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Thursday, March 1, 2001

ACL surgery review finds 8% need second procedure

A retrospective review of 618 patients who had anterior cruciate ligament (ACL) reconstructive surgery found there is an 8 percent incidence for return to the operating room for a second surgical procedure.

Investigators said Wednesday in scientific paper 40 that between 1989 and 1999, 618 consecutive primary single-incision bone-patella tendon-bone autograft ACL reconstructive procedures were retrospectively reviewed for factors causing a secondary return to the operating room.

A total of 50 of 618 (8 percent) patients required a second operation. Patients were followed for a period of two to 10 years. The mean age of the patients was 28 (range: 14 to 53). The mean number of days to return to the operating room was 689.4 days (range: 30 to 2816). The most common reasons for a second operation were loss of motion and graft failure. Of all the problems that required a second surgery, a total of 21 (42 percent), were due to loss of motion.

One patient improved with only manipulation under anesthesia, eight (16 percent) had cyclops debridement and 10 (20 percent) lysis of adhesions. Two required revision notchplasty for impingement. Thirteen (26 percent) had revision ACL surgery. Ten (20 percent) of patients had removal of a painful tibial interference screw and one had removal of a loosened femoral screw. Fourteen (28 percent) had meniscal tears requiring partial menisectomies. Five (10 percent) had patella fractures necessitating open reduction and internal fixation.

One patient had persistent patella tendonitis that required open exploration and debridement. Other second surgeries included three medial femoral condyle chondroplasties, one patella chondroplasty, one irrigation and debridement for an infection, and one lateral release for patella tracking pathology.

Coauthors of the study are Drew A. Stein, MD; John Bonamo, MD; Mark Pitman, MD; and Orrin Sherman, MD, all of the department of orthopaedic surgery, NYU Hospital for Joint Diseases, New York, N.Y.; and Stephen Silver, MD, Beth Israel Medical Center, New York, N.Y.

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Last modified 14/February/2001 by IS