When consecutive ACL reconstructions fail in a young, active patient, restoring multi-planar stability presents a major surgical challenge. This complex case explores the clinical and radiological analysis of a double hamstring autograft failure combined with a subtotal meniscectomy.
- Male 28 years old
Primary surgery:
- 2017 ACL reconstruction
- Hamstrings autograft,
- Failed 6 months later
2nd surgery:
- Revision ACL hamstrings autograft (contralateral side) plus subtotal meniscectomy
- Failed again without significant trauma
- Full ROM,
- Lachman test (+++),
- Pivot shift test(++)
Pre-op x-rays (8/22)
Pre-op MRI
What is your opinion of previous surgeries?
- ✔️None of the previous answers is correct
How would you manage this condition?
- ✔️Bone patellar tendon bone for ACL reconstruction
- ✔️Lateral tenodesis
- ✔️Medial meniscus transplantation
Performing a lateral tenodesis (anterolateral ligament reconstruction or lemaire modified procedure) should be done according to the anterolateral ligament experts' group, since it’s a revision surgery.
Sonnery-Cottet B, Daggett M, Fayard JM, Ferretti A, Helito CP, Lind M, Monaco E, de Pádua VBC, Thaunat M, Wilson A, Zaffagnini S, Zijl J, Claes S. Anterolateral Ligament Expert Group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament - deficient knee. J Orthop Traumatol. 2017 Jun;18(2):91-106. doi: 10.1007/s10195-017-0449-8. PMID: 28220268; PMCID: PMC5429259.
- Bone patellar tendon bone for ACL reconstruction
- Lateral tenodesis
- Medial meniscus transplantation
Medial meniscus transplantation
