Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-06-2012 | Knee Revision Surgery

Revision of anterior cruciate ligament reconstruction with patellar tendon allograft and autograft: 2- and 5-year results

Authors: Hermann O. Mayr, Doerthe Willkomm, Amelie Stoehr, Mathias Schettle, Norbert P. Suedkamp, Anke Bernstein, Robert Hube

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 6/2012

Abstract

Introduction

The most common failure reasons of an anterior cruciate ligament (ACL) graft are incorrect positioning of the drill channels and insufficient fixation. In many cases, one-stage revision with patellar tendon graft and the appropriate corrections are possible. For previous use of the ipsilateral patellar tendon third, an allograft seems favorable for reconstruction. So far, no study compared the results of revision surgery of autologous versus allogenous patellar tendon grafts for revision surgery of the ACL in a 5-year follow-up.

Materials and methods

A retrospective study was conducted to analyze the clinical outcome and stability results 2 years (19.2 ± 5.8 months) and 5 years (68.8 ± 6.8 months) after revision of ACL reconstruction using middle-third patellar tendon allografts and autografts. The allografts were cleansed by mechanical means only. There were 15 patients in the allograft group and 14 in the autograft group. Patients with isolated re-rupture of the ACL graft were included in the study. Clinical results were evaluated by International Knee Documentation Committee 2000 forms (IKDC), Lysholm score, Tegner activity score, and visual analog scale. Stability was evaluated by means of KT-1000 arthrometer, Lachman test, and pivot-shift test. Location of drill holes was evaluated radiologically. Gonarthritis was graded according to Kellgren and Lawrence on the basis of radiographs.

Results

There were no significant differences between the two groups in anterior translation, manual examination for stability, IKDC 2000 findings, Tegner activity score, or Lysholm score. Extension deficits were more frequent in the autograft group at the first follow-up (P = 0.010). Lateral gonarthritis and femoral tunnel widening were more common in the allograft group at the second follow-up (P = 0.049 and P = 0.023, respectively). Pain on walking downhill was significantly more frequent in the allograft group at the second follow-up (P = 0.027).

Conclusions

The functional results with allografts that had not undergone irradiation or chemical sterilization were comparable to those with autografts in ACL revision surgery. Allografts represent a good alternative to autogenous patellar tendons in revision surgery.

Ahn JH, Lee SH, Yoo JC, Ha HC (2007) Measurement of the graft angles for the anterior cruciate ligament reconstruction with transtibial technique using postoperative magnetic resonance imaging in comparative study. Knee Surg Sports Traumatol Arthrosc 15:1293–1300PubMedCrossRef

Almazán A, Miguel A, Odor A, Ibarra JC (2006) Intraoperative incidents and complications in primary arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 22:1211–1217PubMedCrossRef

Barrett G, Stokes G, White M (2005) Anterior cruciate ligament reconstruction in patients older than 40 years: allograft versus autograft patellar tendon. Am J Sports Med 33:1505–1512PubMedCrossRef

Basdekis G, Abisafi C, Christel P (2008) Influence of knee flexion angle on femoral tunnel characteristics when drilled through the anteromedial portal during anterior cruciate ligament reconstruction. Arthroscopy 24:459–464PubMedCrossRef

Buchner M, Schmeer T, Schmitt H (2007) Anterior cruciate ligament reconstruction with quadrupled semitendinosus tendon—minimum 6 year clinical and radiological follow-up. Knee 14(4):321–327PubMedCrossRef

Carson EW, Anisko EM, Restrepo C, Panariello RA, O’Brien SJ, Warren RF (2004) Revision anterior cruciate ligament reconstruction: etiology of failures and clinical results. J Knee Surg 17:127–132PubMed

Chang SK, Egami DK, Shaieb MD, Kan DM, Richardson AB (2003) Anterior cruciate ligament reconstruction: allograft versus autograft. Arthroscopy 19:453–462PubMedCrossRef

Chen NC, Boykin RE, Millett PJ (2007) Broken femoral cross pin after hamstring anterior cruciate ligament reconstruction: case report. J Knee Surg 20:245–248PubMed

Cheung SC, Allen CR, Gallo RA, Ma CB, Feeley BT (2012) Patients’ attitudes and factors in their selection of grafts for anterior cruciate ligament reconstruction. Knee 19:49–54PubMedCrossRef

10.

Clatworthy MG, Annear P, Bulow JU, Bartlett RJ (1999) Tunnel widening in anterior cruciate ligament reconstruction: a prospective evaluation of hamstring and patella tendon grafts. Knee Surg Sports Traumatol Arthrosc 7:138–145PubMedCrossRef

11.

Cole DW, Ginn TA, Chen GJ, Smith BP, Curl WW, Martin DF, Poehling GG (2005) Cost comparison of anterior cruciate ligament reconstruction: autograft versus allograft. Arthroscopy 21:786–790PubMedCrossRef

12.

Daniel DM, Stone ML, Dobson BE, Fithian DC, Rossman DJ, Kaufman KR (1994) Fate of the ACL-injured patient: a prospective outcome study. Am J Sports Med 22:632–644PubMedCrossRef

13.

Fink C, Zapp M, Benedetto KP, Hackl W, Hoser C, Rieger M (2001) Tibial tunnel enlargement following anterior cruciate ligament reconstruction with patellar tendon autograft. Arthroscopy 17:138–143PubMedCrossRef

14.

Fink C, Hoser C, Benedetto KP (1994) Development of arthrosis after rupture of the anterior cruciate ligament: a comparison of surgical and conservative therapy. Unfallchirurg 97:357–361PubMed

15.

Fox JA, Pierce M, Bojchuk J, Hayden J, Bush-Joseph CA, Bach BR Jr (2004) Revision anterior cruciate ligament reconstruction with nonirradiated fresh-frozen patellar tendon allograft. Arthroscopy 20:787–794PubMedCrossRef

16.

Giffin JR, Harner CD (2001) Failed anterior cruciate ligament surgery: overview of the problem. Am J Knee Surg 14:185–192PubMed

17.

Gorschewsky O, Klakow A, Riechert K, Pitzl M, Becker R (2005) Clinical comparison of the Tutoplast allograft and autologous patellar tendon (bone-patellar tendon-bone) for the reconstruction of the anterior cruciate ligament: 2- and 6-year results. Am J Sports Med 33:1202–1209PubMedCrossRef

18.

Gorschewsky O, Browa A, Vogel U, Stauffer E (2002) Klinisch-histologischer Vergleich des allogenen und autologen Patellarsehnendrittels (Bone-Tendon-Bone) zur Rekonstruktion des vorderen Kreuzbands. Unfallchirurg 105:703–714PubMedCrossRef

19.

Graham SM, Parker RD (2002) Anterior cruciate ligament reconstruction using hamstring tendon grafts. Clin Orthop 402:64–75PubMedCrossRef

20.

Höher J, Möller HD, Fu FH (1998) Bone tunnel enlargement after anterior cruciate ligament reconstruction: fact or fiction? Knee Surg Sports Traumatol Arthrosc 6:231–240PubMedCrossRef

21.

Ito MM, Tanaka S (2006) Evaluation of tibial bone-tunnel changes with X-ray and computed tomography after ACL reconstruction using a bone-patella tendon-bone autograft. Int Orthop 30:99–103PubMedCrossRef

22.

Johnson DL, Swenson TM, Irrgang JJ, Fu FH, Harner CD (1996) Revision anterior cruciate ligament surgery: experience from Pittsburgh. Clin Orthop Relat Res 325:100–109PubMedCrossRef

23.

Kamiński A, Gut G, Marowska J, Lada-Kozłowska M, Biwejnis W, Zasacka M (2008) Mechanical properties of radiation-sterilised human bone–tendon–bone grafts preserved by different methods. Cell Tissue Bank 10:215–219PubMedCrossRef

24.

Katthagen BD, Scheffler S, Becker R, Willkomm D, Mayr HO, Pruß A (2008) Gewinnung, Prozessierung und Transplantation allogener muskuloskelettaler Gewebe. Transfus Med Hemother 35:438–445CrossRef

25.

Kellgren JH, Lawrence JS (1957) Radiological assessment of osteoarthrosis. Ann Rheum Dis 16:494–502PubMedCrossRef

26.

Kleipool AE, Zijl JA, Willems WJ (1998) Arthroscopic anterior cruciate ligament reconstruction with bone-patellar tendon-bone allograft or autograft: prospective study with an average follow up of 4 years. Knee Surg Sports Traumatol Arthrosc 6:224–230PubMedCrossRef

27.

Kohn D (2000) Das Knie. Thieme Stuttgart, New York, p 151

28.

Kokkinakis M, Ashmore A, El-Guindi M (2010) Intraoperative complications using the Bio-Transfix femoral fixation implant in anterior cruciate ligament reconstruction. Arch Orthop Trauma Surg 130(3):375–379PubMedCrossRef

29.

Kustos T, Bálint L, Than P, Bárdos T (2004) Comparative study of autograft or allograft in primary anterior cruciate ligament reconstruction. Int Orthop 28:290–293PubMedCrossRef

30.

Lee MC, Seong SC, Lee S, Chang CB, Park YK, Jo H, Kim CH (2007) Vertical femoral tunnel placement results in rotational knee laxity after anterior cruciate ligament reconstruction. Arthroscopy 23:771–778PubMedCrossRef

31.

Malinin TI, Levitt RL, Bashore C, Temple T, Mnaymneh W (2002) A study of retrieved allografts used to replace anterior cruciate ligaments. Arthroscopy 18:163–170PubMedCrossRef

32.

Mayr HO, Hube R, Bernstein A, Seibt AB, Hein W, von Eisenhart-Rothe R (2007) Beta-tricalcium phosphate plugs for press-fit fixation in ACL reconstruction—a mechanical analysis in bovine bone. Knee 14:239–244PubMedCrossRef

33.

Mehta VM, Mandala C, Foster D, Petsche TS (2010) Comparison of revision rates in bone–patella tendon–bone autograft and allograft anterior cruciate ligament reconstruction. Orthopedics 33:12PubMedCrossRef

34.

Nagda SH, Altobelli GG, Bowdry KA, Brewster CE, Lombardo SJ (2010) Cost analysis of outpatient anterior cruciate ligament reconstruction. Clin Orthop Relat Res 468:1418–1422PubMedCrossRef

35.

Nin JRV, Leyes M, Schweitzer D (1996) Anterior cruciate ligament reconstruction with fresh-frozen patellar tendon allografts: sixty cases with 2 years’ minimum follow-up. Knee Surg Sports Traumatol Arthrosc 4:137–142PubMedCrossRef

36.

Noyes FR, Barber-Westin SD (2001) Revision anterior cruciate ligament reconstruction: report of 11-year experience and results in 114 consecutive patients. Instr Course Lect 50:451–461PubMed

37.

Noyes FR, Barber-Westin SD (1996) Revision anterior cruciate ligament surgery: experience from Cincinnati. Clin Orthop Relat Res 325:116–129PubMedCrossRef

38.

Ohly NE, Murray IR, Keating JF (2007) Revision anterior cruciate ligament reconstruction: timing of surgery and the incidence of meniscal tears and degenerative change. J Bone Joint Surg Br 89(8):1051–1054PubMedCrossRef

39.

O’Neill DB (1996) Arthroscopically assisted reconstruction of the anterior cruciate ligament: a prospective randomized analysis of three techniques. J Bone Joint Surg Am 78:803–813PubMed

40.

Peterson RK, Shelton WR, Bomboy AL (2001) Allograft versus autograft patellar tendon anterior cruciate ligament reconstruction: a 5-year follow-up. Arthroscopy 17:9–13PubMedCrossRef

41.

Rihn JA, Irrgang JJ, Chhabra A, Fu FH, Harner CD (2006) Does irradiation affect the clinical outcome of patellar tendon allograft ACL reconstruction? Knee Surg Sports Traumatol Arthrosc 14:885–896PubMedCrossRef

42.

Rougraff B, Shelbourne KD, Greth PK, Warner J (1993) Arthroscopic and histologic analysis of human patellar tendon autografts used for anterior cruciate ligament reconstruction. Am J Sports Med 21:277–284PubMedCrossRef

43.

Saddemi SR, Frogameni AD, Fenton PJ, Hartman JA, Hartman W (1993) Comparison of perioperative morbidity of anterior cruciate ligament autografts versus allografts. Arthroscopy 9:519–524PubMedCrossRef

44.

Segawa H, Omori G, Tomita S, Koga Y (2001) Bone tunnel enlargement after anterior cruciate ligament reconstruction using hamstring tendons. Knee Surg Sports Traumatol Arthrosc 9:206–210PubMedCrossRef

45.

Seitz H, Chrysopoulos A, Egkher E, Mousavi M (1994) Long-term results of replacement of the anterior cruciate ligament in comparison with conservative therapy. Chirurg 65:992–998PubMed

46.

Shelbourne KD, O’Shea JJ (2002) Revision anterior cruciate ligament reconstruction using the contralateral bone–patellar tendon–bone graft. Instr Course Lect 51:343–346PubMed

47.

Shelton WR, Papendick L, Dukes AD (1997) Autograft versus allograft anterior cruciate ligament reconstruction. Arthroscopy 13:446–449PubMedCrossRef

48.

Silva A, Sampaio R, Pinto E (2010) Femoral tunnel enlargement after anatomic ACL reconstruction: a biological problem? Knee Surg Sports Traumatol Arthrosc 18:1189–1194PubMedCrossRef

49.

Stringham DR, Pelmas CJ, Burks RT, Newman AP, Marcus RL (1996) Comparison of anterior cruciate ligament reconstructions using patellar tendon autograft or allograft. Arthroscopy 12:414–421PubMedCrossRef

50.

Victor J, Bellemans J, Witvrouw E, Govaers K, Fabry G (1997) Graft selection in anterior cruciate ligament reconstruction—prospective analysis of patellar tendon autografts compared with allografts. Int Orthop 21:93–97PubMedCrossRef

51.

Wilcke A (2004) Vordere Kreuzbandläsion: Anatomie, Pathophysiologie, Diagnose, Therapie, Trainingslehre, Rehabilitation. Steinkopff, Darmstadt, pp 95–97

52.

Wilson TC, Kantaras A, Atay A, Johnson DL (2004) Tunnel enlargement after anterior cruciate ligament surgery. Am J Sports Med 32(2):543–549PubMedCrossRef

53.

Wirth CJ, Peters G (1998) The dilemma with multiply reoperated knee instabilities. Knee Surg Sports Traumatol Arthrosc 6:148–159PubMedCrossRef

54.

Youmans WT (1989) Surgical complications of the patellofemoral articulation. Clin Sports Med 8(2):331–342PubMed

Title: Revision of anterior cruciate ligament reconstruction with patellar tendon allograft and autograft: 2- and 5-year results
Authors: Hermann O. Mayr
Doerthe Willkomm
Amelie Stoehr
Mathias Schettle
Norbert P. Suedkamp
Anke Bernstein
Robert Hube
Publication date: 01-06-2012
Publisher: Springer-Verlag
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 6/2012
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-012-1481-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Revision of anterior cruciate ligament reconstruction with patellar tendon allograft and autograft: 2- and 5-year results

Abstract

Introduction

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2012

Surgical management for multilevel noncontiguous thoracic spinal tuberculosis by single-stage posterior transforaminal thoracic debridement, limited decompression, interbody fusion, and posterior instrumentation (modified TTIF)

The epidemiology of knee injuries in children and adolescents

Percutaneous fixation of acetabular fractures: computer-assisted determination of safe zones, angles and lengths for screw insertion

Suture fixation versus cable cerclage of the tuberosities in shoulder arthroplasty-clinical and radiologic results

A novel method of image-based navigation in fracture surgery

Position of the popliteal artery in revision total knee arthroplasty