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Guo J, Zhang P, Lv M, Chen P, Li C, Jiang X, Zhang X. Over-the-Top Double-Bundle Revision Anterior Cruciate Ligament Reconstruction Technique With Hybrid Hamstring Tendon Autograft-Allograft and Associated Lateral Extra-articular Tenodesis. Arthrosc Tech 2024; 13:102944. [PMID: 38835449 PMCID: PMC11144845 DOI: 10.1016/j.eats.2024.102944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/31/2023] [Indexed: 06/06/2024] Open
Abstract
Revision anterior cruciate ligament (ACL) presents many technical challenges that are not commonly seen in primary ACL reconstruction. The purpose of this article is to describe an alternative technique consisting of over-the-top double-bundle ACL revision combined with lateral extra-articular tenodesis using hybrid hamstring tendon autograft-allograft. This technique provides a valid treatment option in ACL revision surgery.
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Affiliation(s)
- Jiang Guo
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Shenzhen City, China
| | - Peng Zhang
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Shenzhen City, China
| | - Maojiang Lv
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Shenzhen City, China
| | - Peng Chen
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Shenzhen City, China
| | - Canfeng Li
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Shenzhen City, China
| | - Xiaocheng Jiang
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Shenzhen City, China
| | - Xintao Zhang
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Shenzhen City, China
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Macchiarola L, Pizza N, Patania V, Grassi A, Dal Fabbro G, Marcacci M, Zaffagnini S. Double-bundle non-anatomic ACL revision reconstruction with allograft resulted in a low revision rate at 10 years. Knee Surg Sports Traumatol Arthrosc 2023; 31:340-348. [PMID: 36070000 DOI: 10.1007/s00167-022-07151-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/30/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE This study aimed at reporting the long-term second revision rate and subjective clinical outcomes from a cohort of patients who underwent a double-bundle (DB) ACLR first revision with allograft at a single institution. METHODS The Institutional database was searched according to the following inclusion criteria: (1) patients that underwent DB-ACL first revision with Achilles tendon allograft, (2) surgery performed between January 2000 and December 2012, (3) age at revision ≥ 18 y/o. Patients' general information, history, surgical data, and personal contacts were extracted from charts. An online survey platform was implemented to collect responses via email. The survey questions included: date of surgeries, surgical data, date of graft failure and subsequent second ACL revision surgery, any other surgery of the index knee, contralateral ACLR, KOOS score, and Tegner scores. RESULTS Eighty-one patients were included in the survival analysis, mean age at revision 32 ± 9.2 y/o, 71 males, mean BMI 24.7 ± 2.7, mean time from ACL to revision 6.8 ± 5.4 years, mean follow-up time 10.7 ± 1.4 years. There were 12 (15%) second ACL revisions during the follow-up period, three females and nine males, at a mean of 4.5 ± 3 years after the index surgery. The overall survival rates were 85% from a second ACL revision and 68% from all reoperations of the index knee. Considering only the successful procedures (61 patients), at final follow-up, the mean values for the KOOS subscales were 84 ± 15.5 for Pain, 88.1 ± 13.6 for Symptoms, 93 ± 11.6 for ADL, 75 ± 24.5 for Sport, and 71 ± 19.6 for Qol. Twenty-nine (48%) patients performed sports activity at the same level as before ACLR failure. CONCLUSIONS Double-bundle ACL revision with fresh-frozen Achilles allograft yields satisfactory results at long-term follow-up, with an 85% survival rate from a second ACL revision at mean 10 years' follow-up and good patient-reported clinical scores. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Luca Macchiarola
- Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy. .,Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Foggia (FG), Viale Luigi Pinto, 1, 71122, Foggia, Italy.
| | - Nicola Pizza
- Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy
| | - Vittorio Patania
- Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy
| | - Alberto Grassi
- Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy
| | - Giacomo Dal Fabbro
- Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy
| | - Maurilio Marcacci
- Humanitas Clinical and Research Center, Rozzano (MI), Via Alessandro Manzoni, 56, 20089, Italy
| | - Stefano Zaffagnini
- Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy
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[Research progress of anterior cruciate ligament reconstruction with over-the-top technique]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1166-1171. [PMID: 36111481 PMCID: PMC9626294 DOI: 10.7507/1002-1892.202203097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To review the research progress regarding the over-the-top technique for anterior cruciate ligament (ACL) reconstruction. METHODS The relevant literature on ACL reconstruction using the over-the-top technique was analyzed for its evolution, clinical application, advantages, and limitations. RESULTS Over-the-top technique for ACL reconstruction is a combined intra- and extra-articular technique. Because it avoids drilling the femoral tunnel, its advantages are mainly highlighted in the protection of the femur. Therefore, it is widely used in children and adolescents with epiphyseal occlusion and in patients with revision reconstruction. In addition, significant improvements in postoperative joint stability, functional scores, and return to exercise rates are found in long-term follow-up studies of patients with primary ACL reconstruction and combined anterolateral tenodesis. However, the technique also has some limitations, such as poor stability of knee flexion after operation, high requirement for graft length, and easy impact of graft in the intercondylar fossa. CONCLUSION The current research results show the effectiveness and safety of the over-the-top technique for primary and revision ACL reconstruction, with the advantages of wide application, simple operation, and quick recovery; however, more researches are needed to further optimize the selection of grafts and femoral condyle management problems, and to clarify the long-term effectiveness.
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Editorial Commentary: Bone Tunnel Grafting for Two-Stage Anterior Cruciate Ligament Revision and the Meaning of Life for an Arthroscopic Surgeon. Arthroscopy 2020; 36:186-188. [PMID: 31864575 DOI: 10.1016/j.arthro.2019.09.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 02/02/2023]
Abstract
Accurate bone tunnel filling in a 2-staged anterior cruciate ligament revision is indubitably fundamental for a successful outcome. Bone autograft is commonly employed and it is usually harvested from the iliac crest: this requires longer surgical time, and donor-site morbidity following bone harvest is a well-known problem. Therefore, strategies to minimize or abolish it have been attempted: the use of allografts may seem promising, but their use is associated with high costs and strict regulatory limitations. Bony substitutes instead represent a new and potentially effective solution: they could help surgeons to fill bone tunnels in an easier and faster way that elicits satisfactory lamellar bone formation within the tunnels, and their use is associated with fewer postoperative complications, such as pain and local hematoma. Evidence from literature suggests that this approach could provide significant advantages over traditional autograft harvesting, with comparable outcomes in terms of bone formation and integration, allowing a correct tunnel placement during revision surgery.
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Meniscal allograft transplantation combined with anterior cruciate ligament reconstruction provides good mid-term clinical outcome. Knee Surg Sports Traumatol Arthrosc 2019; 27:1914-1923. [PMID: 30083970 DOI: 10.1007/s00167-018-5078-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 07/23/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE Aim of this study is to document if combined meniscal allograft transplantation (MAT) and ACL reconstruction can improve knee function, reduce pain and allow patients with meniscal defect and ACL lesion to resume sport activities. METHODS Fifty MAT, arthroscopically performed without bone plugs and combined with one-stage primary or revision ACL reconstruction, with or without high tibial osteotomy (HTO), were included. Patients (aged 38.2 ± 10.6 years, 87% males) were evaluated at a mean follow-up of 5 years with Lysholm, Tegner and VAS scores. Patient satisfaction was also recorded, together with complications and failures. RESULTS VAS and Lysholm scores improved significantly (from 63.7 to 24.5 and from 60.6 to 82.7, respectively, p < 0.001), while the Tegner score did not reach pre-injury values (p < 0.001), but it improved significantly compared to pre-surgery values (from 2.8 to 4.6, p < 0.001). Medial MAT reported significantly better results compared to lateral MAT. Patients undergoing concomitant HTO reported a significantly higher decrease of VAS. Younger patients with higher pre-operative pain and lower activity level presented higher satisfaction. Eight patients needed a reoperation. Three patients were considered surgical failures while four were considered clinical failures, for a total of 15% failures. CONCLUSIONS Meniscal allograft transplantation combined with ACL reconstruction represents a safe and suitable treatment, which should be considered as a suitable option in the clinical practice. All evaluated patient profiles, ACL injury in a patient with post-meniscectomy syndrome, failed ACL reconstruction in patients with a meniscus defect, and ACL reconstruction in patients with malalignment due to meniscal defect, benefited from the combined MAT procedure at medium-term follow-up. LEVEL OF EVIDENCE IV.
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Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, Roberti Di Sarsina T, Macchiarola L, Mosca M, Neri MP, Marcacci M. Anterior cruciate ligament revision with Achilles tendon allograft in young athletes. Orthop Traumatol Surg Res 2018; 104:209-215. [PMID: 29032309 DOI: 10.1016/j.otsr.2017.09.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 09/22/2017] [Accepted: 09/25/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Return to sport after revision ACL reconstruction is a controversial topic, several studies reported the results of different techniques and graft in sportsman, presenting an incredibly wide range of return to the same pre-injury activity level, from 0% to 100%. The purpose of this study was to evaluate the clinical outcomes and return to sport rate in young athletes after non anatomic double-bundle revision ACL reconstruction with Achilles allograft. HYPOTHESIS The present revision technique was effective in terms of stability, return to sport and functional outcomes. MATERIAL AND METHODS All the athletes undergone Revision ACL reconstruction with non-irradiated Achilles tendon allograft with a non-anatomical double-bundle technique were included in the study. A split Achilles tendon allograft was used to reproduce the anteromedial (AM) bundle using the over-the-top position, while the posterolateral (PL) bundle was reconstructed through a femoral tunnel located in the anatomical PL footprint. Sport activity, knee function with Lysholm score, knee laxity and re-injury or re-operations were evaluated. RESULTS Twenty-six athletes (23 males, three females) with a mean age of 23.4±3.6 years were evaluated at a mean follow-up of 6.0±1.6 years. Overall 69% of patients returned to sport both at elite (44%) or county level (56%) after a mean 6.7±1.5 (3-9 range) months. The mean Lysholm score showed a significant improvement from 64.4±8.1 at pre-operative status to 83.8±11.3 at final follow-up (P<.0001). Seven patients (30%) were rated as excellent, nine (39%) as good, five (22%) as fair and 2 (9%) as poor. Three patients (12%) experienced a further graft rupture after a mean 2.6 years, (3.5 months-48 months range) and two had >5mm side-to-side difference at KT-1000. Therefore, the overall survival rate at mean six years follow-up was 81%. CONCLUSION The ACL revision with a double-bundle technique using Achilles tendon allograft was successful in 81% of athletes at six years mean follow-up. TYPE OF STUDY AND LEVEL OF EVIDENCE Retrospective case series, level IV.
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Affiliation(s)
- S Zaffagnini
- II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - A Grassi
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, 40136 Bologna, Italy.
| | - G M Marcheggiani Muccioli
- II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - T Roberti Di Sarsina
- II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - L Macchiarola
- II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - M Mosca
- II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - M P Neri
- II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
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Zaffagnini S, Roberti di Sarsina T, Bonanzinga T, Nitri M, Macchiarola L, Stefanelli F, Lucidi G, Grassi A. Does Donor Age of Nonirradiated Achilles Tendon Allograft Influence Mid-Term Results of Revision ACL Reconstruction? JOINTS 2018; 6:10-15. [PMID: 29675501 PMCID: PMC5906117 DOI: 10.1055/s-0038-1626739] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 01/02/2018] [Indexed: 01/25/2023]
Abstract
Purpose
The purpose of the present study was to investigate if the donor age of nonirradiated Achilles tendon allograft could influence the clinical results of revision anterior cruciate ligament (ACL) reconstruction.
Methods
All patients that underwent ACL revision between 2004 and 2008 with at least 4 years of follow-up were included. For all the patients that met the inclusion criteria, the age of the graft donor was obtained from the tissue bank. Lysholm score was administered to patients that met inclusion criteria. In addition, patients were divided in two groups based on the donor age (<45 years vs. ≥45 years), and the baseline characteristics and outcomes were compared.
Results
Fifty-two patients were evaluated at a mean 4.8 ± 0.8 years follow-up with Lysholm score. The Lysholm significantly improved from 62.3 ± 6.6 at preoperative status to 84.4 ± 12.3 at final follow-up. The mean donor age was 48.7 ± 8.4 years; a significant difference in Lysholm score was noted between patients that received an allograft with a donor age <45 years (14 patients; 27%) and those receiving an allograft with a donor age ≥45 years (38; 73%) (89.5 ± 3.2 vs. 80.1 ± 11.1, respectively;
p
= 0.0469). The multiple regression model showed the donor age, the final follow-up, and the preoperative Lysholm score as significant predictors of postoperative Lysholm score (
p
< 0.0002).
Conclusion
Donor age of nonirradiated Achilles tendon allograft influenced the mid-term results of revision ACL reconstruction, thus advising the use of grafts from young donors.
Level of Evidence
Level III, retrospective comparative study.
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Affiliation(s)
- Stefano Zaffagnini
- II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Bologna, Italy.,Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Tommaso Roberti di Sarsina
- II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Bologna, Italy.,Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Tommaso Bonanzinga
- II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Bologna, Italy.,Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Nitri
- II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Bologna, Italy.,Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Macchiarola
- II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Bologna, Italy.,Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Federico Stefanelli
- II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Bologna, Italy.,Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gianandrea Lucidi
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Grassi
- II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Bologna, Italy.,Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy
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Hofbauer M, Murawski CD, Muller B, van Eck CF, Fu FH. Revision surgery after primary double-bundle ACL reconstruction: AAOS exhibit selection. J Bone Joint Surg Am 2014; 96:e30. [PMID: 24553899 DOI: 10.2106/jbjs.m.01038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Marcus Hofbauer
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Kaufmann Medical Building, Suite 1011, Pittsburgh, PA 15213. E-mail address for F.H. Fu:
| | - Christopher D Murawski
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Kaufmann Medical Building, Suite 1011, Pittsburgh, PA 15213. E-mail address for F.H. Fu:
| | - Bart Muller
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Kaufmann Medical Building, Suite 1011, Pittsburgh, PA 15213. E-mail address for F.H. Fu:
| | - Carola F van Eck
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Kaufmann Medical Building, Suite 1011, Pittsburgh, PA 15213. E-mail address for F.H. Fu:
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Kaufmann Medical Building, Suite 1011, Pittsburgh, PA 15213. E-mail address for F.H. Fu:
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Strategies for revision surgery after primary double-bundle anterior cruciate ligament (ACL) reconstruction. Knee Surg Sports Traumatol Arthrosc 2013; 21:2072-80. [PMID: 23579225 DOI: 10.1007/s00167-013-2470-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 02/26/2013] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of this article was to discuss pre- and intra-operative considerations as well as surgical strategies for different femoral and tibial tunnel scenarios in revision surgery following primary double-bundle anterior cruciate ligament (ACL) reconstruction. METHODS Based on the current literature of ACL revision surgery and surgical experience, an algorithm for revision surgery after primary double-bundle ACL reconstruction was created. RESULTS A guideline and flowchart were created using a case-based approached for revision surgery after primary double-bundle ACL reconstruction. CONCLUSION Revision surgery after primary double-bundle ACL reconstruction can be a challenging procedure that requires flexibility and a repertoire of surgical techniques. The combination of pre-operative planning with 3D-CT reconstruction, in addition to careful intra-operative assessment, and the use of this flowchart can simplify the ACL revision procedure. LEVEL OF EVIDENCE V.
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