The results of revision reconstruction greatly depend on a correct isometric position. A two-stage procedure consists of removal of the failed graft and fixation material and spongioplasty followed by revision surgery. In a moderate degree of femoral tunnel ventral malposition, we make decisions individually. We perform one-stage surgery when the position of tunnels is correct, with the exception of revision due to infection, and in all malpositions but for a dorsally positioned tibial tunnel. Errors in tunnel position are differentiated according to the part of the tunnel (tibial, femoral or both) tunnel direction (ventral, dorsal, lateral or medial) and the degree of malposition (mild, moderate or serious). Causes of failure are categorized as 1) traumatic (major trauma, too early weight-bearing, minor trauma due to rehabilitation) 2) surgery-related (erroneous position of the tibial and/or femoral tunnels, insufficient tensioning of the graft and its insufficient fixation) 3) biological (poor graft incorporation and restructuring, infection) and 4) combination of all previous causes. Revision surgery is indicated on the basis of subjective complaints (instability), and the results of clinical examination (Lachman's and pivot-shift tests) and imaging methods (X-ray, MRI, arthroscopy). We distinguish four steps in the revision procedure: 1) diagnosis and analysis of the ACL reconstruction failure 2) preoperative planning and surgery timing (one- or two-stage procedure, graft type, fixation method) 3) operative procedure 4) postoperative care including rehabilitation. Revision surgery after ACL reconstruction with a BTB graft fixed with a non-absorbable interference screw and with a hamstring tendon graft was performed in 18 and 5 patients, respectively.

In the same period we performed 24 revision ACL reconstructions (6 %) with BTB allografts 19 were in men and five in women.

In the 2002-2004 period, 421 reconstructions of the anterior cruciate ligament, using patellar BTB or hamstring tendon autografts, were carried out in our orthopedic ward. The study evaluates our experience with revision anterior cruciate ligament (ACL) surgery, with emphasis placed on the use of allografts.

Tibial tunnel bone allograft cpt