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Revision Anterior Cruciate Ligament Reconstruction in Level 1 Athletes: Similar Outcomes With Bone-Patellar
Timothy McAleese1, Gordon R Daly2, Enda King3
1RCSI University of Medicine and Health Sciences, Dublin, Ireland; UPMC Sports Surgery Clinic, Santry, Dublin, Ireland.
Introduction:
This study reports Revision Anterior Cruciate Ligament Reconstruction (R-ACLR) outcomes using Bone-Patellar Tendon-Bone (BPTB) vs. Hamstring (HT) autografts with and without lateral extra-articular tenodesis (LEAT) in a cohort of level 1 athletes.
Methods:
A consecutive cohort of 262 athletes who underwent R-ACLR between 2014 and 2018 were analysed. The decision to augment revision ACLR with LEAT was guided by younger age and generalised hypermobility. There were 157 patients in the BPTB cohort (BPTB = 53 vs. BPTB + LEAT = 104) and 105 patients in the HT cohort (HT = 32 vs. HT + LEAT = 73). Return to Play (RTP), ipsilateral/contralateral ACL injuries and patient-reported outcome measures (International Knee Documentation Committee Score (IKDC), Marx) were assessed at 2 years.
Results:
The mean age was 25.4 +/- 6.3 years and 84.4% of patients were male. RTP rates (BPTB +/- LEAT: 65.2% vs. HT +/- LEAT: 62.8%; p=.400) and time to RTP (13.3 ± 5.7 vs. 12.4 ± 6.1 months) were comparable. Increasing age was independently associated with reduced odds of return to play, with each additional year associated with a 6.9% reduction in the odds of RTP (OR 0.93, 95% CI 0.89-0.98; p = 0.005). There was no statistically significant difference in graft re-injury rates with or without LEAT (BPTB vs. BPTB + LEAT: 1.9% (1/52) vs. 2.9% (3/2.9), p=.720) and (HT vs. HT + LEAT: 6.3% (2/30) vs. 1.4% (1/72), p=.163). There was no statistically significant difference in IKDC score (BPTB: 83.3 +/- 11.7 vs. HT: 83.6 +/- 13.9, p = .885). Both cohorts demonstrated a reduction in Marx score from their preoperative levels (BPTB +/- LEAT: 10.7 to 8.1 vs. HT +/- LEAT: 11.1 to 8.7).
Conclusion:
This study demonstrated that using ipsilateral BPTB and HT autografts for R-ACLR in level 1 athletes resulted in no statistically significant difference in RTP, re-injury and patient-reported outcomes. There was also no difference in re-injury rate in the group that received LEAT. Interestingly, although patients in the LEAT group were younger and had a lower incidence of chondral injuries, this did not translate into improved patient-reported outcomes. Notably, all patients' activity levels were substantially reduced after revision ACLR, regardless of the type of graft used. LEVEL OF EVIDENCE 3: Cohort study.