1 case was graded as normal, 4 nearly normal, 1 abnormal. Mean side to side difference of manual maximum anterior displacement using the KT-2000 arthrometer was 1.8mm. The success rate was $83\%$. Conclusion : ACL revision surgery using quadruple hamstring autograft with double fixation is considered good procedure with successful results.

• Journal of the Korean Arthroscopy Society
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• v.3 no.1
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• pp.40-43
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• 1999

Arthroscopic anterior cruciate ligament(ACL) reconstruction using four-strand hamstring tendon with looping around transfixing screw in femoral tunnel requires osteointegration between the grafted tendon and bone for stability of the knee. Authors have experienced a histologic finding of osteointegration between the grafted autogenous hamstring tendon and bone in femoral tunnel after arthroscopic ACL reconstruction. A patient received arthroscopic ACL reconstruction with autogenous four strand hamstring tendon for the ACL injury. Traumatic re-rupture of mid-substance of ACL graft was developed at thirteenth week after operation. During the procedures of arthroscopic revision at fifteenth week after initial ACL reconstruction, biopsy was performed at the site of interface between grafted tendon and bone in femoral tunnel. Integration between the grafted tendon and bone was evident by demonstrating the continuity of collagen fiber between bond and tendon. This histologic finding and the low incidence of early graft failure suggest that free tendon autograft attached to bone by looping around a transfixing screw in femoral tunnel undergoes adequate osteointegration between 12 and 15 weeks after surgery and authors thought that insertion of bone chip into the femoral tunnel would accelerate osteointegration procedure.

• Journal of Korean Orthopaedic Sports Medicine
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• v.10 no.2
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• pp.47-53
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• 2011

Purpose: As the number of the anterior cruciate ligament (ACL) reconstruction has increased, the incidence of revision of ACL reconstruction due to reconstruction failure has been also increased. Therefore, authors analyzed the reason of the failure of ACL reconstruction and the clinical result of the ACL revision. Materials and methods: From February 1998 to July 2010, we selected 36 cases which was followed at least 12months after the ACL reconstruction failure. Duration from reconstruction to revision, the average duration was 60 months (5~334) and on first reconstruction, we used allograft on 23 cases (63.9%) and autograft on 13 cases (36.1%). For the main symptom of ACL reconstruction failure, instability was the most common symptom, and 35 cases (97.5%) were undergone only one reconstruction and 1case (2.5%) was undergone two reconstruction. Clinical results were evaluated by Lysholm knee joint score, pivot shift test, and Telos device. Results: Average follow-up duration of the patients was 21 months (12~40), and the reason for the ACL reconstruction failure, trauma was most common by 19 cases (52.8%), malposition of the femoral tunnel was 13 cases (36.1%), malposition of the tibia tunnel was 1case (2.8%), and failure of osteointegration was 3 cases (8.4%). On performing the ACL revision, we used allograft on 34 cases (94%) and autograft on 2 cases (6%), and 21 cases accompanied injury of the meniscus (medial meniscus 14 cases, lateral meniscus 7 cases). Lysholm knee joint score was improved from 66.5 points, preoperatively to 92 points on last follow-up (p<0.01). In most cases, patients were satisfied (92%) with the operation results. Tegner activity score was also improved from 2.0 points preoperatively to 6.2 points on the last follow-up. On Lachman and pivot sift test, 33 cases and 30 cases were improved to grade I respectively, and on stability test using Telos device, the bilateral difference was improved from mean 15.5 mm preoperatively to 4.5 mm on the last follow-up. Conclusion: After 1 year follow-up, Revision of ACL had a little anterior instability but it showed satisfactory result on clinical result and patient's subjective satisfaction.

• Journal of the Korean Arthroscopy Society
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• v.7 no.2
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• pp.169-175
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• 2003

Purpose : The purpose was to evaluate the early result of revision of failed anterior cruciate ligament (ACL) reconstruction. Materials and Methods : From August 1997 to February 2002, this report presents the findings of 18 patients who had revision surgery for failed ACL reconstruction. There was an average of 39 $(7\~120)$months from index procedure to the time of revision. Allografts were used in 14 $(78\%)$cases and autografts were used in 4 $(22\%)$cases and the revision procedures were assisted by arthroscopic technique. The majority of chief complaints were instability in 16 $(89\%)$cases. Sixteen $(89\%)$ cases had 1 previous reconstruction, 2 $(11\%)$ cases had 2. Before and after revision, patients were evaluated by Lachman test, pivot shift test, KT 2000, radiographs, Lysholm score and HSS score and subjective satisfaction. Results : Average length of followup was 27 $(12\~60)$months. Preoperatively, all cases were positive in Lachman test and pivot shift test. After revision the majority of cases were negative. Objectively improving stability was confirmed by KT 2000 and all average KT 2000 was 7.75 $(3.5\~12.5)$mm preoperatively and 2.36 $(1.0\~6.0)$mm at final followup. Lysholm score and HSS score were also improved from 72.6 $(66\~77)$ and 72.5 $(68\~78)$ preoperatively to 89.2 $(80\~92)$ and 88.2 $(81\~92)$ at final followup. Most $(89\%)$ of patients were satisfied with their results. The most common causes of failed ACL reconstruction were malposition of femoral tunnel in 11 $(61\%)$cases. Conclusion : Arthroscopic revision ACL surgery with adequate graft for failed ACL reconstruction was successful in objectively and subjectively improving stability. However, considering the most common causes of failure after ACL reconstruction were errors in surgical technique, it is important that the primary ACL reconstruction should be performed with correct surgical technique.

• Journal of the Korean Arthroscopy Society
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• v.13 no.2
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• pp.143-148
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• 2009

Purpose: To investigate the causes of failure on ACL reconstructions and evaluate the effectiveness of one stage revision ACL reconstructions. Materials and Methods: From November 2004 to July 2008, thirty three patients who had got revision ACL recontstructions after reruptures of ACL were evaluated. The causes of failure of ACL reruptures were 22 vertical femoral tunnels, 7 neglected PLRI, 3 severe traumas and 1 deep infection after ACL reconstruction. The femoral tunnels were aimed at the 10 or 2 o'clock position and the tibial tunnels were used with previous tunnels. Previous femoral screws from the improper femoral tunnels were removed and filled with the new allograft bones. Results: The average periods of follow up were 22.2 months (12~52 months). There was improvement on an average Lysholm knee score from $61.5{\pm}16.8$ to $86.3{\pm}11.5$, IKDC score from $63.9{\pm}15.1$ to $81.3{\pm}14.3$. Mean side to side difference was decreased from $6.0{\pm}2.2\;mm$ to $1.6{\pm}1.4\;mm$ using KT-2000 arthrometer. Conclusion: One stage revision ACL reconstruction can be a useful method with good clinical results.