[Revision anterior cruciate ligament reconstruction due to knee instability].

INTRODUCTION: The primary goal of anterior cruciate ligament reconstruction is to provide stability to the knee and regain full range of motion. Although great improvement has been achieved in surgical techniques and rehabilitation, some patients are not completely satisfied with the results of surgery and a revision anterior cruciate ligament reconstruction is necessary. MATERIAL AND METHODS: Revision arthroscopic anterior cruciate ligament reconstruction was carried out in eleven patients with bone-tendon-bone autografts. The surgery was performed in a standard manner and the graft was taken from the opposite knee. Eight men and three women were evaluated. The mean age of patients was 26 (17-34) years. Repeated instability of the knee was caused by injury in five patients, while six patients were unsatisfied with the position of the graft. RESULTS: The follow up was 4,2 years (2-8) respectively. The mean Lysholm and Gillquist score after operation was 88 (65-90). Preoperative and postoperative tibial shift was 9mm (6-15) and 2mm (0-4), respectively. The preoperative pivot shift test was grade 2 and 3 in all patients. Postoperative pivot shift test was negative in seven patients, in three it was grade 1 and grade 2 in one patient. According to the IKDC scale, preoperative results were abnormal in three patients and in eight they were severly abnormal. Postoperative IKDC score was normal in five patients, in four nearly normal, and in one patient the score was still abnormal. Five patients continued to be active in sports activities, four patients decreased the level of sports activity and two stopped all sports activities. CONCLUSION: Success of revision anterior cruciate ligament reconstruction requires detailed preoperative evaluation of the repeated instability of the knee. The treatment plan is then decided upon. The patients must be preoperativevely informed about the real possibilities of revision surgery. Only a mutual collaboration between the patient, physiatrist and a surgeon is a key for successful treatment and return to previous level of sports activities.

[Correlation between radiological and clinical findings after anterior cruciate ligament reconstruction].

INTRODUCTION: In the last two decades, the gold standard for anterior cruciate ligament reconstruction is the bone-patellar tendon-bone graft procedure. Correct position of the bone-patellar tendon-bone graft significantly affects the postoperative knee stability. The aim of this study was to establish if and how clinically measured knee stability is associated with radiographic position of bone-patellar tendon-bone graft in the femoral and tibial bones. MATERIAL AND METHODS: The prospective study included 39 patients, 30 men and 9 women. We analyzed and compared results of clinical and radiographic examinations prior to and 2 years following surgery. RESULTS: The mean arthrometric difference between the anterior tibial movement prior to surgery was 11.2 mm and 2.4 mm (p < 0.05) after surgery. The preoperative Tegner and Lysholm score was 1.49, and postoperative 8.23 (p < 0.05). The preoperative Lysholm-Gillquist scale was 51.56 and postoperative 97.74 (p < 0.05). The International Knee Documentation Committee (IKDC) scores were as follows: grade A in 32 patients (84.6%), grade B in 5 patients (12.8%), and grade C in 1 patient (2.6%). By comparison of IKDC scores and radiographic parameters (M1-M10) of anterior-posterior and profile views, a statistical significance was found only between IKDC and M9 index (sagittal femoral index OR'/RR' x 100). DISCUSSION: By using bone-patellar tendon-bone grafts, it is not possible to entirely achieve anatomical positions. Correct graft position within the bone tunnels is of great significance concerning knee stability after anterior cruciate ligament reconstruction. CONCLUSION: Correlation between radiological and clinical findings after anterior cruciate ligament reconstruction in our 39 patients shows that only the position of the graft affects the clinical outcome. Posterior graft location provides better clinical outcome and knee stability. On the other hand, anterior location is associated with worse postoperative IKDC scores, unstable knee and worse clinical outcome.