Safran M R, Harner C D
Division of Orthopaedic Surgery, University of California, San Diego, USA.
Clin Orthop Relat Res. 1996 Apr(325):50-64. doi: 10.1097/00003086-199604000-00007.
Revision anterior cruciate ligament surgery will become more common as the number of primary anterior cruciate ligament reconstructions increases. Also contributing to this increase are those patients who had anterior cruciate ligament reconstruction using synthetic ligaments and other nonanatomic techniques that are no longer used. Preoperative planning is imperative to a successful outcome. This begins with determining the primary, and often times secondary, mechanism of failure for each patient. The determination of the etiology of failure is the first step in a carefully constructed preoperative plan, including the type of revision, skin incision, graft removal, hardware removal, tunnel placement, graft selection, graft fixation, and rehabilitation. The precise preoperative plan should have enough flexibility to accommodate unanticipated findings in the operating room. Rehabilitation protocols must be designed specifically for the revision surgery patient and be flexible enough to accommodate changes based on surgical findings and techniques. Finally, the importance of counseling the patient preoperatively regarding the potential results which, in general, are somewhat less satisfactory than with most primary reconstructions, must be emphasized. However, with proper planning, attention to detail, and adherence to basic principles of anterior cruciate ligament reconstruction, revision anterior cruciate ligament surgery can provide a satisfying solution to difficult knee instability cases.
随着初次前交叉韧带重建手术数量的增加，翻修前交叉韧带手术将会变得更加常见。那些曾使用合成韧带及其他已不再使用的非解剖技术进行前交叉韧带重建的患者，也促使了这一增长。术前规划对于成功的手术结果至关重要。这始于确定每位患者的主要（通常还有次要）失败机制。确定失败的病因是精心构建的术前计划的第一步，该计划包括翻修类型、皮肤切口、移植物取出、内植物取出、隧道定位、移植物选择、移植物固定及康复等内容。精确的术前计划应具备足够的灵活性，以应对手术室中意外发现的情况。康复方案必须专门为翻修手术患者设计，并且要有足够的灵活性，以便根据手术发现和技术进行调整。最后，必须强调术前向患者咨询潜在结果的重要性，一般来说，这些结果通常不如大多数初次重建手术那样令人满意。然而，通过适当的规划、注重细节以及遵循前交叉韧带重建的基本原则，翻修前交叉韧带手术能够为膝关节不稳定的复杂病例提供令人满意的解决方案。
