Clinical outcomes and return to sport after single-stage revision anterior cruciate ligament reconstruction by bone-patellar tendon autograft combined with lateral extra-articular tenodesis

Abstract

Purpose: The anterior cruciate ligament reconstruction (ACLR) failure rate continues to increase. Involvement of a young population with a desire to return to sport, explains the increased need for ACLR (revACLR) revision. The aim of this study was to evaluate clinical outcome, complications, failure rate and return to sport of a single-stage revACLR using bone patellar tendon-bone (BTBT) combined with lateral extra-articular tenodesis (LET).

Material and methods: A retrospective analysis was performed on 36 patients who underwent revACLR. Knee stability was assessed by Lachman and Pivot shift test. Objective anterior laxity was determined by KT-2000 arthrometer. The IKDC subjective, Lysholm, ACL-RSI Scores, level of sport activity and Forgotten Joint Score-12 were recorded.

Results: Of 36 patients, we collected data from 17 who underwent single-stage revACLR with autologous BTBT combined with LET, performed using an extra-articular MacIntosh procedure as modified by Arnold-Coker. The side-to-side difference in Lachman test and Pivot shift test significantly improved postoperatively. The subjective IKDC, Lysholm and ACL-RSI significantly improved from 71.4 ± 9.03 to 92 ± 6.9, from 58.3 ± 19.3 to 66.8 ± 27.7 and from 50.4 ± 12.2 to 68.6 ± 24.5, respectively during the post-operative follow-up. Ten patients (58.8%) returned to their desired level of sport. One patient was considered a failure because of the postoperative laxity.

Conclusion: Single-stage revACLR with BPTB combined with LET is a safe procedure that shows good objective and subjective outcomes, and a high rate of return to the same level of sport. Reducing rotational instability and strain on intra-articular reconstructed structures results in a low rate of complications and failure.

Keywords: Anterior cruciate ligament; Bone patellar tendon bone; Lateral extra-articular tenodesis; Revision ACLR; Single-stage revision.

Fig. 1

Patients excluded and included in the study

Fig. 2

A 3D-CT reconstruction of femoral lateral condyle in the sagittal view (with suppression of the medial femoral condyle), with no superimposition between the previous (blu) and the new planned tunnels (green) B 3D-CT reconstruction of femoral lateral condyle in the sagittal view, case of not tolerated superimposition between the old and new planned tunnels, that required two-stage revACLR (colour figure online)

Fig. 3

A 3D-CT reconstruction of the tibial plateau in the axial view with complete superimposition between the previous (blu) and the new planned tunnels (green); B 3D-CT reconstruction of the tibial plateau in the axial view with tolerated superimposition, candidate for single-stage revACLR (colour figure online)

Fig. 4

A Ileotibial band (ITB) incision starting from the Gerdy’s tubercle (GT) for 10 cm proximally B The harvested ileotibial band before passing under the lateral collateral ligament C The ileotibial band sutured to the lateral collateral ligament and to itself and to Gerdy’s tubercle

Fig. 5

A ACL-RSI score range pre and post-surgery, B IKDC score range pre and post-surgery, C Lysholm score range pre and post-surgery. The box height represents the interquartile range (Q1–Q3), the line within the box is the median value, the lower and upper whiskers represent the lowest and the highest samples, respectively. Circles in boxplots represent outlier samples (> 1.5xIQR)