Electronic Letters to:

Knee: N. E. Ohly, I. R. Murray, and J. F. Keating Revision anterior cruciate ligament reconstruction: TIMING OF SURGERY AND THE INCIDENCE OF MENISCAL TEARS AND DEGENERATIVE CHANGE J Bone Joint Surg Br 2007; 89-B: 1051-1054 [Abstract] [Full text] [PDF]

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Revision anterior cruciate ligament (ACL) reconstruction

Benedict A Rogers, Charline Roslee   (15 October 2007)

Revision anterior cruciate ligament (ACL) reconstruction 15 October 2007
Benedict A Rogers, Specialist Registrar The Princess Royal Hospital, Haywards Heath, UK, Charline Roslee Send letter to journal: Re: Revision anterior cruciate ligament (ACL) reconstruction benedictrogers{at}hotmail.com Benedict A Rogers, et al.	Sir, We read this paper with interest and would like to make the following points regarding several potential confounding factors that may exist: 1. This retrospective study was conducted using a cohort of patients that had undergone revision ACL reconstruction at one unit. Where was the primary ACL reconstructive surgery performed, and how experienced were the surgeons who performed the original surgery? Further, was an anatomical double bundle technique or a single bundle technique used during the primary surgery? 2. Physiotherapy is beneficial to the outcome of ACL injuries in general,1 and specifically following surgical repair.2 Was there any variation in the amount of physiotherapy received or undertaken between the different patient groups studied? 3. Given the high loads transmitted through the ACL and the young age of the patient cohort studied, was any record made of the weight and occupation or sporting activity of the patients? 4. It is indicated in the methods section that a mal-positioned tunnel was considered a technical failure. How did the authors define mal-position and with what degree of error? Was this independently confirmed in order to eliminate any potential bias? 5. From this study it is unclear to what extent the articular degeneration or meniscal pathology was a consequence of the original ACL rupture or as a result of a failure of the ACL reconstruction. More details regarding the original arthroscopic findings would be very informative. Further, was any qualitative or quantitative analysis made of the meniscal tears which were identified? B.A. Rogers, MA, MSc, MRCGP, MRCS Specialist Registrar, C. Roslee, MRCS, Princess Royal Hospital, Haywards Heath, UK. 1. Friden T, Zatterstrom R, Lindstrand A, Moritz U. Anterior-cruciate-insufficient knees treated with physiotherapy. A three-year follow-up study of patients with late diagnosis. Clin Orthop Relat Res 1991;190-9. 2. Liu-Ambrose T, Taunton JE, MacIntyre D, McConkey P, Khan KM. The effects of proprioceptive or strength training on the neuromuscular function of the ACL reconstructed knee: a randomized clinical trial. Scand J Med Sci Sports 2003;13:115-23.