Anterior Cruciate Ligament Revision Surgery: Ipsilateral Quadriceps Versus Contralateral Semitendinosus-Gracilis Autografts

Abstract

To evaluate the subjective outcomes, knee stability, and donor-site morbidity after revision ACL reconstruction using either autologous ipsilateral quadriceps tendon or contralateral semitendinosus-gracilis tendon. A sample size calculation suggested that we needed 25 patients in each group to detect equality between both groups. Therefore, we evaluated 30 consecutive patients who underwent an ACL revision surgery with ipsilateral bone-quadriceps tendon grafts and 30 consecutive patients with the contralateral semitendinosus-gracilis grafts between January 2010 and December 2012. Because of follow-up and exclusion criteria, finally 51 patients were evaluated. All patients were followed prospectively for at least 2years with KT1000 arthrometer testing and the International Knee Documentation Committee (IKDC) objective grading. At the 24-month follow-up, additional clinical scores were evaluated: the Knee Injury Osteoarthritis Outcome Score (KOOS), the Lysholm score, assessing pain during kneeling, and anterior knee pain. The KT1000 postoperative arthrometer side-to-side difference was 2.0 ± 1.2mm for the quadriceps group and 3.0 ± 2.9mm for the semitendinosus-gracilis group. The difference was not statistically significant (P= .461). There was also no difference in the rate of positive pivot-shift tests between groups (P= .661). The Lysholm score was 82.5 ± 18 in the quadriceps group and 73.8 ± 19 in the semitendinosus-gracilis group. The difference was not statistically significant (P= .060). There was also no significant difference in the single KOOS subscores, assessing pain while kneeling and anterior knee pain (included in the KOOS score). No rerupture occurred during follow-up. Revision ACL reconstruction using the quadriceps tendon graft showed clinical outcomes similar to those of the contralateral semitendinosus-gracilis graft in terms of knee stability and function. Thus, the bone-quadriceps tendon graft may be a good alternative to the contralateral semitendinosus-gracilis tendon graft for revision ACL reconstruction. Level II, prospective comparative study.