Nicole is a competitive cheerleader from a local University. She had aspirations of pursuing her dream until it was cut short during an injury which left her knee unstable, unable to cheer and unable to complete. She was crushed.
Three years later, and after her ACL repair and subsequent revision repair, she was still unstable. She had given up on pursuing her dream. “Doctor why did this happen?”
Nicole’s story is unfortunately not unique. About 20,000 to 35,000 people who have ACL reconstruction will fail and need to be revised. The need for a third revision is more unique. These revision surgeries are much more complex, often require staged procedures, have higher complication rates, and a more conservative rehabilitation than the first surgery.
The first question I try to answer is why did this happen: Both for the patient and for myself. A better understanding of the ‘why’ will help to maximize the chance that the next surgery will be successful.
An ACL repair or reconstruction, which I perform frequently, is done by using a tissue graft in the place of the torn ligament. This graft either comes from your knee, or from a donor. When done correctly, many patients are able to return to sports, and have normal knee function and stability.
I believe the most common reason for failure of an ACL repair is a technical concern on the part of the surgeon related to tunnel placement. Getting the graft in exactly the right place is essential for a good outcome. To the layman, this seems it should be easy. The reality is there are several pitfalls that can occur and the result can be wrong tunnel placement that will lead to failure. Anatomic landmarks in the knee must be carefully identified and checked before committing to the location of a tunnel. Placement of the femoral tunnel too forward (anterior) or two vertical is far too common. A tunnel in the wrong place creates abnormal stress on the graft which can cause it to stretch out or tear.
Return to activities too early: Go back to sports too soon and the chance of failure goes up. Patients need to be sure they are ready. This isn’t just a time consideration (like 6 months out), but rather a functional consideration. Once normal strength, endurance and agility are possible, return to sport may be considered. Running a patient through a ‘sport test’ may help. I like to follow patients out until they are back completely to be sure they are ready.
Other key factors include
• Recurrence of injury
For the purchased this generic viagra first time, researchers had a reliable count of men and could relate their medical histories to other diseases and disorders. You do not have to go through the discomfort of Premature Ejaculation (PE) and allow you to: Experience a happier and more fulfilling relationship Enjoy sex to the fullest Heighten your confidence Enhance your quality of life cheap cialis tadalafil of cancer patients has been vastly improved as a result of this advancement. It has considerably marred the sexual life of many couples have become fun and enjoyable as males can experience longer and harder erections with the sildenafil tablet viagra http://appalachianmagazine.com/2018/12/01/nose-to-toe-bed-sharing-in-appalachia-back-when-getting-sleep-was-work/ use of this medication. This is not a shocker-if unhealthy bile is not treated, some patients will not be well after their viagra generic no prescription gallbladder has been removed.
• Poor muscle function
• Infection
• Other injuries
Find a surgeon with experience
Surgeons who perform more than a few ACLs a month are more likely to have better outcomes than patients who do a 0-4 a month. Staying up with the most common and up-to-date techniques is important. Find someone who performs an true anatomic reconstruction.
Don’t be afraid to ask your surgeon how many ACLs he does a month. We are honest people and will tell you. Get a second opinion if you like. A confident surgeon will give you the option of looking elsewhere if you like.
At the time of Nicole’s surgery, Her tunnels were in the wrong place – too forward on the femur, too far back on the tibial side. The tunnels were close to the right place. Both tunnels were grafted with bone. Four months later, she went back to the OR for her staged reconstruction. Nicole rehab’d hard. At one year out, she started back to competition. Last month, she competed and medaled in the world cheer competition.
I hope this was her last knee surgery. Five surgeries later, she is back chasing her passion and not looking back.
Dr. Hacker,
I had an ACL reconstruction done in 2005 and it lasted 14+ years until august 2019. One day I kneeled to sit down and pop it just went. I couldn’t believe it I had done nothing wrong that I could think of. So next I had a revision done and it was a bad graft and it failed 1.5 months later. So I got all that junk taken out and bone tunnels filled with donor bone. Waited 6 months and had the revision done again with a additional tendonesis (auto) for rotational stability in July. The allograft I used for new acl was patellar tendon, failed in a similar fashion in 4 weeks, by me merely pulling my 2 small dogs to me with the leash. It seems staggering that it could re-tear so easily, my PT said that shouldn’t happen and I agree, it seems very odd. The failure wasn’t valgus or rotational its clearly anterior-posterior plane of movement. I think my tendonesis is still intact, only the allograft failed :( I am a otherwise healthy life long athlete, I am trying to figure out what is wrong, help! TIA
That’s quite a story. Definitely a complicated knee. There must be more going on? Other structures which are loose? Could there be an infection that was not identified? Hard to give medical advice here especially in a complicated situation like this, but I would definitely want to see new x-rays, MRI scan, lab tests including CBC, ESR and CRP and careful in the exam to best understand the cause. Best wishes with this.