2015 ISAKOS Biennial Congress Paper #0

Mid-Term Outcomes Of Repeated Revision Anterior Cruciate Ligament (Acl) Reconstructions With Allografts In Isolate And Complex Cases Of Multiple Failures

Alberto Grassi, PhD, Bologna ITALY
Nicola Pizza, MD, Bologna ITALY
Giacomo Dal Fabbro, MD, Bologna ITALY
Luca Macchiarola, MD, Foggia ITALY
Stefano Zaffagnini, MD, Prof., Bologna ITALY
IRCCS Rizzoli Orthopaedic Institute, Bologna, Emilia-Romagna, ITALY

FDA Status Cleared

Summary: Good mid-term clinical results can be obtained after repeated ACL revision with allograft in patients that experienced multiple failures, however, who need additional procedure due to malalignment or post-meniscectomy syndrome reported lower objective and subjective results.

Abstract:

Background

Anterior Cruciate Ligament (ACL) revision reconstruction are always complex scenarios due to eventual associated meniscal and cartilage lesion or degeneration. Nevertheless, these procedures have reached a satisfactory return to impact activity rate, and so the occurrence of an ACL revision reconstruction failures is destinated to increase. Only few studies with a limited number of patients focused on clinical outcomes of multiple ACL revision reconstruction reporting contrasting results.

Purpose

To evaluate the mid-term clinical outcomes of a cohort of patients who underwent multiple ACL revision reconstruction. The hypothesis was that patients with pre-existing meniscal deficiency conditions, malalignment and cartilage degeneration would have obtained lower results.
Study Design: retrospective cohort study

Methods

All cases of Multiple ACL Revisions performed with Allograft tissue at one single sport-medicine institution were extracted and patient’s whit a minimum 2 years of follow-up included. WOMAC, Lhysolm, IKDC, Tegner activity level before injury and at last follow-up was collected and laxity evaluated with KT-1000 arthrometer and KiRA triaxal accelerometer.

Results

From a cohort of 241 ACL revision, 28 patients (12%) with Repeated ACL Revision reconstructions were included. Fourteen cases (50%) were considered “Complex” due to the addition of Meniscal Allograft Transplantation (8) or Meniscal Scaffold (3) or High Tibial Osteotomy (3). The remaining 14 cases (50%) were considered as “Isolate”. Mean WOMAC score was 84.6±11.4, Lysholm 81.7±12.3, subjective IKDC 77.2±12.1, median Tegner score 6 (IQR 5–6) at pre-injury and at final follow-up. Statistically significant inferior values of WOMAC (p=0.0079), Lysholm (p=0.0185) and Subjective IKDC (p=0.0193) was detected between “Complex” and “Isolate” revision groups.
Higher average value of anterior translation at KT-1000 at both 125 N (p=0.0346) and manual maximum displacement test (p=0.0299) were reported in “Complex” respect to “Isolate” revisions. Four patients were considered as failures and occurred in patients with “Complex” revisions, none occurred in the “Isolate” (30%vs0%; p=0.0407).

Conclusion

Good mid-term clinical results can be obtained after repeated ACL revision with allograft in patients that experienced multiple failures, however, who need additional procedure due to malalignment or post-meniscectomy syndrome reported lower objective and subjective results.