Background: The outcome of revision anterior cruciate ligament
reconstruction has only rarely been reported. The purpose of this study was to
evaluate the results of revision anterior cruciate ligament surgery with use
of an autogenous doubled semitendinosus and gracilis graft in association with
an extra-articular procedure.
Methods: Between 1997 and 2003, thirty patients underwent a repeat
reconstruction of a previously reconstructed torn anterior cruciate ligament
with use of a doubled semitendinosus and gracilis graft combined with an
extra-articular reconstruction. Primary reconstruction had been done with an
autogenous patellar tendon graft in twenty-six patients and with a prosthetic
ligament in four patients; the average time from the primary reconstruction to
the revision was five years. Functional outcomes, graft survival, and
radiographic outcomes were evaluated at a mean of five years. A graft was
considered to have failed when a revision was done or when the side-to-side
difference on KT-1000 arthrometer testing was >5 mm and/or the pivot-shift
test grade was greater than a trace.
Results: One patient underwent another revision reconstruction
because of graft failure at three years postoperatively. The mean
International Knee Documentation Committee (IKDC) subjective knee score for
the remaining twenty-nine patients was 84 ± 12 points, and the mean
Lysholm knee score was 90 ± 10 points. The side-to-side difference as
measured with the KT-1000 arthrometer with maximum manual force was <3 mm
in twenty patients (of the twenty-eight who returned for follow-up), between 3
and 5 mm in six patients, and >5 mm in two patients. The result of the
pivot shift examination was normal in fifteen patients, slightly positive in
eleven patients, and positive in two patients. Twenty-five percent of the
patients showed no radiographic signs of degenerative joint disease.
Conclusions: Revision anterior cruciate ligament reconstruction with
use of an autogenous doubled semitendinosus and gracilis graft combined with
an extra-articular procedure provided satisfactory functional outcomes, with a
failure rate of 10%.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.