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Bob's ACL WWWBoard
Re: Question on Different ACL Surgeries
Posted By: SueBW
Date: Saturday, 23 August 2008, at 4:40 p.m.
In Response To: Question on Different ACL Surgeries (Holly)
> I am scheduled for my second ACL reconstruction on my right
> knee on September 2nd. My previous doctor used the
> hamstring graft back in 2000. This time (with a new doctor)
> it will be an Allograph (sp?). Is it possible that my
> previous doctor didn't do a good surgery? I just went in
> for a second opinion because I didn't like the way my
> previous OS discussed the results of the MRI. I have read
> that second surgeries are not always successful and am
> afraid I will be worse off than I am now. Has anyone else
> been in my situation? If so, please share your story and
> ease my mind. THANK YOU!
Holly,
We have information on our web site regarding revision ACL reconstruction (http://www.cincinnatisportsmed.com/csmref/index.asp?ipath=../csm/patedu/knee/aclpclrevisions.htm)
and have written a course on this problem for the Knee Guru site (http://www.kneeguru.co.uk/KNEEnotes/node/155). In addition, we've published several articles on the use of a variety of graft sources for this operation. If you are interested in reading these, I'm happy to e-mail these via PDF file format.
Our studies, and those of other Centers, have found a higher rate of ACL revision graft failure with allografts compared to PT or quadriceps tendon autografts. Just as important is the analysis of the causes of ACL reconstruction failure - unfortunately, surgeon error in graft placement is near the top of the list. Other common causes are uncorrected varus malalignment (bowed legs) and deficiency of other knee ligaments (PCL, MCL, LCL/posterolateral) that was left untreated.
You are correct in that the results of revision ACL reconstruction are not as predictable as those of primary procedures. Usually, ACL revision knees have compounding problems such as pre-existing joint arthritis, prior meniscectomy, muscle weakness, etc. that negatively effect the outcome. In addition, the ability to restore stability to the knee worsens with each ACL procedure. Therefore, it is extremely important to ensure that your surgeon is well-experienced with ACL revision procedures and that he/she has documented that there are no other problems with your knee/lower limb that might have caused the previous graft failure.
If your new surgeon believes that poor graft placement was the cause of the failure, find out the method to be used to fix this problem. Can new femoral and tibial tunnels be drilled? How close would they be to the existing tunnels? Will the prior fixation devices be removed? And what is the rehab protocol? How long will it be before you can return to your desired activities? The more informed you are going in, the better you will feel. Good luck,
SueBW
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