Retrospective Evaluation of Synthetic Ligament-Based Revision of Anterior Cruciate Ligament Reconstruction for Postoperative Re-Rupture

Summary

This study evaluates the clinical and technical outcomes of synthetic ligament-based revision anterior cruciate ligament (ACL) reconstruction for postoperative re-rupture.

Abstract

Re-rupture following anterior cruciate ligament (ACL) reconstruction remains a challenging complication, necessitating effective revision strategies. To evaluate the clinical and technical outcomes of synthetic ligament-based revision ACL reconstruction for postoperative re-rupture, a retrospective analysis was conducted on patients undergoing synthetic ligament revision ACL reconstruction between January 2023 and January 2024. Preoperative assessments included laboratory tests (ESR, CRP, tuberculosis antibodies), radiographic imaging (X-ray, CT, MRI), and functional scoring (VAS, IKDC, Lysholm). Surgical protocols emphasized meticulous tunnel planning, arthroscopic debridement, synthetic ligament placement, and dual fixation with metallic interference screws. Postoperative care involved early mobilization, systematic rehabilitation, and regular follow-ups. Results showed that the procedure demonstrated technical feasibility, with successful ligament fixation and no intraoperative complications. Postoperative evaluations revealed improved functional scores (IKDC, Lysholm) and reduced pain (VAS). Imaging confirmed proper ligament positioning and graft integrity. No instances of infection, graft failure, or significant joint instability were reported during follow-up. Those results indicate that synthetic ligament revision ACL reconstruction offers a reliable solution for re-rupture cases, combining precise surgical techniques with rigorous postoperative rehabilitation. This approach addresses anatomical challenges, restores knee stability, and enhances patient outcomes, supporting its adoption in complex revision scenarios.

Introduction

Anterior cruciate ligament (ACL) injuries are among the most prevalent musculoskeletal disorders, particularly affecting active individuals and athletes, often leading to knee instability and functional impairment^1,2. Primary ACL reconstruction, utilizing autografts or allografts, remains the gold standard for restoring knee stability and enabling return to activity. Postoperative re-rupture occurs in approximately 3%-15% of cases, necessitating revision surgery^3,4. While multiple revisions yield inferior results compared to primary reconstructions, th....

Protocol

All procedures in this study were approved by the Ethics Committee of the Sixth Affiliated Hospital of Xinjiang Medical University. All patients provided consent for the publication of their clinical data under the condition that their identities remain undisclosed. From January 2023 to January 2025, a retrospective analysis was conducted on the clinical and imaging data of patients undergoing revision surgery for re-rupture after ACL reconstruction using synthetic ligaments. Diagnosis of re-rupture was confirmed through imaging studies, specialized physical examinations, and arthroscopy. The consumables and equipment used are listed in the Table of Materials<....

Results

A total of 28 patients (mean age: 32.4 years ± 6.8 years; 18 males, 10 females) underwent synthetic ligament revision ACL reconstruction during the study period, with a mean follow-up duration of 12.3 months ± 2.1 months (range: 6-18 months). Preoperative functional assessments revealed significant knee impairment, with mean VAS pain scores of 6.8 ± 1.2, IKDC scores of 45.3 ± 7.5, and Lysholm scores of 52.1 ± 8.9. Postoperatively, all patients exhibited marked improvements: VAS scores decreased to 1.5 ± 0.8 (p &.......

Discussion

The current study demonstrates that synthetic ligament-based revision ACL reconstruction provides reliable clinical outcomes, with significant improvements in knee stability and function (IKDC: 45.3 -82.6; Lysholm: 52.1- 88.7; p < 0.001) and low complication rates. The findings of this study underscore the technical feasibility and clinical efficacy of synthetic ligament-based revision of anterior cruciate ligament (ACL) reconstruction in addressing postoperative re-rupture. This approach demonstrated signif.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
9 mm metallic interference screws	Arthrex	AR-1390E	9 mm × 20 mm cannulated interference screw for emoral and tibial graft fixation
Arthroscopic burr	DePuy Mitek	www.jnjmedtech.com/en-US/product/vue-arthroscopic-equipment-solutions	Bone preparation
Arthroscopic shaver	Stryker System 8	www.surgicaldirect.com/m_product_page.php?item=Stryker+System+8+LG	Model: 8205-000-000 (System 8 Dual-Trigger Rotary Handpiece)
Drill	Arthrex Drill Guide	AR-8956G-20	2.0 mm drill guide
Guide pins	Smith & Nephew	410236	Richards guide pin, 230 mm × 2.4 mm
Polyethylene terephthalate-based synthetic ligament	LARS Ligament (Corin)	www.coringroup.com/healthcare-professionals/products/lars	Graft material for revision ACL reconstruction
Reamers (7.5 mm)	Arthrex	AR-1407.5	Cannulated headed reamer, 7.5 mm
SPSS	IBM	www.ibm.com/products/spss-statistics	Software; Version 27.3