الفهرس | Only 14 pages are availabe for public view |
Abstract Surgical revision of a failed ACL reconstruction requires thorough preoperative planning and evaluation of the factors that may have caused the failure so that the correction of these problems may be addressed during the revision operation. This should include a thorough history, a physical examination and a standard radiographic examination to evaluate the orientation of the tunnels and their possible enlargement, and the type of preexisting fixation devices. The most common etiologic factor of ACL failure is an error in surgical technique: an improper intra-articular placement of the graft; impingement of the graft in the intercondylar notch due to an insufficient notchplasty or due to an anteriorly placed tibial tunnel; an improper tension of the graft or inadequate graft fixation. Other causes of ACL failure are infections, a new knee injury or recurrent swelling following the use of prosthetic ligament in the primary reconstruction. MRI permits direct evaluation of ACL graft, bone tunnels, and additional disorders of the knee. Recognizing the appearance not only of complications, but also of the asymptomatic findings after ACL reconstruction is essential for the radiologist and the clinician. It is clear that the management of ACL injuries is complex and continues to evolve Surgical techniques of ACL reconstruction require proper placement and tensioning,avoidance of impingement and stress risers on the implanted tissue, and adequate fixation. The ideal graft for ACL reconstruction should have biomechanical properties similar to those of the native ACL, enable stable initial fixation and rapid biologic incorporation, and offer a low rate of morbidity. Anatomic double bundle ACL reconstruction is technically demanding, but provides better restoration of normal knee anatomy and kinematics than does single bundle ACL reconstruction. |