Revision ACL Reconstruction

Diagnosis

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Clinical examination can reveal laxity in patients with ACL retear. However, confirming partial or complete tear by examination can be difficult. Often the knee may not be swollen like it does in primary tear. 

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MRI Scan. MRI Scan is an important investigation, however the MRI images may not always give a clear picture due to artifacts post surgery. A 3 Tesla MRI scan is often better than 1.5 Tesla MRI scan in identifying the ACL retear. In addition, it is important to assess the condition of the meniscus (cushions in the knee joint), cartilage and other ligaments. 

 

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Treatment

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ACL Revision Prehabilitation

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ACL Prehab exercises can be started once the pain and swelling improve. These exercises help in regaining the knee movements and keep the muscles in a good condition.

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Revision ACL Reconstruction

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Revision ACL reconstruction is a bigger procedure than the primary ACL surgery. When considering revision surgery, it is important to take the position of the tunnels, bone quality around the tunnels, rest of the joint structures integrity need to be taken into account. Based on these parameters a decision will have to be taken as to whether the surgery will be single stage or two stage procedure. If there is a lot of bone loss, then first stage of the surgery to perform bone grafting and second stage is to do the reconstruction. In patients needing a 2 stage procedure a gap of 3 to 6 months between the 2 procedures is needed for bone healing. 

 

Next concern is regarding the type of graft to be chosen for this. As the first surgery may have utilised either hamstrings or patellar tendon (BTB or Bone tendon bone) for graft, the graft material will have to be carefully chosen. The tendon thickness and tendon alone or bone tendon bone graft matters. Usually quadriceps tendon from thigh or the peroneus longus tendon from the leg is utilised for this. 

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Thirdly, additional joint problems such as cartilage loss and / or meniscal tears if present, needs pre planning in terms of type of chondroplasty and meniscal repair techniques for the treatment. 

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Revision ACL Rehabilitation

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Post-surgery, you are allowed to walk on the next day. If meniscus is intact and only revision ACL reconstruction surgery has been performed, then you are allowed to walk with full weight on the leg. Initial one to three weeks you may need the support of a walker. Within 2 weeks most people manage to walk without support. Physiotherapy exercises start early. In the first 6 weeks the focus is mainly on getting the full ROM and help regain the muscle strength. The whole rehabilitation process will take about 9 to 12 months before returning back to playing sports on the ground or court.

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