PURPOSE: The aim of the present study was to make an in-depth clinical, radiographical, and histological evaluation of patients who underwent anterior cruciate ligament (ACL) revision surgery with reharvested central third patellar tendon autograft. METHODS: Four patients (two women and two men) underwent ACL revision surgery with reharvested patellar tendon autograft 71 (66-120) months after the primary reconstruction. The patients were followed prospectively and underwent a clinical examination and magnetic resonance imaging (MRI) at two and 10 years. Furthermore, they underwent a second-look arthroscopy involving a biopsy procedure from the reconstructed ACL 3 years after revision surgery. RESULTS: The clinical results were poor both at two and 10 years, but the knees were stable and had a firm endpoint in all four patients in the Lachman test. At the second-look arthroscopy, the graft appeared macroscopically normal in all four patients. Histologically two patients had a normal or close to normal appearance of the reconstructed ACL with no or slight increase in cellularity and vascularity. Two patients had a marked increase in cellularity and vascularity, and the findings revealed that ligamentization was present in all four patients. CONCLUSIONS: The clinical outcome 10 years after ACL revision surgery was poor in these four patients. In contrast, the reharvested patellar tendon appeared close to normal on MRI, and the second-look arthroscopy with the concomitant histological findings revealed that the grafts were viable 3 years after revision. Therefore, the reharvested patellar tendon seems to have the potential for ligamentization when used for ACL revision surgery. LEVEL OF EVIDENCE: Case series, Level IV.
PURPOSE: The aim of the present study was to make an in-depth clinical, radiographical, and histological evaluation of patients who underwent anterior cruciate ligament (ACL) revision surgery with reharvested central third patellar tendon autograft. METHODS: Four patients (two women and two men) underwent ACL revision surgery with reharvested patellar tendon autograft 71 (66-120) months after the primary reconstruction. The patients were followed prospectively and underwent a clinical examination and magnetic resonance imaging (MRI) at two and 10 years. Furthermore, they underwent a second-look arthroscopy involving a biopsy procedure from the reconstructed ACL 3 years after revision surgery. RESULTS: The clinical results were poor both at two and 10 years, but the knees were stable and had a firm endpoint in all four patients in the Lachman test. At the second-look arthroscopy, the graft appeared macroscopically normal in all four patients. Histologically two patients had a normal or close to normal appearance of the reconstructed ACL with no or slight increase in cellularity and vascularity. Two patients had a marked increase in cellularity and vascularity, and the findings revealed that ligamentization was present in all four patients. CONCLUSIONS: The clinical outcome 10 years after ACL revision surgery was poor in these four patients. In contrast, the reharvested patellar tendon appeared close to normal on MRI, and the second-look arthroscopy with the concomitant histological findings revealed that the grafts were viable 3 years after revision. Therefore, the reharvested patellar tendon seems to have the potential for ligamentization when used for ACL revision surgery. LEVEL OF EVIDENCE: Case series, Level IV.
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