I Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Via G.C. Pupilli 1, Bologna 40100, Italy.
Am J Sports Med. 2013 Feb;41(2):402-10. doi: 10.1177/0363546512471025. Epub 2013 Jan 4.
Multiple-revision anterior cruciate ligament (ACL) reconstructions represent a surgical challenge due to the presence of previous tunnels, hardware, injuries to the secondary stabilizers, and difficulties in retrieving autologous tendons. An anatomic ACL reconstruction may therefore result in a demanding surgery, thus requiring 2 stages.
To analyze the efficacy of an over-the-top ACL reconstruction technique plus extra-articular plasty using Achilles or tibialis posterior tendon allograft in restoring knee stability in patients with at least 2 failed previous ACL reconstructions, as well as to evaluate the factors able to affect the final outcome.
Case series; Level of evidence, 4.
From 2002 to 2008, 24 male athletes with a mean age of 30.8 years underwent surgery. Twenty patients had undergone 2, whereas 4 patients had undergone 3 previous reconstructions. The International Knee Documentation Committee (IKDC) score and KT-2000 arthrometric evaluation were used to measure outcomes at a mean follow-up period of 3.3 years (range, 2-7).
The mean ± SD IKDC subjective score at follow-up was 81.3 ± 14.0. The IKDC objective score was an A or B in 20 patients (83%). Arthrometer side-to-side difference averaged 3.1 ± 1.1 mm. Range of motion was normal or nearly normal in 23 patients and abnormal in 1. Of the 20 good results, 17 patients resumed sports activity at the preinjury level.
A 2-stage revision is an accepted option in cases of excessive tunnel enlargement and bone loss, especially on the femoral side, to achieve anatomic reconstruction. Nonanatomic over-the-top ACL reconstruction and lateral extra-articular plasty technique allow one to overcome difficult anatomic situations on the femoral side, permitting a 1-step surgery. The overall results obtained in this series are comparable with those of other ACL revision series. The higher rate of mild instability observed in our series may not be attributable to the surgical technique but rather to the chronic instability suffered by these knees before last revision.
由于存在先前的隧道、硬件、对次要稳定器的损伤以及自体肌腱取出困难等问题，多次 Revision 前交叉韧带（ACL）重建术代表了一项手术挑战。因此，解剖学 ACL 重建术可能导致手术要求较高，需要 2 个阶段。
分析经顶置（over-the-top）ACL 重建技术联合使用跟腱或胫骨后肌腱同种异体移植物进行关节外成形术，以恢复至少 2 次失败的前交叉韧带重建术患者膝关节稳定性的效果，并评估能够影响最终结果的因素。
病例系列；证据等级，4 级。
2002 年至 2008 年，24 名男性运动员平均年龄 30.8 岁接受了手术。20 名患者接受了 2 次，4 名患者接受了 3 次。使用国际膝关节文献委员会（IKDC）评分和 KT-2000 关节测量评估来测量平均随访 3.3 年（范围，2-7 年）后的结果。
随访时平均（±SD）IKDC 主观评分 81.3±14.0。20 名患者的 IKDC 客观评分均为 A 或 B（83%）。关节测径仪的侧-侧差值平均为 3.1±1.1mm。23 名患者的关节活动度正常或接近正常，1 名患者异常。20 个良好结果中，17 名患者恢复了受伤前的运动水平。
在隧道扩大和骨质丢失过多，尤其是股骨侧的情况下，2 期 Revision 是一种可接受的选择，以实现解剖重建。非解剖学经顶置 ACL 重建和外侧关节外成形术技术允许克服股骨侧的困难解剖情况，实现 1 步手术。本系列获得的总体结果与其他 ACL Revision 系列相当。我们系列中观察到的轻度不稳定发生率较高，可能不是由于手术技术，而是由于这些膝关节在最后一次 Revision 前经历了慢性不稳定。
