title: Revision anterior cruciate ligament reconstruction with ipsi- or contralateral hamstring tendon grafts.
abstract: OBJECTIVE
  With the increasing number of primary anterior cruciate ligament (ACL) reconstructions, the need for revision ACL surgery has risen over the past few years. The purpose of the present study is to retrospectively compare the clinical outcome of ipsilateral versus contralateral hamstring tendon autografts for ACL revision surgery, specifically with regard to patient satisfaction, post-operative functional outcomes, and return to sports.
  
  
  METHODS
  Between 2004 and 2011, 64 patients underwent ACL revision surgery. Forty-five were successfully recontacted and retrospectively reviewed at an average follow-up of 6.3 years. Twenty-two subjects underwent revision ACL reconstruction with ipsilateral autogenous hamstring tendon grafts; in 23 subjects contralateral hamstring were used for reconstruction. Clinical, arthrometric, and functional evaluations were performed. The Tegner activity level, Knee Injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) Subjective Knee Form were used. Objective evaluation included range of motion, Lachman test, pivot shift test and KT-1000 instrumented laxity testing.
  
  
  RESULTS
  No major complications were reported. Follow-up examination showed that there were no significant differences in the IKDC and KOOS scores between the groups. No differences in anterior tibial translation as measured with KT-1000 arthrometer were reported between the groups, although there was a trend for more of the patients undergoing ipsilateral DGST reconstruction to have a glide on the pivot shift test. The percentage of patients returning to pre-injury level was high in both groups.
  
  
  CONCLUSIONS
  The use of contralateral hamstring tendon autografts for ACL revision surgery produced similar subjective and objective outcomes at 6-years follow-up compared to revision with ipsilateral hamstring tendon autografts. Patients undergoing revision surgery with contralateral autografts experienced a quicker return to sports compared to patients who underwent ipsilateral DGST revision surgery.
authors.affiliation: IRCCS Galeazzi Orthopaedic Institute, Milan, Italy. clegnan@alice.it.
authors.forename: Claudio
authors.initials: C
authors.lastname: Legnani
authors.affiliation: IRCCS Galeazzi Orthopaedic Institute, Milan, Italy.|Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Peretti
authors.affiliation: Sports Traumatology and Minimally Invasive Articular Surgery Center, San Siro Clinical Institute, Milan, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Borgo
authors.affiliation: Scuola di Specializzazione in Ortopedia e Traumatologia, Policlinico Universitario P. Giaccone, Palermo, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Zini
authors.affiliation: Sports Traumatology and Minimally Invasive Articular Surgery Center, San Siro Clinical Institute, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Ventura
mesh_terms: D000293:Adolescent; D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries / Q000601:surgery; D059549:Anterior Cruciate Ligament Reconstruction / Q000009:adverse effects* / Q000379:methods; D064592:Autografts; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D000070632:Hamstring Tendons / Q000637:transplantation*; D006801:Humans; D007593:Joint Instability / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000502:physiology*; D012086:Reoperation / Q000379:methods* / Q000534:rehabilitation; D012189:Retrospective Studies; D018570:Risk Assessment; D016378:Tissue Transplantation / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
keywords: ACL revision surgery; Anterior cruciate ligament; Contralateral; Ipsilateral