ACL Revision Surgery
ACL revision surgery is a procedure to correct a previous ACL reconstruction. While ACL reconstruction is highly successful (80-90%), there are on occasion circumstances when a revision surgery is needed, even when reconstruction was successful.
As many as 8% of patients who have had an ACL reconstruction will undergo a subsequent revision procedure. Many patients know something is wrong when they experience instability and other symptoms. In fact, the symptoms of a failure often mimic the symptoms that led to the ACL reconstruction. Pain may indicate cartilage or meniscus damage.
The purpose of revision surgery is to improve knee function, correct instability and allow the patient to return to their activities.
What causes the need for revision surgery?
ACL reconstruction surgery is complex requiring exceptional experience and technical expertise. Circumstances that could indicate the need for revision surgery include but are not limited to reinjury of the ACL, an unsatisfactory outcome (poor graft healing and other problems), overly aggressive rehabilitation and poor surgical technique.
- Technical errors involve improper surgical technique and mistakes. When reconstruction fails within the first six months after surgery, it is usually due to technical errors. Additionally, technique related errors are also the most common cause of instability after reconstruction.
- Biological failures may mean the type of graft used for reconstruction failed, allograft rejection, untreated preexisting meniscus deficiency, status of the articular cartilage and collateral ligaments, a partial meniscectomy that increases stress on the ACL graft, infection, hardware complications or a combination of factors.
- Returning to sports too soon can reinjure the ACL graft. Non-contact trauma that reinjures the knee and the ACL is a common reason for revision surgery.
When is an ACL revision recommended?
When a patient has completed reconstruction surgery and rehabilitation and continues to experience instability and other symptoms; or symptoms reoccur, revision surgery may be recommended.
What to consider when deciding whether to have revision surgery?
A successful ACL revision surgery depends on a methodical approach to identify and correct all potential causes of failure. Each case requires individual appraisal and accurate preoperative planning.
Dr. Godin must investigate and evaluate the causes of failure. He will request the records and imaging studies from the failed reconstruction and order new imaging studies. He will evaluate all the evidence to determine the best course of action for each patient. This will help Dr. Godin will develop a precise preoperative plan, vital to the success of revision surgery.
What is the procedure for revision?
It depends on the cause of the failure of the previous surgery. Revision surgery will also be performed arthroscopically. During arthroscopy Dr. Godin will be able to examine the inside of the knee and identify problems such as a failed meniscus repair, bony problems, and technical deficiencies; and repair in cumulative staged procedures.
Revision is substantially more challenging than ACL reconstruction. There is no single standard revision procedure. Because of its complexity, ACL revision surgery may be performed in stages. Revision surgery is successful about 75-80% of the time.
Dr. Godin and his team will develop a Post-op rehabilitation plan based on a number of variables personal to each patient. Rehab is begun almost immediately after surgery to control pain and swelling.
Dr. Jonathan Godin has the scientific and technical expertise and experience to help you get back to the life you love. Contact The Steadman Clinic to schedule a consultation with Dr. Godin today.