Revision anterior cruciate ligament reconstruction with nonirradiated fresh-frozen patellar tendon allograft.
OBJECTIVE
To evaluate the effectiveness of a revision anterior cruciate ligament reconstruction with nonirradiated patellar tendon allograft used to salvage a failed index patellar tendon autograft procedure.


METHODS
Retrospective case series with minimum 2-year follow-up.


METHODS
Between 1993 and 1999, 39 patients underwent a revision reconstruction. Clinical, radiographic, arthrometric, and functional evaluations were performed. The Tegner, Lysholm, Noyes, Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), and SF-12 rating scales were used. Statistical analysis was conducted with our Biostatistics Department.


RESULTS
Thirty-two of 38 patients (84%) were personally evaluated. The mean patient age was 28 years (range, 16 to 57 years); the mean follow-up was 4.8 years (range, 2.1 to 12.1 years). After revision, there were significant improvements in the Lachman and pivot-shift test results: 87% had a grade 0/1+ Lachman and a 0/1+ pivot-shift. However, 25% had a grade 1+ pivot-shift. Postoperatively, KT-1000 testing revealed that 84% had a maximum manual side-to-side difference of < or =3 mm and 6% had >5 mm. Functional testing revealed a mean 4% difference in side-to-side comparisons for a single-leg hop for distance and time, as well as vertical jump. The mean results of Noyes sports function (72), Lysholm (75), Tegner (6.3), KOOS sports activity scale (67), SF-12 physical component (48), SF-12 mental component (55), and IKDC (71) were obtained. The Noyes sports activity score showed a significant improvement from 55 preoperatively to 70 at follow-up. Subjectively, 87% of patients indicated that they were completely or mostly satisfied with the surgical outcome. One patient required another revision.


CONCLUSIONS
The 2- to 11-year follow-up showed that the results of revision ACL reconstruction with a nonirradiated patellar tendon allograft were less favorable than those of a primary anterior cruciate ligament reconstruction, with a lower subjective satisfaction level and a higher percentage of patients with grade 1+ or higher pivot-shift results. However, when compared with previously published reports, our results were comparable and underscore that revision anterior cruciate ligament surgery should be approached with tempered enthusiasm and careful preoperative counseling, and considered as a salvage procedure.


METHODS
Level IV.
Fox
Jeff A
JA
Central States Orthopedic Specialists, Tulsa Sports Medicine and Wellness Center, Tulsa, Oklahoma, USA.
Pierce
Mark
M
Bojchuk
John
J
Hayden
Jennifer
J
Bush-Joseph
Charles A
CA
Bach
Bernard R
BR
D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000000981:diagnostic imaging / Q000601:surgery*; D001182:Arthroscopy / Q000379:methods; D001265:Athletic Injuries / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D011795:Surveys and Questionnaires; D013710:Tendons / Q000637:transplantation*; D014184:Transplantation, Homologous; D016896:Treatment Outcome