AANA25 Knee Access Pass-CONCURRENT SESSION 2G: Revision ACL

Video Transcription

Video Summary

This comprehensive discussion on revision anterior cruciate ligament (ACL) reconstruction emphasizes the complexity of treating athletes, especially high-risk adolescent and collegiate individuals returning to pivoting sports. Dr. Cassandra Lee introduces cases highlighting multifactorial causes of ACL graft failures, including mechanical errors like femoral tunnel malposition, biologic factors, and patient-specific issues such as mental state and biomechanics. Revision outcomes worsen with multiple surgeries; thus, understanding root causes is crucial.<br /><br />Key considerations include graft choice—favoring autografts over allografts for revisions—meniscal preservation, alignment (coronal and sagittal), tunnel placement, and addressing posterior tibial slope, which is linked to increased graft strain and failure risk, especially above 12 degrees. Dr. Travis Decker underscores the significance of correcting coronal plane deformities through proximal tibial osteotomies, noting their contribution to reducing ACL graft strain and improving stability, with single-stage corrections becoming more feasible due to advances in instrumentation. Dr. David Tennant focuses on posterior tibial slope measurement variability and the critical role of slope correction in revision scenarios to restore knee biomechanics and reduce failure risks.<br /><br />Dr. Mike Sikile synthesizes these factors, underscoring the powerful role of osteotomies in reducing graft forces, contrasting them with lateral extra-articular tenodesis (LET), and emphasizing the need for careful patient selection, staged versus simultaneous surgeries, and rehabilitation planning. The debate between one-stage versus two-stage revisions centers on tunnel quality: one-stage favored for adequate tunnels, two-stage preferred for widened (>12mm) or malpositioned tunnels to optimize outcomes and lower failure rates.<br /><br />Overall, thorough preoperative assessment—including imaging and mechanical alignment—patient counseling on realistic expectations, and individualized surgical strategies remain paramount. The panel advocates prioritizing precise initial surgery to minimize revision risks and tailoring interventions to optimize mechanical and biologic environments for durable knee stability and function.

Asset Caption

Moderator: Cassandra A. Lee, M.D.
Travis J. Dekker, M.D., FAANA | David J. Tennent, M.D. | Michael A. Zacchili, M.D. | Katherine J. Coyner, M.D., M.B.A. | Eric C. McCarty, M.D.

Keywords

revision ACL reconstruction

anterior cruciate ligament graft failure

femoral tunnel malposition

autograft versus allograft

meniscal preservation

posterior tibial slope correction

proximal tibial osteotomy

lateral extra-articular tenodesis (LET)

one-stage versus two-stage revision

preoperative assessment and patient counseling