Abstract
Introduction
Numerous types of graft can be used for revision of anterior cruciate ligament (ACL) reconstruction. The goal of our studies was to analyze mid term outcomes of revision of anterior cruciate ligament reconstructions conducted by means of ipsilateral bone -patellar tendon -bone (B-PT-B) transplant.
Materials and methods
We conducted a retrospective study on a consecutive series of 44 patients. All patients were operated on by the same senior surgeon in our institution between 2003 and 2009. All patients had undergone a first ACL reconstruction with B-PT-B transplant. They all had ACL revision under arthroscopic assistance and by means of ipsilateral B-PT-B transplant after a minimum of 18 months after primary surgery. At time of ACL revision, the mean patients age was 28 years (range, 17–49 years). The average postoperative follow up after revision was 55 months (range, 12–88 months). We had no patient lost to follow up. All patients were evaluated by an independent observer using IKDC scoring system and KT 2000.
Results
The postoperative IKDC score averaged 78.2 (range, 41,4–97,7). 10 patients (22.7%) had their knee graded A, 25 patients (56.8%) grade B, 8 patients (18.2%) grade C and one patient (2.3%) grade D. The post operative maxi manual differential KT 2000 averaged 1,52 mm (range, −1mm/12mm). The identified aetiologies for poor clinical outcomes were menisectomy in the first ACL reconstruction (p<0.01) and articular cartilage lesions (ICRS grade III and IV) found during ACL revision. In most cases, return to sport activities was achieved but not at the same level. We had no specific complication after second harvesting of the patellar tendon.
Discussion
The type of graft used in revision of ACL reconstructions is a controversy. In the literature, many studies reported the results of revision of ACL reconstructions but with poor methodology and few data for every type of graft. In our study, we found clinical results comparable to those classically reported in the literature. Clinical evaluation showed good control of the laxity and no specific patellar tendon complication.
Conclusion
The clinical results of revision of ACL reconstructions is lower than in primary surgery. We did not noticed specific patellar tendon complication after second harvesting of BPTB transplant. The revision of ACL reconstruction with ipsilateral BPTB transplant showed good clinical results and good control of the anteroposterior laxity.
