An excellent new evidence shows a higher osteoarthritis risk after ACL graft rupture 30 years after ACL reconstruction compared to those with intact ACL grafts. So, intact ACL graft reduces the risk for increased OA development (Knee Surgery, Sports Traumatology, Arthroscopy volume 28, pages 2139–2146 (2020).
This study data indicates, that in a period of median 31 (range 28–33) years after ACL reconstruction, 50% of the patients showed an intact ACL graft and no side-to-side difference regarding anterior knee laxity. But, if ACL grafts were ruptured, patients had more osteoarthritis in the medial tibiofemoral compartment than those with intact ACL grafts. No more doubt – knee has to be stable to avoid early osteoarthritis, also, successful ACL reconstruction technique is most important, and if rupture of the ACL graft happens, revision ACL reconstruction should be performed to make knee stable and prevent osteoarthritis in the future. Excellent results can be achieved with regard to functional knee stability after revision ALC reconstruction even in early osteoarthritic knees.
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There is no perfect graft choice for primary or revision ACL reconstruction. Both allograft and autograft options are reasonable, but each is associated with unique risks and benefits. Allografts eliminate concerns of donor site morbidity and may be particularly useful in the setting of multiligament knee reconstructive surgery. Furthermore, grafts such as the Achilles tendon offer a large cross-sectional area and may be useful to fill large but well-positioned tunnels in a single-stage revision ACL reconstruction. However, there is a small risk of disease transmission with allografts that is not present with autografts. Allografts tend to incorporate more slowly than autografts, which can prolong the rehabilitation process.
Figure ). In the absence of significant tunnel expansion, this tunnel may be avoided by independent preparation of a new tunnel with divergent trajectory toward a more anterior anatomic position within the tibial ACL footprint. The ACL tibial footprint extends anteriorly to the intermeniscal ligament, which allows for a more anterior position of the new tibial tunnel. In the setting of significant tunnel expansion and slight posterior malposition, a staged approach may be required to avoid tunnel convergence or recurrent malposition (see The graft fixation site should be assessed for quality of bone and relative size of the graft versus the tunnel diameter to achieve adequate fixation with interference devices. Appropriate fixation may be difficult to obtain if there is bone loss and poor bone stock at the fixation site. In the absence of significant tunnel expansion and good bone stock, interference screw fixation can be utilized in a manner analogous to primary ACL reconstruction. However, stacked screws or any fixation technique that may compromise graft fixation should not be used to facilitate a single-stage reconstruction at the expense of an increased risk of failure. As in primary ACL reconstructions, the screw divergence from the tunnel should not exceed 15 (
Thank you so much, just very, very great remarks. We are able to reach all mentioned points fixing the graft not with interference screws, but with large button system – it works perfectly more, than 3 years in my hands!