Patients undergo ACL revision surgery when primary ACL reconstruction fails due to re-injury. The risk of re-injury increases with each revision surgery. Therefore, Dr. Marx recommends injury prevention exercises to minimize patient risk of re-injury. However for some patients hoping to return to high levels of activity and rigorous sports, Dr. Marx may recommend surgical procedures that reinforce ACL function from another part of the knee. These operations, known as extra-articular reconstruction, can improve knee stability.
One such procedure includes iliotibial band (ITB) tenodesis. See pictures of Dr. Marx in the images below. This procedure requires two stages. The first involves constructing an autograft for the ACL: a small piece of tissue removed from the patient, which is then surgically reconnected in the knee. In many cases autografts are removed from hamstring or patellar tendons. Dr. Marx anchors the autograft in the tibia and femur with screws. This step occurs in all ACL revision cases. The second step provides additional ACL security for patients at high risk of re-tear. In this stage of surgery, Dr. Marx tightens the iliotibial band – a piece of tissue on the lateral side of the knee. After detaching a small portion of the iliotibial band and sliding it under the fibular collateral ligament (FCL), Dr. Marx secures it to the femur to add additional support to the ACL.