Arthroscopic ACL Reconstruction (Revision)
Arthroscopic revision ACL reconstruction is a specialized surgery performed when a previous ACL reconstruction fails, using minimally invasive techniques to restore knee stability and function.
What Is Arthroscopic Revision ACL Reconstruction?
- Definition:A second (or subsequent) surgery to reconstruct the anterior cruciate ligament (ACL) after a failed primary ACL reconstruction.
- Approach:Done arthroscopically, meaning through small incisions with a camera and instruments, which reduces tissue damage compared to open surgery.
- Complexity:More demanding than the first ACL surgery, requiring careful planning and specialized techniques.
Why Is It Needed?
Revision ACL reconstruction may be recommended if:
- Graft rupture – the ligament graft from the first surgery tears again.
- Tunnel malposition – the bone tunnels drilled in the first surgery were incorrectly placed.
- Persistent instability – the knee continues to give way during activity.
- Infection or biological failure – the graft does not heal properly.
- High activity demands – patients wishing to return to sports or physically demanding work.
The Procedure
- Preoperative planning
- Detailed imaging (X-rays, CT, MRI) to assess bone tunnels and graft condition.
- Review of the first surgery to understand why it failed.
- Arthroscopic surgery
- Small incisions are made, and an arthroscope is inserted.
- Old graft remnants and hardware are removed.
- New bone tunnels may be created if the old ones are malpositioned or widened.
- Graft choice
- Options include hamstring tendon, patellar tendon, quadriceps tendon, or donor tissue (allograft).
- Choice depends on patient age, activity level, and tissue availability.
- Fixation
- The new graft is secured with screws or fixation devices.
- Sometimes staged procedures are needed if bone healing must occur before graft placement.
Recovery and Rehabilitation
- Hospital stay: Usually same-day or overnight.
- Rehabilitation: Structured physiotherapy is essential, often longer than after primary ACL surgery.
- Return to sports: Typically 9–12 months, depending on healing and rehab progress.
- Outcome: Success rates are good, but slightly lower than primary ACL reconstruction due to complexity.
Key Message for Patients
Arthroscopic revision ACL reconstruction is a safe but technically demanding procedure designed to restore knee stability when the first ACL surgery fails. With careful planning, appropriate graft choice, and dedicated rehabilitation, many patients can return to sports and active lifestyles, though recovery may take longer than the initial surgery.
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