Outcome of Single Stage Revision ACL Reconstruction. Retrospective Study and Review of Literature

Abstract

Background. Pragmatic review of outcomes for single stage revision ACL reconstruction performed in a single center and the reasons for failure in primary surgery. Material and methods. Retrospective study included 59 patients with revision ACL reconstruction done by one surgeon from 2007 to 2017.Clinical records, operative notes and x-rays were assessed to find the reasons of failure. Results. The cause of failure was traumatic in 26 (44.1%) patients after primary reconstruction, incorrect tunnel position in 18(30.5%) and biological failure in 15 (25.4%). All ACL revisions were done using autografts; patellar tendon grafts in 33 patients (55.9%), ipsilateral hamstrings in 12 (20.3%), contralateral hamstrings in 9 (15.3%) and quadriceps tendons in 5 (8.5%). Twenty-one patients were contactable as regards postoperative functional outcome scores. There was an average 18 point improvement in Oxford knee score (OKS) post-operatively, 1.6 point improvement in Tegner scores and 30 point improvement in Lysholm scores. One patient (1.7%) developed septic arthritis, 4 (6.8%) had superficial infection, while 6 (10.2%) had residual instability after revision but did not have further surgery. There was lack of full extension in 4 (6.8%) patients. In BTB grafts, 2 (6.1%) patients sustained a post-traumatic patellar fracture. Conclusions: 1. Good outcomes of single stage revision ACL reconstruction surgery are achievable as de­monstrated in our cohort. 2. There is need for good quality research to identify whether BTB, hamstrings or quadriceps autografts are better for ACL Reconstruction.

Double-Layered Quadriceps Tendon Autografts Provide Lower Failure Rates and Improved Clinical Results Compared With Hamstring Tendon Grafts in Revision ACL Reconstruction

“…Literature regarding the use of quadriceps tendon grafts in revision ACLR is limited, and there is a need for studies that evaluate the differences between grafts in revision ACLR. 2 , 15 , 32 We have developed a quadriceps tendon technique using a double-layered, partial-thickness, soft tissue quadriceps tendon (dlQUAD) graft for revision ACLR, which allows for easy femoral loop button fixation and limits the harvest depth in the quadriceps tendon.…”