ORIGINAL ARTICLE   

Minerva Ortopedica e Traumatologica 2019 June;70(2):70-7

DOI: 10.23736/S0394-3410.19.03924-9

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Anterior cruciate ligament reconstruction following failed primary repair: surgical technique and a report of three cases

Jelle P. van der LIST ¹ ✉, Harmen D. VERMEIJDEN ², Robert O’BRIEN ², Gregory S. DIFELICE ²

¹ Departement of Orthopedic Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands; ² Orthopedic Sports Medicine and Trauma Service, Department of Orthopedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, NY, USA

BACKGROUND: Over the last decade, there has been a resurgence of interest in arthroscopic primary repair for patients with proximal anterior cruciate ligament (ACL) tears. This procedure is minimally invasive, quick and has few complications. Theoretically, if primary repair fails, a reconstruction procedure can still be performed, but no studies have assessed this. The goal of this study was therefore to (I) describe the surgical technique, (II) assess potential complications or technical difficulties, and (III) report the outcomes in three cases.
METHODS: In a total cohort of 90 patients treated with arthroscopic primary repair between April 2008 and April 2017, three patients were identified that underwent ACL reconstruction following failed ACL repair and had clinical examination and functional outcomes at minimum one-year follow-up. The surgical technique and cases are described.
RESULTS: Three female patients (age 17-21 years) underwent ACL reconstruction. The procedure was uncomplicated and similar to primary ACL reconstruction. At final follow-up, all patients had clinically stable knees and reported excellent functional outcomes.
CONCLUSIONS: ACL reconstruction following failed primary ACL repair is an uncomplicated procedure that is similar to primary ACL reconstruction and thus no surgical bridges for ACL reconstruction seem to be burned when performing primary ACL repair. Patients should be educated to expect a longer and more difficult rehabilitation following ACL reconstruction than following primary ACL repair based on these three cases.

KEY WORDS: Anterior cruciate ligament reconstruction; Rupture; Rehabilitation