Anterior cruciate ligament revision reconstruction: results using a quadriceps tendon-patellar bone autograft.
BACKGROUND
The quadriceps tendon is a viable graft source for revision anterior cruciate ligament reconstruction.


OBJECTIVE
To determine the functional results and graft failure rates in knees in which the patellar tendon had been previously harvested or was unavailable, expanded tunnels precluded the use of a semitendinosus-gracilis graft, or patients requested autogenous tissues instead of allografts for revision reconstruction.


METHODS
Case series; Level of evidence, 4.


METHODS
The authors observed 21 patients for a mean of 49 months postoperatively after revision anterior cruciate ligament reconstruction with a quadriceps tendon graft. The results were determined by KT-2000 arthrometer testing, the Cincinnati Knee Rating System, and the International Knee Documentation Committee Rating System. Fifteen knees required a concurrent procedure, including reconstruction of posterolateral structures in 5 knees, meniscal repairs in 5 knees, and high tibial osteotomy in 2 knees.


RESULTS
Significant improvements occurred in symptoms (P < .0001), daily activities (P < .05), sports activities (P < .01), and the overall rating scores (P < .0001). Eighteen patients rated their knee condition as improved. Total mean anterior-posterior displacements decreased from 8.4 +/- 3.1 mm preoperatively to 2.0 +/- 2.3 mm at follow-up (P < .001). On the International Knee Documentation Committee knee ligament rating, 17 knees were graded as normal or nearly normal, 3 were graded as abnormal, and 1 was graded as severely abnormal.


CONCLUSIONS
The revision operation provided reasonable results in this group of complex knees. However, the functional and overall results were inferior to those reported for primary anterior cruciate ligament reconstruction. Many knees (90%) had compounding problems of articular cartilage damage, meniscectomy, varus malalignment, or additional ligamentous injury that most likely affected the results.
Noyes
Frank R
FR
Cincinnati Sportsmedicine Research and Education Foundation, 10663 Montgomery Road, Cincinnati, OH 45242, USA.
Barber-Westin
Sue D
SD
D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D050376:Bone-Patellar Tendon-Bone Grafting; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000601:surgery; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular; D012086:Reoperation; D014182:Transplantation, Autologous; D016896:Treatment Outcome