Anatomy & Function

Revision of cruciate ligament reconstruction - despite increasing improvement in the quality of care and constant further development of surgical procedures and implants, a not inconsiderable number of patients re-injure their anterior cruciate ligament. This not only explains the increase in the revision rate for anterior cruciate ligament(ACL) reconstruction in recent decades, but may also be due to high sports participation and increasing physical activity.

Failure of primary anterior cruciate ligament reconstruction accounts for approximately 6.2% of surgeries. Of these, approximately 30% are traumatic causes, approximately 65% are nontraumatic causes, and approximately 7% are biological causes. Unsatisfactory results after cruciate ligament reconstruction can have various causes. If revision surgery is necessary, precise planning before reoperation and cause analysis is essential.

Definition: In medicine, revision refers to the repetition or extension of a previously performed procedure (revision surgery). The most common reason for a revision is the insufficient success of the previous operation or complications that have occurred. The revision is intended to achieve the originally intended treatment success or at least an improvement of the current condition.

Symptoms & Complaints

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Causes

The causes for an unsatisfactory outcome after cruciate ligament reconstruction can be complex and multifactorial. An inadequate preoperative diagnosis, technical complications during the surgical procedure as well as an inappropriate postoperative rehabilitation can lead to a failure of the cruciate ligament reconstruction. In addition, factors that cannot be influenced by the surgeon, such as patient compliance and graft rupture due to retrauma, also play a role.

Diagnosis

Cruciate ligament reconstruction can be considered a failure if the patient complains of persistent or new feelings of instability during sports as well as in everyday life and an examination of the operated knee joint reveals increased instability, often there are latent effusion formations ("fluid in the knee") , which the injured person often notices late. The cause analysis requires careful diagnostics before renewed surgical treatment. On the basis of these, our further strategy of possible revision surgery is derived. In the list below, we describe the most important examination methods, whereby the decision as to which diagnostic measures are to be applied is individually patient-specific.

The root cause analysis requires careful diagnostics before renewed surgical treatment. On the basis of these, our further strategy of possible revision surgery is derived. In the list, we describe the essential examination methods, whereby the decision as to which diagnostic measures are to be applied is individually patient-specific.

Possible examinations for cruciate ligament revision:

  • Manual stability examination: The clinical stability examination is essential to check the strength and stability of the plastic as well as accompanying instabilities such as the medial and lateral ligaments, ALL etc.
  • X-ray examination: X-ray examination provides information about the position and width of the bore tunnel, the position of metal implants, tibial slope (sagittal inclination of the tibial plateau).
  • MRI: MRI (Magnetic Resonance Imaging) gives us more information about concomitant injuries such as meniscus-cartilage injuries, bore tunnel position and width, graft condition, graft failure of the plastic, concomitant instabilities (medial-external ligament, ALL; etc).
  • 3D-CT: The 3D-CT (computer tomogram) is ideal for the exact determination of the bore tunnel position and width, if this cannot be clearly assigned with MRI and X-ray.
  • X-ray of the whole leg: The X-ray in the standing position gives us information about a leg axis malposition such as bow-leg (varus) or also X-B (valgus).
  • Laboratory & Microbiological: Laboratory and microbiological examination with possible punctate examination to exclude an expired infection during the initial operation.

Treatment

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Aftercare

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FAQs

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dr tarek schlehuber
  • Specialist for orthopedics and trauma surgery in Freiburg
  • Leitender Arzt Sportorthopädie Loretto Krankenhaus

  • Certified knee surgeon of the DKG
  • Certified arthroscopist of the AGA
  • Sports doctor of the GOTS
  • Manual medicine / chiropractic
  • Team doctor Bahlinger SC / Cooperation doctor EHC
dr dan potthoff
  • Specialist in orthopedics and trauma surgery
  • Schulter- und Kniechirurgie

  • Artificial joint replacement of knee and hip joints
  • Cartilage surgery
  • Arthroscopic surgery
  • Joint wear and tear (arthrosis), sports injuries
  • Conservative orthopaedics