ACL graft integrity

[skiknee66]

I have posted here in the past, but I am still having ongoing issues after an ACL reconstruction.  I have had conflicting opinions regarding graft laxity.  I have been recently been told that I have a 10 mm side to side difference of anterior tibial translation.  I was told by one source that I need a revision.  Another source thought this was an acceptable difference for a female with a hamstring graft.  My total anterior tibial translation in the ACL knee was 17mm.

I also had one source perform a pivot shift test, and got a clunk, which I felt.  The other source got a glide, which was also a new development from this source.  My PT states he could use my Lachman's test for show and tell(he says it is very positive).  My orthopaedic surgeon who got the glide result does not see this as an issue, even though he has never been able to get a positive pivot shift on me awake before.

I am about to spend a large sum of money to have a possible revision pending assessment.  My question is:  Is it possible to have a functioning graft with these test results?  I do have instability and pain!

Thank you for any input you might add.

[Michael L Gross, MD]

The key is in your last sentence. You DO have instability, case closed.  That said, my experience, and this is reflected in the literature, the combination of increased AP translation, positive Lachman's Test (no endpoint), and, most important, a positive pivot shift, in a young, active individual, is a generally accepted indication for ACL surgery.
As an aside, please be sure that your surgeon is experienced not only in ACL surgery, but in REVISION ACL surgery. One of the keys to a successful outcome is an experienced surgeon. Don't be embarrassed to ask how many they've done, and how many they do in a year.

[skiknee66]

A related discussion, Post  ACL revision surgery was started.

[skiknee66]

Thank you:)