What are some of the considerations for revision (redo) ACL reconstruction?
A revision ACL reconstruction procedure is usually indicated in those who continue to have clinical instability of the knee, significant pain, or difficulty with range of motion of the knee after having a prior ACL reconstruction procedure. Other patients may be indicated for a revision ACL reconstruction due to re-rupture which is more commonly seen in active younger patients. Many patients who have re-rupture can be treated without surgery, but discussion must include patient goals for the level of activity they would like to return to. A thorough physical exam in clinic will be performed to examine the stability of the knee and the function of the ACL. This helps to determine whether reconstruction is worthwhile and guides the type of graft to use in the procedure. Additional radiographic imaging is needed to evaluate the previous ACL reconstruction graft and tunnels from the previous operation.
Revision reconstruction can be performed as either a one or two stage procedure according to the preoperative examinations. If it is determined that a previous tunnel is not in the right orientation or there is tunnel enlargement which may interfere with the new tunnel during revision surgery, a two-stage procedure can be considered. The tunnels will be filled with a bone graft during the first stage procedure and a reconstruction be performed during the second stage. Patients should expect to be in a hinged knee brace with the knee completely extended for about 4-6 weeks after surgery during walking. Patients should also expect a delayed return to high intensity activity at around 9-12 months following the revision surgery to ensure adequate healing time.