1. Revision ACL Reconstruction
Dr Mbugua Francis
Orthopedic Surgeon
AIC CURE International Hospital

2. Introduction
The anterior cruciate ligament (ACL) is an important stabilizing ligament of the knee that is frequently injured by athletes and trauma victims.
It is the most common injured ligament of the knee in both contact and non-contact situations.
Kenya is a sporting nation and sports injuries are increasingly becoming a big part of the orthopedic care that we are facing.
With a growing interest in ACL reconstructions, Recurrent ACL rupture is becoming a big concern for patients and surgeons

3. What we do We perform ACL reconstructions for What we use
All sportsmen
All young patients
All patients with symptomatic instability regardless of age
Older patients without osteoarthritis
What we use
Autograft tissue – both BTB and hamstring
Younger high demand pts – BTB
All others - Hamstring

4. Method
We performed a retrospective review of patients who underwent a revision ACL reconstruction over a 4-year period.
Variables we looked;
Mechanism of re-injury
Associated injuries
Initial graft choice vs revision graft choice
Rehabilitation period and return to previous level of activity.
Complication rate

5. Results Number of ACL reconstructions – 124pts
No. of Revision ACLs – 10.6% (13)
Primary surgery
BTB – 38.5 % (5)
Hamstring – 61.5% (8)
Patients referred from elsewhere – 84.6% (11)

6. Results Mechanism of Re-injury Techniques Fixation Method
Clear mechanism – 30.8% (4)
Unclear – 69.2% (9)
Techniques
Tendon choice;
BTB – 38.5% (5)
Ipsilateral Hamstring – 38.5% (5)
Contra-lateral hamstring – 23% (3)
Fixation Method
Interference screws – 76.9% (10)
Dual fixation(screws, button, staples) – 23.1 % (3)

7. Results Intra-op findings Tunnel Malpositioning – 76.9% (10)
Femoral tunnel commonest
Associated pathology
Meniscus tears – 30.8% (4)
Chondral lesions – 38.5% (5)
Arthrofibrosis – 23.1% (3)
Return to pre-injury level of activity(no sports) – 76.9% (10)

9. Pre-op planning Multiligamentous injury – 0%
Xrays – 100% - no angular deformities
CT Scan – 23.1 % (3)
MRI – 100%

10. Rehab Hinged unlocked knee brace – 2 weeks
Crutches(Partial weight bearing as tolerated) – 2 weeks
Full weight bearing and off brace when have quad control
ROM – as tolerated
Running – 4 months
Return to sports – 6-9mths

11. Key considerations
Cause of failure – Mechanism of re-injury, pre-op eval, intra-op findings
Concomitant pathology
Tunnel position
Previous hardware
Graft choice and fixation
Early Rehab
One Stage vs 2 stage procedure?