• The Knee · Dec 2015

    Case series: Revision anterior cruciate ligament reconstructions using patellar tendon autografts.

    • Yuji Takazawa, Hiroshi Ikeda, Yoshitomo Saita, Muneaki Ishijima, Masataka Nagayama, Haruka Kaneko, Yohei Kobayashi, Shinnosuke Hada, Ryo Sadatsuki, and Kazuo Kaneko.
    • Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyou-ku, Tokyo 113-8421, Japan. Electronic address: ytakaza@juntendo.ac.jp.
    • Knee. 2015 Dec 1; 22 (6): 569-73.

    BackgroundUsing intra-operative findings and clinical results, including return to play (RTP) at the pre-injury level, this study investigated the causes of primary graft failure after revision anterior cruciate ligament (ACL) reconstruction with bone-patellar-tendon-bone (BPTB) autografts.MethodsA total of 54 patients were followed for a mean of 38.2 ± 10.2 months post-surgery. Subjective and objective results were evaluated using single assessment numeric evaluation (SANE) scores, Lachman tests, KT-2000 arthrometer results, and pivot-shift tests. The change in each patient's Tegner activity scale and RTP at the pre-injury level were also evaluated.ResultsInappropriate positioning of the tunnels was the most important reason (54%) for primary graft failure. After revision surgery, anterior knee stability was significantly improved (1.2 (mean) ± 1.2 (SD)mm vs 4.5(mean) ± 1.9 (SD)mm; P < 0.01). Two (4%) patients sustained revision graft ruptures while two (4%) sustained contralateral knee ACL tears. The rate of RTP at the pre-injury level was 67% (36 patients), and mean SANE scores at the time of RTP were higher than before surgery (74.8 ± 13.8 points vs 24.1 ± 16.4; P<0.001). The average time from primary graft failure to revision surgery was shorter (12.2 (mean) ± 4.0 (SD) vs 37.6 (mean) ± 8.8 (SD)months; P < 0.01) and the ratio of major cartilage injury was lower (39% vs 83%; P < 0.05) in the RTP group than that in the non-RTP group.ConclusionsThe time from primary graft failure to revision surgery and the extent of the cartilage injury are major factors in RTP after revision ACL reconstructions.Copyright © 2015 Elsevier B.V. All rights reserved.

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