Open AccessQuadriceps tendon autograft is becoming increasingly popular in revision ACL reconstruction
Author(s) -
Winkler Philipp W.,
Vivacqua Thiago,
Thomassen Stephan,
Lovse Lisa,
Lesniak Bryson P.,
Getgood Alan M. J.,
Musahl Volker
Publication year - 2022
Publication title -
knee surgery, sports traumatology, arthroscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.806
H-Index - 125
eISSN - 1433-7347
pISSN - 0942-2056
DOI - 10.1007/s00167-021-06478-y
Subject(s) - medicine , anterior cruciate ligament , surgery , quadriceps tendon , patellar tendon , tendon
Abstract Purpose To evaluate trends in revision anterior cruciate ligament reconstruction (ACL‐R), with emphasis on intra‐articular findings, grafts, and concurrent procedures. It was hypothesized that revision ACL‐Rs over time show a trend toward increased complexity with increased use of autografts over allografts. Methods This was a two‐center retrospective study including patients undergoing revision ACL‐R between 2010 and 2020. Demographic and surgical data including intra‐articular findings and concurrent procedures were collected and compared for the time periods 2010–2014 and 2015–2020. All collected variables were compared between three pre‐defined age groups (< 20 years, 20–30 years, > 30 years), right and left knees, and males and females. A time series analysis was performed to assess trends in revision ACL‐R. Results This study included 260 patients with a mean age of 26.2 ± 9.4 years at the time of the most recent revision ACL‐R, representing the first, second, third, and fourth revision ACL‐R for 214 (82%), 35 (14%), 10 (4%), and 1 (< 1%) patients, respectively. Patients age > 30 years showed a significantly longer mean time from primary ACL‐R to most recent revision ACL‐R (11.1 years), compared to patients age < 20 years (2.2 years, p < 0.001) and age 20–30 years (5.5 years, p < 0.05). Quadriceps tendon autograft was used significantly more often in 2015–2020 compared to 2010–2014 (49% vs. 18%, p < 0.001). A high rate of concurrently performed procedures including meniscal repairs (45%), lateral extra‐articular tenodesis (LET; 31%), osteotomies (13%), and meniscal allograft transplantations (11%) was shown. Concurrent LET was associated with intact cartilage and severely abnormal preoperative knee laxity and showed a statistically significant and linear increase over time ( p < 0.05). Intact cartilage (41%, p < 0.05), concurrent medial meniscal repairs (39%, p < 0.05), and LET (35%, non‐significant) were most frequently observed in patients aged < 20 years. Conclusion Quadriceps tendon autograft and concurrent LET are becoming increasingly popular in revision ACL‐R. Intact cartilage and severely abnormal preoperative knee laxity represent indications for LET in revision ACL‐R. The high rate of concurrent procedures observed demonstrates the high surgical demands of revision ACL‐R. Level of evidence Level III.