Case series: Revision anterior cruciate ligament reconstructions using patellar tendon autografts

Using intra-operative findings and clinical results, including return to play (RTP) at the pre-injury level, this study investigated the causes of primary graft failure after revision anterior cruciate ligament (ACL) reconstruction with bone-patellar-tendon-bone (BPTB) autografts.

A total of 54 patients were followed for a mean of 38.2 ± 10.2 months post-surgery. Subjective and objective results were evaluated using single assessment numeric evaluation (SANE) scores, Lachman tests, KT-2000 arthrometer results, and pivot-shift tests. The change in each patient's Tegner activity scale and RTP at the pre-injury level were also evaluated.

Inappropriate positioning of the tunnels was the most important reason (54%) for primary graft failure. After revision surgery, anterior knee stability was significantly improved (1.2 (mean) ± 1.2 (SD)mm vs 4.5(mean) ± 1.9 (SD)mm; P < 0.01). Two (4%) patients sustained revision graft ruptures while two (4%) sustained contralateral knee ACL tears. The rate of RTP at the pre-injury level was 67% (36 patients), and mean SANE scores at the time of RTP were higher than before surgery (74.8 ± 13.8 points vs 24.1 ± 16.4; P<0.001). The average time from primary graft failure to revision surgery was shorter (12.2 (mean) ± 4.0 (SD) vs 37.6 (mean) ± 8.8 (SD)months; P < 0.01) and the ratio of major cartilage injury was lower (39% vs 83%; P < 0.05) in the RTP group than that in the non-RTP group.

The time from primary graft failure to revision surgery and the extent of the cartilage injury are major factors in RTP after revision ACL reconstructions.