Surgical Considerations in Revision ACL Reconstruction (AANA19)-How To Manage Concomitant Pathology Related to Alignment and Meniscus Insufficiency-Dr. Cory Edgar, M.D.

How To Manage Concomitant Pathology Related to Alignment and Meniscus Insufficiency-Dr. Cory Edgar, M.D.

Video Transcription

Video Summary

The speaker discusses managing failed ACL reconstructions, emphasizing the importance of addressing lower extremity alignment issues like valgus/varus deformities and tibial slope, which increase graft strain and risk of failure. Correcting malalignment, often via high tibial osteotomy, can improve outcomes. The medial meniscus plays a critical secondary stabilizing role alongside the ACL; meniscus deficiency raises ACL graft failure risk. Meniscus transplantation is increasingly considered in revision cases with deficient menisci as it supports knee stability. The speaker also highlights the significance of hidden or "ramp" lesions—posterior medial meniscocapsular separations—that affect rotational stability and ACL strain. These lesions can be arthroscopically repaired, improving knee function. Proper physical and radiologic exams, including weight-bearing x-rays and thorough intraoperative assessment, guide treatment decisions. Staged procedures are sometimes necessary. Overall, a comprehensive approach addressing alignment, meniscal integrity, and concomitant injuries is crucial in revision ACL reconstruction to optimize knee stability and durability.

Asset Caption

Instructional Course Lecture: Surgical Considerations in Revision ACL Reconstruction

Keywords

ACL reconstruction failure

lower extremity malalignment

meniscus deficiency

ramp lesions

high tibial osteotomy