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This Article Full Text Full Text (PDF) O'Neill Appendixes All Versions of this Article: 32/8/1833    most recent 0363546504264585v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Request Reprints Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (6) Citing Articles via Google Scholar Google Scholar Articles by O’Neill, D. B. Search for Related Content PubMed PubMed Citation Articles by O’Neill, D. B. Related Collections Reconstruction Graft fixation Knee

Revision Arthroscopically Assisted Anterior Cruciate Ligament Reconstruction With Previously Unharvested Ipsilateral Autografts

From the Christus St. John Sports Medicine Center, Nassau Bay, Texas

^* Address correspondence to Daniel B. O’Neill, MD, PA, Christus St. John Sports Medicine Center, 2020 NASA Rd 1, Suite 200, Nassau Bay, TX 77058 (e-mail: nbjs{at}ev1.net).

Background: Revision anterior cruciate ligament reconstruction requires flexibility and variability in treatment options. This study analyzed the functional outcomes and graft stability of 48 consecutive revision anterior cruciate ligament reconstructions using previously unharvested ipsilateral autografts.

Hypothesis: Using previously unharvested ipsilateral autografts will achieve similar outcomes to other graft choices in revising previously failed anterior cruciate ligament reconstructions.

Study Design: Prospective nonrandomized clinical trial.

Methods: Forty-eight patients (48 operations) were observed for 2 to 13 years (mean, 90 months). All agreed to have revision reconstruction with ipsilateral autografts. The details of the technique varied according to the original graft choice and the abnormality encountered. Concomitant procedures were necessary in 40 (84%) of 48 knees. Twenty-three patients (48%) had revision reconstruction with previously unharvested ipsilateral autogenous hamstring tendons. Ten (21%) were 2-stranded grafts, and 13 (27%) were 4-stranded (quadrupled) autografts. Twenty-five patients (52%) had revision reconstruction with previously unharvested ipsilateral patellar tendon autografts, 6 (12%) using the 2-incision rear-entry method and 19 (40%) using the single-incision technique.

Results: Results were evaluated with Lysholm and Gillquist scores and International Knee Documentation Committee ratings, including KT-2000 arthrometer examinations. Seventy-three percent of the patients had International Knee Documentation Committee normal (A) or nearly normal (B) knees (42% of the patients had A knees and 42% had B knees). Twelve percent of patients had C knees, and 4% had a D rating. Sixty-seven percent of the knees had a KT-2000 arthrometer side-to-side difference of 3 mm or less, and an additional 21% of the knees had a side-to-side difference of 3 to 5 mm; therefore, 94% of the grafts were functional or partially functional. Six percent of grafts had more than 5 mm of laxity and were considered failures.

Conclusions: Previously unharvested ipsilateral autografts proved reliable in improving function and stability in revision anterior cruciate ligament reconstruction. However, outcomes were less favorable with revision reconstructions than with primary reconstructions.

Key Words: revision • anterior cruciate reconstruction • ipsilateral autografts

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