Abstract
We hypothesize that larger prior tunnel size is associated with an increased risk
of failure of single-stage revision anterior cruciate ligament reconstruction (ACLR)
as defined by the performance of a re-revision (third) ACLR on the index knee. Retrospective
review identified 244 patients who underwent single-stage revision ACLR at a single
center with available preoperative radiographs. Patient and surgical factors were
extracted by chart review. The maximum diameter of the tibial tunnel was measured
on lateral radiographs and the maximum diameter of the femoral tunnel was measured
on anteroposterior radiographs. Record review and follow-up phone calls were used
to identify failure of the revision surgery as defined by re-revision ACLR on the
index knee. One hundred and seventy-one patients (70%) were reviewed with a mean of
3.9 years follow-up. Overall, 23 patients (13.4%) underwent re-revision surgery. Mean
tibial tunnel size was 12.6 ± 2.8 mm (range: 5.7–26.9 mm) and mean femoral tunnel
size was 11.7 ± 2.8 mm (range: 6.0–23.0 mm). Re-revision risk increased with tibial
tunnel size. Tibial tunnels 11 mm and under had a re-revision risk of 4.2%, while
tunnels > 11 mm had a risk of 17.1% (relative risk: 4.1, p = 0.025). No significant association between femoral tunnel size and re-revision
risk was noted. Patients with prior tibial tunnels > 11mm in diameter at revision
surgery had significantly increased risk of re-revision ACLR. Further studies are
needed to explore the relationship between prior tunnel size and outcomes of revision
ACLR.
Keywords
ACL reconstruction - tibial tunnel - single-stage revision - re-revision
