Ansari Mohammad Humza, Claes Steven, Wascher Daniel C, Neyret Philippe, Stuart Michael J, Krych Aaron J
Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota.
Instr Course Lect. 2017 Feb 15;66:543-556.
Primary anterior cruciate ligament (ACL) reconstruction is a common orthopaedic procedure. A graft failure rate of 5% to 10% after primary ACL reconstruction has resulted in an increased need for revision ACL reconstruction. ACL reconstruction failure etiologies include trauma, technical errors, and biologic factors. Based on the current literature, the outcomes of revision ACL reconstruction are clearly inferior compared with those of primary reconstruction. A thorough patient evaluation, including surgical history, a physical examination, and imaging studies, is crucial in the assessment of a failed ACL reconstruction. Tunnel malposition, which is a technical error, is the most common reason for ACL reconstruction failure. Tunnel positioning and widening are important factors to consider in the decision to perform either one-stage or two-stage revision ACL reconstruction. Other concomitant factors such as malalignment, pathologic posterior tibial slope, and meniscal or ligamentous deficiency (in particular, deficiency of the anterolateral ligament) must be considered and addressed to achieve an optimal outcome. Patients who have a positive pivot shift test and rotational instability may require extra-articular anterolateral ligament reconstruction. In addition, patients who have severe pathologic tibial slope and anterior tibial translation may require a tibial deflexion osteotomy.
初次前交叉韧带（ACL）重建是一种常见的骨科手术。初次ACL重建后5%至10%的移植物失败率导致了翻修ACL重建需求的增加。ACL重建失败的病因包括创伤、技术失误和生物学因素。根据当前文献，与初次重建相比，翻修ACL重建的结果明显较差。全面的患者评估，包括手术史、体格检查和影像学检查，对于评估失败的ACL重建至关重要。隧道位置不当作为一种技术失误，是ACL重建失败的最常见原因。在决定进行一期或二期翻修ACL重建时，隧道位置和扩大是需要考虑的重要因素。其他伴随因素，如对线不良、病理性胫骨后倾以及半月板或韧带缺损（特别是前外侧韧带缺损），必须加以考虑并解决，以获得最佳结果。前抽屉试验阳性且存在旋转不稳定的患者可能需要进行关节外前外侧韧带重建。此外，患有严重病理性胫骨后倾和胫骨前移的患者可能需要进行胫骨后倾截骨术。
