Revision Anterior Cruciate Ligament Reconstruction with Contralateral Hamstring Tendon Grafts: 6 Years Follow-Up

Abstract

Purpose The purpose of this study was to retrospectively evaluate the clinical outcome of revision anterior cruciate ligament (ACL) reconstruction with contralateral hamstring tendon autografts, specifically with regard to patient satisfaction, return to preinjury activity level, and postoperative functional outcomes. Methods Between 2004 and 2011, 23 patients underwent revision ACL reconstruction with contralateral autogenous hamstring tendon grafts and were retrospectively reviewed at an average follow-up of 6.3 years. Subjective and functional evaluations were performed. The Tegner score, Knee Injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) Subjective Knee Form were used. Objective evaluation included range of motion, Lachman test, pivot-shift test, and KT-1000 instrumented laxity testing. Wilcoxon test was used to compare the preoperative and follow-up status. Differences with a p -value of <0.05 were considered statistically significant. Results No major complications were reported. The mean KOOS significantly increased from a preoperative mean of 62.8 ± 8.3 to 85.8 ± 6.9 ( p < 0.001). IKDC subjective score significantly improved from 29.2 ± 10.4 to 72.8 ± 5.2 ( p < 0.001). The median Tegner activity score significantly improved from a preoperative mean of 6.5 (range: 4–10) to 7.5 (range: 7–10) ( p < 0.001). Most of the patients increased or returned to the same activity level, with 61% of the patients returning to cutting and pivoting sports. Conclusion The use of contralateral hamstring tendon autografts for ACL revision surgery represents a valid option following a failed primary ACL reconstruction and confirms subjective and objective clinical improvement 6 years after surgery. Level of Evidence Level IV, therapeutic case series.

Outcome After Anterior Cruciate Ligament Revision

“…A contralateral autologous graft harvest for ACL revision could be advantageous in order to avoid further donor site morbidity in the injured limb. Studies on contralateral hamstring (HT) harvest for ACL revision report this as a feasible option [33], with a similar clinical and patient-reported outcome compared with both ipsilateral HT harvest and allograft [34–36].…”

“…Pooling of the current literature indicates improved PRO following ACL revision compared with what patients report preoperatively [36, 40, 57, 58], though the results appear inferior compared with primary ACL reconstruction [53•]. However, most studies evaluating outcome following ACL surgery compare primary ACL and revision ACL reconstruction, the latter one with small study samples which should be acknowledged when interpreting study results.…”

Equivalent outcomes of ACL revision with over-the-top single and double-bundle reconstruction using hamstring tendon compared to anatomical single and double-bundle reconstruction

“…Preoperative planning for revision ACLR involves the evaluation of the primary bone tunnel, selection of single or second stage, selection of the graft tendon to be used, and the method of reconstruction [ 2 , 6 , 10 , 11 , 18 , 19 , 22 ]. Preoperative bone tunnel evaluation can be most accurately assessed with 3D-CT, and the decision to use a bone tunnel can be made preoperatively [ 9 ].…”

“…As for the choice of graft tendon, several methods can be used, such as using BTB, quadriceps tendon, and hamstring tendon, all of which have been reported to provide good results [ 11 , 19 , 22 ]. Therefore, it is considered best to use the surgeon’s preferred tendon.…”

Correlation of Isokinetic Testing and ACL Failure With the Short Graft Tape Suspension Technique at Six Months

“…The rates of rerupture after anterior cruciate ligament reconstruction are of the order of 1.7 to 10.3% when considering studies with a minimum 3-year follow-up in cases of semitendinosus/gracilis tendons autograft (ST/G). 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 Although mispositioning of bone tunnels is the primary cause of anterior cruciate ligament (ACL) reconstruction rerupture by positive or negative anisometry ranging from 52.2% to 95.6%, 9 , 10 , 11 , 12 , 13 the number of risk factors for rerupture are clearly identified in the literature, including genu varum, posterior tibial slope, anterior tibial subluxation and intercondylar notch size. 14 , 15 , 16 , 17 , 18 While data on muscle recovery and return-to-sport (RTS) are very well documented.…”