This document discusses ACL reconstruction failure and revision surgery. It notes that instability, stiffness, and pain could indicate failure. The main causes of failure discussed are traumatic failure, biologic failure, and technical error, particularly malpositioned tunnels. It provides statistics on ACL reconstruction and failure rates. It highlights potential pitfalls in revision surgery like malpositioned tunnels, widened tunnels, soft tissue grafts, and fixation devices. The conclusion emphasizes that ACL revision is demanding, requires careful preoperative planning, and has lower success rates than primary ACL reconstruction. Experience is important for managing revision cases.

1. REVISION ACL
Gonzalo Samitier MD PhD
Orthopaedic Sports Medicine Fellow
Henry Ford Health System
RECONSTRUCTION
FAILURE

3. INSTABILITY
STIFF
PAIN
Follow me!! …

4. + 6mm
Pivot +2 or +3

5. - Surgery was totally a succes, everything looks fine …
- I just wouldn’t recommend using that leg anymore or
getting a second opinion from one of my partners …

6. 200.000 ACL/year
75-97%

8. …that’s Ok

9. So WHAT
INSTABILITY
STIFF
PAIN
… is this an ACL reconstruction Failure?

13. INSTABILITY
Descriptive Epidemiology of the Multicenter ACL Revision Study (MARS) Cohort
The MARS Group Am J Sports Med 2010 38: 1979

14. Traumatic failure

15. Biologic failure

16. “TUNEL MALPOSITION”
Value 75%
“OTHERS”
Value 25%
Technical error

17. Allograft source 7%
Femoral fixation 6%
Malalignment 4%
Posterolateral laxity 4%
Tibial fixation 1%
Autograft source 1%
Posteromedial laxity 2%
Other
“OTHERS”
Value 25% Technical error

18. “TUNEL MALPOSITION”
Value 75%
Technical error

22. DOUBLE BUNDLE vs SINGLE BUNDLE

23. … moment of truth

24. VIDEO TECHNIQUE
 See Video at:
 https://www.youtube.com/channel/UCqppa1V7WkCjwj
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25. PEARLS & PITFALLS
• Malpositioned tunnels
• Widened tunnels
• Soft tissue grafts
• Posterior wall fracture
• Fixation devices
• Primary surgery autograft
• Throclear notch narrowing

26. CONCLUSIONS
ACL REVISION is a demanding surgery
PREOP PLANING is mandatory
LOWER RESULTS than primary acl
ANATOMIC reconstruction

27. Experience
… thank you