Simultaneous Bilateral Anterior Cruciate Ligament Revision Reconstruction

There are limited studies in the literature regarding the reconstruction of bilateral anterior cruciate ligament (ACL) injuries in a single-stage setting. However, there have been no published studies describing simultaneous revision reconstructions of previously reconstructed bilateral ACLs. We present the case of a 37-year-old male who underwent previous reconstruction of both ACLs at an outside hospital and presented to our outpatient clinic with instability and pain. Simultaneous bilateral ACL revision reconstruction was performed with the use of tibialis anterior allografts. This case report suggests that single-stage bilateral ACL revision reconstruction is a safe procedure that can provide good results for the patient.

Association between previous meniscal surgery and the incidence of chondral lesions at revision anterior cruciate ligament reconstruction

BACKGROUND

Knees undergoing revision anterior cruciate ligament (ACL) reconstruction typically have more intra-articular injuries than do knees undergoing primary reconstruction.

HYPOTHESIS

Previous partial meniscectomy (PM) is associated with a higher rate of chondral lesions at revision ACL reconstruction, whereas previous meniscal repair (MR) is not associated with a higher rate of chondral lesions at revision ACL reconstruction, compared with knees undergoing revision ACL with no previous meniscal surgery.

STUDY DESIGN

Cohort study (Prevalence); Level of evidence, 2.

METHODS

Data from a multicenter cohort was reviewed to determine the history of prior meniscal surgery (PM/MR) and the presence of grade II/III/IV chondral lesions at revision ACL reconstruction. The association between previous meniscal surgery and the incidence of chondral lesions was examined. Patient age was included as a covariate to determine if surgery type contributes predictive information independent of patient age.

RESULTS

The cohort included 725 ACL revision surgeries. Chondrosis was associated with patient age (P < .0001) and previous meniscal surgery (P < .0001). After adjusting for patient age, knees with previous PM were more likely to have chondrosis than knees with previous MR (P = .003) or no previous meniscal surgery (P < .0001). There was no difference between knees without previous meniscal surgery and knees with previous MR (P = .7). Previous partial meniscectomy was associated with a higher rate of chondrosis in the same compartment compared with knees without previous meniscal surgery (P < .0001) and knees with previous MR (P ≤ .03).

CONCLUSION

The status of articular cartilage at the time of revision ACL reconstruction relates to previous meniscal surgery independent of the effect of patient age. Previous partial meniscectomy is associated with a higher incidence of articular cartilage lesions, whereas previous meniscal repair is not. Although this association may reflect underlying differences in the knee at the time of prior surgery, it does suggest that meniscal repair is preferable when possible at the time of ACL reconstruction.