title: Revision arthroscopically assisted anterior cruciate ligament reconstruction with previously unharvested ipsilateral autografts.
abstract: BACKGROUND
  Revision anterior cruciate ligament reconstruction requires flexibility and variability in treatment options. This study analyzed the functional outcomes and graft stability of 48 consecutive revision anterior cruciate ligament reconstructions using previously unharvested ipsilateral autografts.
  
  
  OBJECTIVE
  Using previously unharvested ipsilateral autografts will achieve similar outcomes to other graft choices in revising previously failed anterior cruciate ligament reconstructions.
  
  
  METHODS
  Prospective nonrandomized clinical trial.
  
  
  METHODS
  Forty-eight patients (48 operations) were observed for 2 to 13 years (mean, 90 months). All agreed to have revision reconstruction with ipsilateral autografts. The details of the technique varied according to the original graft choice and the abnormality encountered. Concomitant procedures were necessary in 40 (84%) of 48 knees. Twenty-three patients (48%) had revision reconstruction with previously unharvested ipsilateral autogenous hamstring tendons. Ten (21%) were 2-stranded grafts, and 13 (27%) were 4-stranded (quadrupled) autografts. Twenty-five patients (52%) had revision reconstruction with previously unharvested ipsilateral patellar tendon autografts, 6 (12%) using the 2-incision rear-entry method and 19 (40%) using the single-incision technique.
  
  
  RESULTS
  Results were evaluated with Lysholm and Gillquist scores and International Knee Documentation Committee ratings, including KT-2000 arthrometer examinations. Seventy-three percent of the patients had International Knee Documentation Committee normal (A) or nearly normal (B) knees (42% of the patients had A knees and 42% had B knees). Twelve percent of patients had C knees, and 4% had a D rating. Sixty-seven percent of the knees had a KT-2000 arthrometer side-to-side difference of 3 mm or less, and an additional 21% of the knees had a side-to-side difference of 3 to 5 mm; therefore, 94% of the grafts were functional or partially functional. Six percent of grafts had more than 5 mm of laxity and were considered failures.
  
  
  CONCLUSIONS
  Previously unharvested ipsilateral autografts proved reliable in improving function and stability in revision anterior cruciate ligament reconstruction. However, outcomes were less favorable with revision reconstructions than with primary reconstructions.
authors.affiliation: Christus St. John Sports Medicine Center, Nassau Bay, Texas 77058, USA. nbjs@ev1.net
authors.forename: Daniel B
authors.initials: DB
authors.lastname: O'Neill
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D001182:Arthroscopy / Q000379:methods*; D001265:Athletic Injuries / Q000601:surgery; D016025:Bone Transplantation; D005260:Female; D006085:Graft Survival; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D012086:Reoperation; D013710:Tendons / Q000637:transplantation*; D014182:Transplantation, Autologous; D016896:Treatment Outcome