Revision of failed anterior cruciate ligament reconstruction with quadrupled semitendinosus allograft: intermediate-term outcome

Abstract

Purpose: The aim of the present study is to present intermediate-term clinical outcome after revision anterior cruciate ligament (ACL) reconstruction using semitendinosus allograft from donor less than 65 years old.

Methods: A retrospective study of patients treated with ACL revision from 2003 to 2011 at a District General Hospital. A Study follow-up took place in 2014; clinical outcomes were measured by IKDC, Tegner, Lysholm, and Pain scores and KT-1000 arthrometry laxity measurements. We also registered reoperations and complications.

Results: Nineteen patients were available for follow-up, and one had telephonic interview. Mean follow-up time was 6 (3-9) years and mean age was 33.68 years, and 14 were men and six women. One patient required staged procedures, 5% were re-revised for early graft failure and clinical instability, and 15% had reoperations for other pathologies. The data analysis reveals statistically significant differences between preoperative and postoperative scores. Lysholm score improved from preoperatively 55.5±11 points (range 35-71 points) to postoperatively 89.7±10 points (range 55-100 points), Tegner activity scale score improved from 2.7±1.3 points (range 1-5 points) to 7.1±2.2 points (range 1-10). Pain score improved from 7.7±1.5 (range 4-10 points) to 1.1±1.9 (range 0-8 points). Level of Activity score improved from 3.6±1.1 (range 2-6 points) to 8.8±1.6 (range 3-10 points).

Conclusion: In our patient series, revision ACL reconstruction showed a statistically significant improvement in postoperative subjective and objective scores. Five percent failure after mean 6 years (3-9 years) is less compared to other studies; surgical technique and donor age could have played a significant role in lower failure rate. In our series 50% patients had meniscal and 55% had Gr I/II chondral injury, this could also explain lower failure rate. Revision of a failed ACL reconstruction using semitendinosus allograft is a safe procedure that improves the function of the patient as demonstrated by clinical scores.

Level of evidence: Retrospective case series, Level IV.