title: Comparison of revision surgery with primary anterior cruciate ligament reconstruction and outcome of revision surgery between different graft materials.
abstract: BACKGROUND
  The number of primary anterior cruciate ligament reconstructions is increasing rapidly; the number of failing grafts and need for revision surgery have also risen.
  
  
  OBJECTIVE
  Revision anterior cruciate ligament reconstruction will produce similar results to those of primary reconstruction, and there may be different results according to graft materials.
  
  
  METHODS
  Case control study; Level of evidence, 3.
  
  
  METHODS
  Fifty-nine revision surgeries were performed at 1 institution between January 1997 and October 2005. Fifty-five patients (56 operations) were followed. The results of 117 patients (117 knees) treated with arthroscopic primary anterior cruciate ligament reconstruction using double-looped semitendinosus and gracilis autograft from September 2001 to November 2002 were also evaluated. Clinical and stability results between primary and revision anterior cruciate reconstruction were compared. For the revision surgery, 21 (37.5%) knees had revision reconstruction with previously unharvested ipsilateral double-looped semitendinosus and gracilis autograft. Twenty (35.7%) were bone-patellar tendon-bone allograft, and 15 (26.8%) were Achilles allograft. The details of the technique varied according to the original graft choice and the abnormality encountered. Concomitant procedures were necessary in 32 (57.1%) of 56 knees. Clinical and stability results according to the different graft materials were also compared.
  
  
  RESULTS
  There were significant improvements in the scores for subjective, objective forms (P < .001), and stability (P < .001). However, the clinical results of revision surgery were inferior to primary reconstruction (P < .001), but as regards stability, the difference between primary and revision cases was not significant (P = .338). There was no difference in clinical and stability results in different groups of graft material (P = .160-.690).
  
  
  CONCLUSIONS
  Revision anterior cruciate ligament reconstruction could improve clinical and stability results, but the clinical results were inferior to those of primary reconstruction. This study also demonstrated that the success of the operation did not depend on the choice of graft materials.
authors.affiliation: Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Jin Hwan
authors.initials: JH
authors.lastname: Ahn
authors.forename: Yong Seuk
authors.initials: YS
authors.lastname: Lee
authors.forename: Hae Chan
authors.initials: HC
authors.lastname: Ha
mesh_terms: D000125:Achilles Tendon / Q000637:transplantation*; D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000000981:diagnostic imaging / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D050376:Bone-Patellar Tendon-Bone Grafting; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D017211:Treatment Failure; D055815:Young Adult