title: Single-stage anterior cruciate ligament revision with bone-patellar tendon-bone: a case-control series of revision of failed synthetic anterior cruciate ligament reconstructions.
abstract: OBJECTIVE
  The purpose of this study was to investigate the clinical results of single-stage revision anterior cruciate ligament reconstruction (ACLR) after synthetic ligament failure.
  
  
  METHODS
  The subjects comprised 20 patients who underwent revision ACLR after synthetic ligament failure. All revisions were performed with bone-patellar tendon-bone graft, and bone tunnel expansion after removal of synthetic materials was treated with bone plugs sized and trimmed as necessary to fill the bone tunnels. Clinical results were assessed at a mean of 2.8 years postoperatively, followed by comparison with the results of 20 primary ACLRs selected as case-matched controls. Assessment included the Lysholm score, International Knee Documentation Committee (IKDC) evaluation, instrumented laxity testing, and radiologic examination.
  
  
  RESULTS
  Bone tunnel enlargement to 11 mm in diameter or greater was found in 10 of 20 revision ACLRs. However, favorable anteroposterior stability was obtained at final follow-up (1.4 +/- 2.0 mm in revision ACLR group and 1.5 +/- 1.5 mm in primary ACLR group). The overall Lysholm score improved significantly from preoperatively to final follow-up, but the revision ACLR group showed significantly worse results for the pain parameter than the primary ACLR group. The final IKDC results also showed significant postoperative improvement, but the number of cases with grade C was significantly higher in the revision ACLR group than in the primary ACLR group, which was attributed to radiologically confirmed osteoarthritis in the revision ACLR group.
  
  
  CONCLUSIONS
  Single-stage revision ACLR with bone-patellar tendon-bone graft after synthetic ligament failure yielded favorable results in terms of IKDC grade, Lysholm score, and anteroposterior stability, despite enlarged bone tunnels after removal of synthetic material. Inferior results for the radiologic and pain parameters of the IKDC and Lysholm scores were attributed to osteoarthritic changes inherent to the revision ACLR group.
  
  
  METHODS
  Level III, therapeutic case-control study.
authors.affiliation: Department of Orthopaedic Surgery, Keio University, Tokyo, Japan. y.niki@lib.bekkoame.ne.jp
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Niki
authors.forename: Hideo
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Enomoto
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Toyama
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Suda
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D050376:Bone-Patellar Tendon-Bone Grafting; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019736:Prostheses and Implants; D011475:Prosthesis Failure; D019651:Plastic Surgery Procedures; D012086:Reoperation; D055815:Young Adult