What are the treatment options in case of ACL graft failure? Dive into this clinical case, find out an innovative technique and understand the reasons for the failure of the first surgery!
- 24 Y.O male
- Professional freestyle skier
- ACL reconstruction with harmstrings 18 months ago
- Knee torsional trauma skiing
- On physical examination, he presents a positive Lachman test and a grade 3 pivot shift test
In this case, our choice was to perform a one-time ACL revision with a hybrid graft composed by the iliotibial band left attached and a gracilis allograft. An outside-in femoral tunnel has been performed, and the same tibial tunnel has been used as it was well positioned. This technique is easy to perform and allows to do a lateral tenodesis and an ACL reconstruction with the same graft, and to avoid a femoral tunnel convergence. A meniscal ramp lesion and a lateral meniscal tear have been sutured at the same time.
Performing a lateral tenodesis (anterolateral ligament reconstruction or lemaire modified procedure) at the time of the first surgery would have been wiser according to the anterolateral ligament experts' group, since the patient is a high-level athlete performing a pivoting sport.
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