Anterior Cruciate Ligament Revision Reconstruction

Abstract

Background The quadriceps tendon is a viable graft source for revision anterior cruciate ligament reconstruction. Purpose To determine the functional results and graft failure rates in knees in which the patellar tendon had been previously harvested or was unavailable, expanded tunnels precluded the use of a semitendinosus-gracilis graft, or patients requested autogenous tissues instead of allografts for revision reconstruction. Study Design Case series; Level of evidence, 4. Methods The authors observed 21 patients for a mean of 49 months postoperatively after revision anterior cruciate ligament reconstruction with a quadriceps tendon graft. The results were determined by KT-2000 arthrometer testing, the Cincinnati Knee Rating System, and the International Knee Documentation Committee Rating System. Fifteen knees required a concurrent procedure, including reconstruction of posterolateral structures in 5 knees, meniscal repairs in 5 knees, and high tibial osteotomy in 2 knees. Results Significant improvements occurred in symptoms (P< .0001), daily activities (P< .05), sports activities (P< .01), and the overall rating scores (P< .0001). Eighteen patients rated their knee condition as improved. Total mean anterior-posterior displacements decreased from 8.4 ± 3.1 mm preoperatively to 2.0 ± 2.3 mm at follow-up (P< .001). On the International Knee Documentation Committee knee ligament rating, 17 knees were graded as normal or nearly normal, 3 were graded as abnormal, and 1 was graded as severely abnormal. Conclusion The revision operation provided reasonable results in this group of complex knees. However, the functional and overall results were inferior to those reported for primary anterior cruciate ligament reconstruction. Many knees (90%) had compounding problems of articular cartilage damage, meniscectomy, varus malalignment, or additional ligamentous injury that most likely affected the results.