2015 ISAKOS Biennial Congress ePoster #1368

Clinical Results After Revision ACL Reconstruction with Patellar Tendon Autograft

Yuji Takazawa, MD, PhD, Tokyo JAPAN
Hiroshi Ikeda, MD, PhD, Tokyo JAPAN
Yoshitomo Saita, MD, PhD, Tokyo JAPAN
Muneaki Ishijima, MD, PhD, Tokyo JAPAN
Haruka Kaneko, MD, PhD, Tokyo JAPAN
Yohei Kobayashi, MD, PhD, Tokyo JAPAN
Shinnosuke Hada, MD, Tokyo JAPAN
Ryo Sadatsuki, MD, Tokyo JAPAN
Kazuo Kaneko, MD, PhD, Prof., Tokyo JAPAN

Dept. of Orthopaedics, Juntendo University, Bunkyo-ku, Tokyo, JAPAN

FDA Status Not Applicable

Summary: The significant predictors of poor outcomes for revision ACL reconstruction were the time from re-injury and the presence of articular surface damage.

Rate:

Abstract:

Background

There is little known about the actual rate and the characteristics of return to sport after revision anterior cruciate ligament (ACL) reconstruction.

Aim

To investigate the rate and the factor of return to sports at the same level after revision ACL reconstruction with bone-patellar tendon-bone (BPTB) autografts.

Methods

From April 2006 to March 2012, retrospective review of our patients’ records revealed that a total of 84 ACL revision reconstructions with isolated re-rupture of the ACL graft were performed in our hospital. Of the 84 patients, 69 patients met the criteria for this study and 54 patients were available for follow-up for a minimum of 24 months (mean, 37.9 ± 22.2 months; range, 24-60 months). The primary outcome measures were graft type at primary reconstruction, cause for graft failure and the time from re-injury to revision reconstruction. The secondary outcome measures were clinical results after revision surgery.

Results

Male patients represented 69% (37 male; 17 female). The time from primary ACL reconstruction to revision ACL reconstruction averaged 52.1 ± 47.6 months (range, 5- 204months) and the time from re-injury to revision surgery was 22.8 ± 29.0 months (range, 1-96 months). The graft source used for primary ACL reconstruction was hamstring graft for 47 patients (single bundle technique 40 patients and double-bundle technique 7 patients), iliotibial tract graft for 6 patients and allograft for 1 patient. synthetic graft. The cause of the previous graft failure was an isolated technical error in 54%, new trauma in 39% and isolated biological graft failure in 7%. At the time of revision ACL reconstruction, meniscectomy was required in a total of 21 (39%) patients and the damaged articular surfaces that were classified as moderate or severe in 14 (26%) patients. The rate of return to the same sport at the same level was 36 (67%) patients. After surgery, anterior stability of the knee, as measured by the KT-2000 arthrometer, was significant better (pre, 4.5 + 1.9 mm vs post, 1.2 + 1.2 mm; P < .05) and the negative ratio of the pivot-shift test was 70%. The number of patients who had a subsequent revision graft tear was 1 (1.9%) patient. On regression analysis, significant contributor to return to the same level of sports were the status of the articular cartilage (odds ratio, 2.2; 95% confidence interval, 0.3-0.7) and the time from re-injury to revision surgery (odds ratio, 2.5; 95% confidence interval, 0.2-0.7).

Conclusion

We confirmed that revision ACL reconstruction with BPTB affords acceptable results. The significant predictors of poor outcomes for revision ACL reconstruction were the time from re-injury and the presence of articular surface damage.