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Review Question - QID 3322

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QID 3322 (Type "3322" in App Search)
A collegiate men's basketball point guard undergoes ACL reconstruction with hamstring autograft. One year following reconstruction, he returns to playing and complains of recurrent instability episodes. He has an acute giving way episode on the court and is found to have an effusion and a positive pivot shift. Which of the following is the most likely cause of his injury?

Improper graft selection

4%

178/4077

Lack of sufficient physical rehabilitation prior to return to basketball

8%

341/4077

Overly aggressive physical rehabilitation during the first 3 months following reconstructive surgery

4%

149/4077

Surgical error in graft tensioning

4%

166/4077

Surgical error in tunnel position

79%

3222/4077

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Failure following primary ACL reconstruction has been associated with surgical error in 65-75% of cases. Of these cases, tunnel malposition is the most common, accounting for 70% of the errors. Successful ACL reconstruction has been demonstrated with hamstring autograft as well as bone-patellar tendon bone autograft, quadriceps autograft and multiple allograft specimens. Appropriate rehabilitation is crucial for successful return to sport, but there is not a more frequent cause of failure than surgical error.

Battaglia et al review a surgical technique for revision ACL reconstruction utilizing freeze-dried allograft bone dowels to fill malpositioned tunnels. Grossman et al review 29 patients who underwent revision ACL reconstruction with bone patellar tendon bone allograft, contralateral bone-patellar tendon-bone autograft, or achilles allograft. All 29 patients reported satisfactory clinical results with an average 67 month follow-up.

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