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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 8/2023

04-04-2023 | KNEE

Good stability and mid-term subjective outcomes after repeated anterior cruciate ligament (ACL) revision surgery using allografts

Authors: Alberto Grassi, Sergio Cialdella, Gianluca Costa, Nicola Pizza, Luca Macchiarola, Giacomo Dal Fabbro, Mirco Lo Presti, Stefano Zaffagnini

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 8/2023

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Abstract

Purpose

To evaluate the mid-term clinical outcomes of a cohort of patients who underwent multiple ACL revision reconstructions. The hypothesis was that patients with pre-existing meniscal deficiency conditions, malalignment and cartilage degeneration would have obtained lower results.

Methods

All cases of multiple ACL revisions performed with allograft tissue at one single sport-medicine institution were extracted and patients with a minimum 2 years of follow-up were included. WOMAC, Lhysolm, IKDC, and Tegner activity level before the injury and at last follow-up was collected and laxity evaluated with KT-1000 arthrometer and KiRA triaxial accelerometer.

Results

From a cohort of 241 ACL revisions, 28 patients (12%) with Repeated ACL Revision reconstructions were included. Fourteen cases (50%) were considered “Complex” due to the addition of meniscal allograft transplantation (8) or meniscal scaffold (3) or high tibial osteotomy (3). The remaining 14 cases (50%) were considered as “Isolate”. The mean WOMAC score was 84.6 ± 11.4, Lysholm 81.7 ± 12.3, subjective IKDC 77.2 ± 12.1, and median Tegner score 6 (IQR 5–6) at pre-injury and at final follow-up. Statistically significant inferior values of WOMAC (p = 0.008), Lysholm (p = 0.02) and Subjective IKDC (p = 0.0193) were detected between “Complex” and “Isolate” revision groups. Higher average values of anterior translation at KT-1000 at both 125 N (p = 0.03) and manual maximum displacement test (p = 0.03) were reported in “Complex” with respect to “Isolate” revisions. Four patients were considered as failures and occurred in patients with “Complex” revisions, none occurred in the “Isolate” (30% vs 0%; p = 0.04).

Conclusion

Good mid-term clinical results can be obtained after repeated ACL revision with allograft in patients who experienced multiple failures; however, those who need additional procedure due to malalignment or post-meniscectomy syndrome reported lower objective and subjective results.

Level of evidence

III.
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Metadata
Title
Good stability and mid-term subjective outcomes after repeated anterior cruciate ligament (ACL) revision surgery using allografts
Authors
Alberto Grassi
Sergio Cialdella
Gianluca Costa
Nicola Pizza
Luca Macchiarola
Giacomo Dal Fabbro
Mirco Lo Presti
Stefano Zaffagnini
Publication date
04-04-2023
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 8/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-023-07399-8

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