Document Title: Colosimo-AJSM-Nov01.shtml
Article Title: Revision Anterior Cruciate Ligament Reconstruction with a Reharvested Ipsilateral Patellar Tendon
Authors: Angelo J. Colosimo, MD*,, Robert S. Heidt, Jr, MD, Jeff A. Traub, MD*, and Richelle L. Carlonas, MS
Publication: The American Journal of Sports Medicine
Date: November 2001
Volume 29, pages 746-750
Keywords: ACL revision reconstruction, patellar-tendon autograft, ipsilateral (same-side).

(Reference-denoting numbers appear in the same point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables.)

Comments: This study shows that reharvesting the patellar tendon is a viable option, and that the resulting graft brings satisfactory results. (This disagrees with the July 1998 AJSM study by Kartus, which found that reharvesting the patellar tendon brings complications and problems. It would have been nice if Colosimo's study would have involved more than 13 knees.) It is interesting to note that Colosimo et al. describe ACL-revision reconstruction as a salvage procedure, a term which might carry an ominous connotation from the viewpoint of the patient. Clearly, it behooves anyone undergoing a revision reconstruction to ensure that the surgeon is well-experienced not only with first-time ACL reconstructions, but with revision reconstructions and complex knee surgeries as well. This study provides a good overview of the dangers inherent in placing excessive demands on a recently reconstructed knee, and it describes the stages through which an ACL graft goes through.

ABSTRACT

The patellar tendon remains the most popular graft choice for anterior cruciate ligament reconstruction and has been proven to be the strongest substitute. Between 1991 and 1998, we performed revision anterior cruciate ligament reconstruction using the reharvested central third of the ipsilateral patellar tendon in 15 patients. Adequate follow-up was obtained in 13 of these 15 patients. The results in these 13 patients (mean age, 27.2 years) were reviewed. At an average postoperative follow-up of 39.4 months (range, 24 to 65), 11 patients had good or excellent results and 2 patients had fair results. Clinical examination revealed an average Tegner knee score of 5.8 (range, 3 to 9) and an average Lysholm knee score of 77.6 (range, 61 to 98). Postoperative KT-1000 arthrometer results showed an average side-to-side difference of 1.92 mm (range, -2.0 to 4.0). No patient demonstrated any loss of range of motion and only one reported patellofemoral problems, which were moderate. These favorable results demonstrate that, with appropriate patient selection, the use of a reharvested central third patellar tendon is a viable option for revision of a failed anterior cruciate ligament reconstruction.

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