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Review
. 2013 Aug 27;1(3):2325967113501789.
doi: 10.1177/2325967113501789. eCollection 2013 Aug.

A Retrospective Review of Anterior Cruciate Ligament Reconstruction Using Patellar Tendon: 25 Years of Experience

Jaskarndip Chahal  1 , Andrew Lee  2 , Wendell Heard  3 , Bernard R Bach Jr  2
Affiliations
Review

A Retrospective Review of Anterior Cruciate Ligament Reconstruction Using Patellar Tendon: 25 Years of Experience

Jaskarndip Chahal et al. Orthop J Sports Med. .

Abstract

Background: The comparative data in the literature regarding rates of reoperation, revision ligament surgery, and contralateral surgery following anterior cruciate ligament reconstruction (ACLR) are variable and are often derived from studies with multiple surgeons, multiple centers, different surgical techniques, and a wide variety of graft choices.

Purpose: To describe and analyze a single surgeon's experience with ACLR using bone-patellar tendon-bone (BPTB) as the primary graft choice over a 25-year period.

Study design: Retrospective case series.

Methods: All patients who underwent ACLR from 1986 to 2012 were identified from a prospectively maintained database. Traditional follow-up was only for patients who sought subsequent surgery with the index surgeon or presented with contralateral ACL injury. Covariates of interest included age, sex, time, and graft selection. Outcomes of interest included reoperation rates after primary/revision ACLR, rate of revision ACLR, success of meniscal repair with concomitant ACLR, and the proportion of patients undergoing contralateral surgery.

Results: A total of 1981 patients (mean age, 29 years; 49% male) were identified. Of patients undergoing primary ACLR (n = 1809), 74% had BPTB autograft and 26% had a central third BPTB allograft. The mean age of patients undergoing autograft and allograft ACLR was 26 and 36 years, respectively (P < .05). Allograft tissue usage increased over time (P < .05). The rate of personal ACLR revision surgery was 1.7% (n = 30) for primary cases and 3.5% (n = 6) for revision cases. There were no significant differences in revision rates between primary autograft (1.6%) and allograft (2.0%) ACLR. With allograft use, the method of sterilization did not affect revision rates. The overall reoperation rate following primary ACLR was 10%; the 5-year reoperation rate was 7.7%. The reoperation rate was lower for primary cases reconstructed with allograft versus autograft (5% vs 12%) (P < .0001). Among primary ACLR cases, 332 patients (18%) underwent concomitant meniscal repair; 14% required revision meniscal surgery. The rate of contralateral ACLR was 6%.

Conclusion: This information is useful for patients in the informed consent process, for perioperative decision making regarding graft choice, and for identifying patients who are at risk for injuring the uninvolved knee. The observed results in this series also emphasize that allograft ACLR can produce sustainable results with low complication rates in appropriately selected patients.

Keywords: allograft; anterior cruciate ligament; contralateral; reoperation rate; revision rate.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: B.R.B. has received educational grants to support the sports medicine fellowship from Smith & Nephew Endoscopy, Ossur, MioMed, Conmed Linvatec, Athletico, Arthrex, and Mitek and has received royalties from Slack Inc.

Figures

Figure 1.
Figure 1.
Age distribution of patients undergoing bilateral anterior cruciate ligament reconstruction (ACLR).
Figure 2.
Figure 2.
Changes in graft selection over time.
Figure 3.
Figure 3.
Graft selection based on patient age. (A) Distribution of total autograft and allograft use according to age. More than 50% of autograft cases are in patients <25 years, while more than 50% of allograft cases are in patients >35 years. (B) Percentage of total anterior cruciate ligament reconstructions (ACLRs) performed with autograft versus allograft based on patient age.
Figure 4.
Figure 4.
Reoperation following index primary or revision anterior cruciate ligament reconstruction (ACLR). PLCR, posterolateral corner reconstruction; HFPS, hypertrophic fat pad syndrome; HTO, high tibial osteotomy; NYD, not yet diagnosed.
Figure 5.
Figure 5.
Reoperation rates over time for all patients.
See this image and copyright information in PMC

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