Document Title: ONeill-AJSM-Dec04
Article Title: Revision Arthroscopically Assisted Anterior Cruciate Ligament Reconstruction With Previously Unharvested Ipsilateral Autografts
Author: Daniel B. O’Neill, MD, PA
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: December 2004
Volume 32, pages 1833-1841
Keywords: ACL revision reconstruction, autograft, ipsilateral (same-side graft harvesting).

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Comments: In this study, ACL-revision reconstruction was performed with the hamstring-group autograft (DLSTG) on 23 patients and with the patellar-tendon autograft on 25 patients. At follow-up (which ranged from 2 to 13 years), 73% of the reconstructions were functional, 21% were partially functional, and 6% had failed. (Although the failed grafts were all from the patellar-tendon group [which is known to have the highest success rate for first-time reconstructions because of the security of bone-plug-to-bone-tunnel healing, an advantage which one would expect to clearly see in the context of revision ACL reconstructions as well], the authors note that these three failures were from the first four ACL-revision grafts done in the study, and so the surgeon had the least amount of experience in this regard. As well, because these failures were the first reconstructions in this study, the follow-up period was longest. If the three failures are excluded from the statistical analysis, then both hamstring and patellar-tendon autografts bring similar success rates for revision ACL reconstruction.) As expected, the results were not as good as those typically found in first-time (also known as primary) ACL recontructions. In any case, for revision ACL reconstructions, autografting brings better results than allografting. (None of the patients in this study had any comcomitant ligament deficiencies.)

ABSTRACT

Background: Revision anterior cruciate ligament reconstruction requires flexibility and variability in treatment options. This study analyzed the functional outcomes and graft stability of 48 consecutive revision anterior cruciate ligament reconstructions using previously unharvested ipsilateral autografts.

Hypothesis: Using previously unharvested ipsilateral autografts will achieve similar outcomes to other graft choices in revising previously failed anterior cruciate ligament reconstructions.

Study Design: Prospective nonrandomized clinical trial.

Methods: Forty-eight patients (48 operations) were observed for 2 to 13 years (mean, 90 months). All agreed to have revision reconstruction with ipsilateral autografts. The details of the technique varied according to the original graft choice and the abnormality encountered. Concomitant procedures were necessary in 40 (84%) of 48 knees. Twenty-three patients (48%) had revision reconstruction with previously unharvested ipsilateral autogenous hamstring tendons. Ten (21%) were 2-stranded grafts, and 13 (27%) were 4-stranded (quadrupled) autografts. Twenty-five patients (52%) had revision reconstruction with previously unharvested ipsilateral patellar tendon autografts, 6 (12%) using the 2-incision rear-entry method and 19 (40%) using the single-incision technique.

Results: Results were evaluated with Lysholm and Gillquist scores and International Knee Documentation Committee ratings, including KT-2000 arthrometer examinations. Seventy-three percent of the patients had International Knee Documentation Committee normal (A) or nearly normal (B) knees (42% of the patients had A knees and 42% had B knees). Twelve percent of patients had C knees, and 4% had a D rating. Sixty-seven percent of the knees had a KT-2000 arthrometer side-to-side difference of 3 mm or less, and an additional 21% of the knees had a side-to-side difference of 3 to 5 mm; therefore, 94% of the grafts were functional or partially functional. Six percent of grafts had more than 5 mm of laxity and were considered failures.

Conclusions: Previously unharvested ipsilateral autografts proved reliable in improving function and stability in revision anterior cruciate ligament reconstruction. However, outcomes were less favorable with revision reconstructions than with primary reconstructions.

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