Failure of primary anterior cruciate ligament surgery using anterior tibialis allograft

The purpose of this study was to evaluate the outcome of anterior cruciate ligament (ACL) reconstruction via anterior tibialis tendon allograft.

We performed a retrospective review of 125 consecutive patients who underwent ACL reconstruction via an anterior tibialis tendon allograft. Of these patients, 69 were available for follow-up at a mean of 55 months (range, 42 to 74 months); their mean age was 31.7 years (range, 19 to 69 years). Clinical evaluation consisted of the Lysholm knee score, activity level assessment, and International Knee Documentation Committee assessment.

Of the 69 patients, 16 (23.1%) required revision ACL reconstruction for graft failure. In addition, 26 patients (37.7%) required repeat surgery, including 16 revision ACL reconstructions, 9 arthroscopic meniscal surgeries, and 1 total knee arthroplasty. The mean age of those patients in whom failure occurred was 22.8 years compared with 34 years in those in whom failure did not occur (P = .0039). The failure/reoperation rate of those aged 25 years or under was 55% (17/31), as compared with 24% (9/38) in those aged over 25 years. The mean Lysholm knee score was 85.6 (range, 15 to 100), and the mean activity score was 4.36 (range, 0 to 9). Of the 52 patients who did not require revision ACL surgery, 86.2% rated their knee as normal or nearly normal.

A reoperation rate of 38% after primary ACL surgery is high. We do not recommend the use of anterior tibialis allograft in young patients (aged < or =25 years) or those who participate frequently in level I ACL-dependent sports.

Level IV, therapeutic case series.