Video Gallery

Revision Anterior Cruciate Ligament Reconstruction via Quadriceps Tendon Autograft and Anterolateral Ligament Reconstruction

March 01, 2019

Contributors: Christopher S Ahmad, MD, FAAOS; Forrest Anderson, MD; Joseph Lombardi, MD; George Popa; David Trofa, MD; Julian Sonnenfeld, MD; Julian Sonnenfeld, MD

The number of anterior cruciate ligament (ACL) reconstruction procedures performed in the United States is rapidly increasing. However, given the 25% failure rate associated with primary ACL reconstruction, the number of revision ACL reconstruction procedures also is increasing. Risk factors for primary graft failure include technical errors (most notably tunnel malpositioning), female sex, younger age at the time of injury, and graft type. In primary and revision ACL reconstruction, allografts fail considerably more often than autografts. In revision ACL reconstruction, the type of autograft does not affect the failure rate, with studies reporting that ipsilateral quadriceps tendon autografts are equivalent to contralateral hamstring autografts. Even after anatomic ACL reconstruction, many patients continue to experience anterolateral rotatory instability. Anterolateral ligament reconstruction may play a role in further stabilizing the knee. Currently, no consensus exists regarding anterolateral ligament reconstruction during primary or revision ACL reconstruction. However, studies have reported that performing lateral extra-articular tenodesis during ACL reconstruction considerably decreases arthritis at long-term follow up. This video demonstrates revision ACL reconstruction via a quadriceps tendon autograft with concomitant anterolateral ligament reconstruction and meniscal débridement/repair. The video discusses the case presentation of a common patient and presents the surgical technique and typical postoperative rehabilitation protocol.