Descriptive Characteristics and Outcomes of Patients Undergoing Revision Anterior Cruciate Ligament Reconstruction With and Without Tunnel Bone Grafting

MARS Group¹; Steven F DeFroda^{2

1}, Brett D Owens^{3

1}, Rick W Wright^{4

1}, Laura J Huston^{4

1}, Jacquelyn S Pennings^{4

1}, Amanda K Haas^{5

1}, Christina R Allen^{6

1}, Daniel E Cooper^{7

1}, Thomas M DeBerardino^{8

1}, Warren R Dunn^{9

1}, Brett Brick A Lantz^{10

1}, Kurt P Spindler^{11

1}, Michael J Stuart^{12

1}, John P Albright^{13

1}, Annunziato Ned Amendola^{14

1}, Christopher C Annunziata^{15

1}, Robert A Arciero^{16

1}, Bernard R Bach Jr^{17

1}, Champ L Baker 3rd^{18

1}, Arthur R Bartolozzi^{19

1}, Keith M Baumgarten^{20

1}, Jeffery R Bechler^{21

1}, Jeffrey H Berg^{22

1}, Geoffrey A Bernas^{23

1}, Stephen F Brockmeier^{24

1}, Robert H Brophy^{5

1}, Charles A Bush-Joseph^{17

1}, J Brad Butler 5th^{25

1}, James L Carey^{26

1}, James E Carpenter^{27

1}, Brian J Cole^{28

1}, Jonathan M Cooper^{29

1}, Charles L Cox^{4

1}, R Alexander Creighton^{30

1}, Tal S David^{31

1}, David C Flanigan^{32

1}, Robert W Frederick^{33

1}, Theodore J Ganley^{34

1}, Elizabeth A Garofoli^{5

1}, Charles J Gatt Jr^{21

1}, Steven R Gecha^{35

1}, James Robert Giffin^{36

1}, Sharon L Hame^{37

1}, Jo A Hannafin^{38

1}, Christopher D Harner^{39

1}, Norman Lindsay Harris Jr^{40

1}, Keith S Hechtman^{41

1}, Elliott B Hershman^{42

1}, Rudolf G Hoellrich^{10

1}, David C Johnson^{43

1}, Timothy S Johnson^{43

1}, Morgan H Jones^{11

1}, Christopher C Kaeding^{32

1}, Ganesh V Kamath^{30

1}, Thomas E Klootwyk^{44

1}, Bruce A Levy^{45

1}, C Benjamin Ma^{46

1}, G Peter Maiers 2nd^{47

1}, Robert G Marx^{38

1}, Matthew J Matava^{5

1}, Gregory M Mathien^{48

1}, David R McAllister^{37

1}, Eric C McCarty^{49

1}, Robert G McCormack^{50

1}, Bruce S Miller^{27

1}, Carl W Nissen^{51

1}, Daniel F O'Neill^{52

1}, Richard D Parker^{11

1}, Mark L Purnell^{53

1}, Arun J Ramappa^{54

1}, Michael A Rauh^{23

1}, Arthur C Rettig^{44

1}, Jon K Sekiya^{27

1}, Kevin G Shea^{55

1}, Orrin H Sherman^{56

1}, James R Slauterbeck^{57

1}, Matthew V Smith^{5

1}, Jeffrey T Spang^{30

1}, Steven J Svoboda^{58

1}, Timothy N Taft^{30

1}, Joachim J Tenuta^{59

1}, Edwin M Tingstad^{60

1}, Armando F Vidal^{49

1}, Darius G Viskontas^{61

1}, Richard A White^{62

1}, James S Williams Jr^{63

1}, Michelle L Wolcott^{49

1}, Brian R Wolf^{13

1}, James J York^{64

1}

Affiliations

¹ Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA.
² University of Missouri, Columbia, Missouri, USA.
³ Brown Alpert Medical School, Providence, Rhode Island, USA.
⁴ Vanderbilt University, Nashville, Tennessee, USA.
⁵ Washington University in St Louis, St Louis, Missouri, USA.
⁶ Yale University, New Haven, Connecticut, USA.
⁷ W.B. Carrell Memorial Clinic, Dallas, Texas, USA.
⁸ The San Antonio Orthopaedic Group, San Antonio, Texas, USA.
⁹ Texas Orthopedic Hospital, Houston, Texas, USA.
¹⁰ Slocum Research & Education Foundation, Eugene, Oregon, USA.
¹¹ Cleveland Clinic, Cleveland, Ohio, USA.
¹² Mayo Clinic, Rochester, Minnesota, USA.
¹³ University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
¹⁴ Duke University, Durham, North Carolina, USA.
¹⁵ Commonwealth Orthopaedics & Rehabilitation, Arlington, Virginia, USA.
¹⁶ University of Connecticut Health Center, Farmington, Connecticut, USA.
¹⁷ Rush University Medical Center, Chicago, Illinois, USA.
¹⁸ The Hughston Clinic, Columbus, Georgia, USA.
¹⁹ 3B Orthopaedics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.
²⁰ Orthopedic Institute, Sioux Falls, South Dakota, USA.
²¹ University Orthopaedic Associates LLC, Princeton, New Jersey, USA.
²² Town Center Orthopaedic Associates, Reston, Virginia, USA.
²³ State University of New York at Buffalo, Buffalo, New York, USA.
²⁴ University of Virginia, Charlottesville, Virginia, USA.
²⁵ Orthopedic and Fracture Clinic, Portland, Oregon, USA.
²⁶ University of Pennsylvania, Philadelphia, Pennsylvania, USA.
²⁷ University of Michigan, Ann Arbor, Michigan, USA.
²⁸ Rush University Medical Center, Chicago, IL USA.
²⁹ HealthPartners Specialty Center, St Paul, Minnesota, USA.
³⁰ University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.
³¹ Synergy Specialists Medical Group, San Diego, California, USA.
³² The Ohio State University, Columbus, Ohio, USA.
³³ Rothman Institute/Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
³⁴ Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
³⁵ Princeton Orthopaedic Associates, Princeton, New Jersey, USA.
³⁶ Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.
³⁷ David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
³⁸ Hospital for Special Surgery, New York, New York, USA.
³⁹ University of Texas Health Center, Houston, Texas, USA.
⁴⁰ Grand River Health-Rifle, Rifle, Colorado, USA.
⁴¹ UHZ Sports Medicine Institute, Coral Gables, Florida, USA.
⁴² Lenox Hill Hospital, New York, New York, USA.
⁴³ National Sports Medicine Institute, Leesburg, Virginia, USA.
⁴⁴ Methodist Sports Medicine, Indianapolis, Indiana, USA.
⁴⁵ Mayo Clinic Rochester, Rochester, Minnesota, USA.
⁴⁶ University of California, San Francisco, California, USA.
⁴⁷ Methodist Sports Medicine Center, Indianapolis, Indiana, USA.
⁴⁸ Knoxville Orthopaedic Clinic, Knoxville, Tennessee, USA.
⁴⁹ University of Colorado Denver School of Medicine, Denver, Colorado, USA.
⁵⁰ University of British Columbia/Fraser Health Authority, British Columbia, Canada.
⁵¹ Connecticut Children's Medical Center, Hartford, Connecticut, USA.
⁵² Littleton Regional Healthcare, Littleton, New Hampshire, USA.
⁵³ Aspen Orthopedic Associates, Aspen, Colorado, USA.
⁵⁴ Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
⁵⁵ Intermountain Orthopaedics, Boise, Idaho, USA.
⁵⁶ NYU Hospital for Joint Diseases, New York, New York, USA.
⁵⁷ University of South Alabama, Mobile, Alabama, USA.
⁵⁸ Keller Army Community Hospital, United States Military Academy, West Point, New York, USA.
⁵⁹ Albany Medical Center, Albany, New York, USA.
⁶⁰ Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, Washington, USA.
⁶¹ Royal Columbian Hospital, New Westminster, British Columbia, Canada.
⁶² Fitzgibbon's Hospital, Marshall, Missouri, USA.
⁶³ Cleveland Clinic, Euclid, Ohio, USA.
⁶⁴ Orthopaedic and Sports Medicine Center, LLC, Pasedena, Maryland, USA.

PMID: 35833922
PMCID: PMC10326863
DOI: 10.1177/03635465221104470

Descriptive Characteristics and Outcomes of Patients Undergoing Revision Anterior Cruciate Ligament Reconstruction With and Without Tunnel Bone Grafting

MARS Group et al. Am J Sports Med. 2022 Jul.

. 2022 Jul;50(9):2397-2409.

doi: 10.1177/03635465221104470.

Authors

Affiliations

¹ Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA.
² University of Missouri, Columbia, Missouri, USA.
³ Brown Alpert Medical School, Providence, Rhode Island, USA.
⁴ Vanderbilt University, Nashville, Tennessee, USA.
⁵ Washington University in St Louis, St Louis, Missouri, USA.
⁶ Yale University, New Haven, Connecticut, USA.
⁷ W.B. Carrell Memorial Clinic, Dallas, Texas, USA.
⁸ The San Antonio Orthopaedic Group, San Antonio, Texas, USA.
⁹ Texas Orthopedic Hospital, Houston, Texas, USA.
¹⁰ Slocum Research & Education Foundation, Eugene, Oregon, USA.
¹¹ Cleveland Clinic, Cleveland, Ohio, USA.
¹² Mayo Clinic, Rochester, Minnesota, USA.
¹³ University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
¹⁴ Duke University, Durham, North Carolina, USA.
¹⁵ Commonwealth Orthopaedics & Rehabilitation, Arlington, Virginia, USA.
¹⁶ University of Connecticut Health Center, Farmington, Connecticut, USA.
¹⁷ Rush University Medical Center, Chicago, Illinois, USA.
¹⁸ The Hughston Clinic, Columbus, Georgia, USA.
¹⁹ 3B Orthopaedics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.
²⁰ Orthopedic Institute, Sioux Falls, South Dakota, USA.
²¹ University Orthopaedic Associates LLC, Princeton, New Jersey, USA.
²² Town Center Orthopaedic Associates, Reston, Virginia, USA.
²³ State University of New York at Buffalo, Buffalo, New York, USA.
²⁴ University of Virginia, Charlottesville, Virginia, USA.
²⁵ Orthopedic and Fracture Clinic, Portland, Oregon, USA.
²⁶ University of Pennsylvania, Philadelphia, Pennsylvania, USA.
²⁷ University of Michigan, Ann Arbor, Michigan, USA.
²⁸ Rush University Medical Center, Chicago, IL USA.
²⁹ HealthPartners Specialty Center, St Paul, Minnesota, USA.
³⁰ University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.
³¹ Synergy Specialists Medical Group, San Diego, California, USA.
³² The Ohio State University, Columbus, Ohio, USA.
³³ Rothman Institute/Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
³⁴ Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
³⁵ Princeton Orthopaedic Associates, Princeton, New Jersey, USA.
³⁶ Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.
³⁷ David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
³⁸ Hospital for Special Surgery, New York, New York, USA.
³⁹ University of Texas Health Center, Houston, Texas, USA.
⁴⁰ Grand River Health-Rifle, Rifle, Colorado, USA.
⁴¹ UHZ Sports Medicine Institute, Coral Gables, Florida, USA.
⁴² Lenox Hill Hospital, New York, New York, USA.
⁴³ National Sports Medicine Institute, Leesburg, Virginia, USA.
⁴⁴ Methodist Sports Medicine, Indianapolis, Indiana, USA.
⁴⁵ Mayo Clinic Rochester, Rochester, Minnesota, USA.
⁴⁶ University of California, San Francisco, California, USA.
⁴⁷ Methodist Sports Medicine Center, Indianapolis, Indiana, USA.
⁴⁸ Knoxville Orthopaedic Clinic, Knoxville, Tennessee, USA.
⁴⁹ University of Colorado Denver School of Medicine, Denver, Colorado, USA.
⁵⁰ University of British Columbia/Fraser Health Authority, British Columbia, Canada.
⁵¹ Connecticut Children's Medical Center, Hartford, Connecticut, USA.
⁵² Littleton Regional Healthcare, Littleton, New Hampshire, USA.
⁵³ Aspen Orthopedic Associates, Aspen, Colorado, USA.
⁵⁴ Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
⁵⁵ Intermountain Orthopaedics, Boise, Idaho, USA.
⁵⁶ NYU Hospital for Joint Diseases, New York, New York, USA.
⁵⁷ University of South Alabama, Mobile, Alabama, USA.
⁵⁸ Keller Army Community Hospital, United States Military Academy, West Point, New York, USA.
⁵⁹ Albany Medical Center, Albany, New York, USA.
⁶⁰ Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, Washington, USA.
⁶¹ Royal Columbian Hospital, New Westminster, British Columbia, Canada.
⁶² Fitzgibbon's Hospital, Marshall, Missouri, USA.
⁶³ Cleveland Clinic, Euclid, Ohio, USA.
⁶⁴ Orthopaedic and Sports Medicine Center, LLC, Pasedena, Maryland, USA.

PMID: 35833922
PMCID: PMC10326863
DOI: 10.1177/03635465221104470

Abstract

Background: Lytic or malpositioned tunnels may require bone grafting during revision anterior cruciate ligament reconstruction (rACLR) surgery. Patient characteristics and effects of grafting on outcomes after rACLR are not well described.

Purpose: To describe preoperative characteristics, intraoperative findings, and 2-year outcomes for patients with rACLR undergoing bone grafting procedures compared with patients with rACLR without grafting.

Study design: Cohort study; Level of evidence, 3.

Methods: A total of 1234 patients who underwent rACLR were prospectively enrolled between 2006 and 2011. Baseline revision and 2-year characteristics, surgical technique, pathology, treatment, and patient-reported outcome instruments (International Knee Documentation Committee [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS], Western Ontario and McMaster Universities Osteoarthritis Index, and Marx Activity Rating Scale [Marx]) were collected, as well as subsequent surgery information, if applicable. The chi-square and analysis of variance tests were used to compare group characteristics.

Results: A total of 159 patients (13%) underwent tunnel grafting-64 (5%) patients underwent 1-stage and 95 (8%) underwent 2-stage grafting. Grafting was isolated to the femur in 31 (2.5%) patients, the tibia in 40 (3%) patients, and combined in 88 patients (7%). Baseline KOOS Quality of Life (QoL) and Marx activity scores were significantly lower in the 2-stage group compared with the no bone grafting group (P≤ .001). Patients who required 2-stage grafting had more previous ACLRs (P < .001) and were less likely to have received a bone-patellar tendon-bone or a soft tissue autograft at primary ACLR procedure (P≤ .021) compared with the no bone grafting group. For current rACLR, patients undergoing either 1-stage or 2-stage bone grafting were more likely to receive a bone-patellar tendon-bone allograft (P≤ .008) and less likely to receive a soft tissue autograft (P≤ .003) compared with the no bone grafting group. At 2-year follow-up of 1052 (85%) patients, we found inferior outcomes in the 2-stage bone grafting group (IKDC score = 68; KOOS QoL score = 44; KOOS Sport/Recreation score = 65; and Marx activity score = 3) compared with the no bone grafting group (IKDC score = 77; KOOS QoL score = 63; KOOS Sport/Recreation score = 75; and Marx activity score = 7) (P≤ .01). The 1-stage bone graft group did not significantly differ compared with the no bone grafting group.

Conclusion: Tunnel bone grafting was performed in 13% of our rACLR cohort, with 8% undergoing 2-stage surgery. Patients treated with 2-stage grafting had inferior baseline and 2-year patient-reported outcomes and activity levels compared with patients not undergoing bone grafting. Patients treated with 1-stage grafting had similar baseline and 2-year patient-reported outcomes and activity levels compared with patients not undergoing bone grafting.

Keywords: bone graft; outcomes; revision anterior cruciate ligament reconstruction; tunnel lysis.

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References

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Descriptive Characteristics and Outcomes of Patients Undergoing Revision Anterior Cruciate Ligament Reconstruction With and Without Tunnel Bone Grafting

Affiliations

Descriptive Characteristics and Outcomes of Patients Undergoing Revision Anterior Cruciate Ligament Reconstruction With and Without Tunnel Bone Grafting

Authors

Affiliations

Abstract

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical