Yuji Takazawa1, Hiroshi Ikeda2, Yoshitomo Saita3, Muneaki Ishijima4, Masataka Nagayama5, Haruka Kaneko6, Yohei Kobayashi7, Shinnosuke Hada8, Ryo Sadatsuki9, Kazuo Kaneko10. 1. Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyou-ku, Tokyo 113-8421, Japan. Electronic address: ytakaza@juntendo.ac.jp. 2. Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyou-ku, Tokyo 113-8421, Japan. Electronic address: hrikeda@juntendo.ac.jp. 3. Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyou-ku, Tokyo 113-8421, Japan. Electronic address: saita0617@hotmail.com. 4. Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyou-ku, Tokyo 113-8421, Japan. Electronic address: ishijima@juntendo.ac.jp. 5. Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyou-ku, Tokyo 113-8421, Japan. Electronic address: masataka_nagayama@yahoo.co.jp. 6. Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyou-ku, Tokyo 113-8421, Japan. Electronic address: harukago@juntendo.ac.jp. 7. Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyou-ku, Tokyo 113-8421, Japan. Electronic address: yo_pei0423@hotmail.com. 8. Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyou-ku, Tokyo 113-8421, Japan. Electronic address: shada@juntendo.ac.jp. 9. Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyou-ku, Tokyo 113-8421, Japan. Electronic address: rsadatsu@juntendo.ac.jp. 10. Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyou-ku, Tokyo 113-8421, Japan. Electronic address: k-kaneko@juntendo.ac.jp.
Abstract
BACKGROUND: Using intra-operative findings and clinical results, including return to play (RTP) at the pre-injury level, this study investigated the causes of primary graft failure after revision anterior cruciate ligament (ACL) reconstruction with bone-patellar-tendon-bone (BPTB) autografts. METHODS: A total of 54 patients were followed for a mean of 38.2 ± 10.2 months post-surgery. Subjective and objective results were evaluated using single assessment numeric evaluation (SANE) scores, Lachman tests, KT-2000 arthrometer results, and pivot-shift tests. The change in each patient's Tegner activity scale and RTP at the pre-injury level were also evaluated. RESULTS: Inappropriate positioning of the tunnels was the most important reason (54%) for primary graft failure. After revision surgery, anterior knee stability was significantly improved (1.2 (mean) ± 1.2 (SD)mm vs 4.5(mean) ± 1.9 (SD)mm; P < 0.01). Two (4%) patients sustained revision graft ruptures while two (4%) sustained contralateral knee ACL tears. The rate of RTP at the pre-injury level was 67% (36 patients), and mean SANE scores at the time of RTP were higher than before surgery (74.8 ± 13.8 points vs 24.1 ± 16.4; P<0.001). The average time from primary graft failure to revision surgery was shorter (12.2 (mean) ± 4.0 (SD) vs 37.6 (mean) ± 8.8 (SD)months; P < 0.01) and the ratio of major cartilage injury was lower (39% vs 83%; P < 0.05) in the RTP group than that in the non-RTP group. CONCLUSIONS: The time from primary graft failure to revision surgery and the extent of the cartilage injury are major factors in RTP after revision ACL reconstructions.
BACKGROUND: Using intra-operative findings and clinical results, including return to play (RTP) at the pre-injury level, this study investigated the causes of primary graft failure after revision anterior cruciate ligament (ACL) reconstruction with bone-patellar-tendon-bone (BPTB) autografts. METHODS: A total of 54 patients were followed for a mean of 38.2 ± 10.2 months post-surgery. Subjective and objective results were evaluated using single assessment numeric evaluation (SANE) scores, Lachman tests, KT-2000 arthrometer results, and pivot-shift tests. The change in each patient's Tegner activity scale and RTP at the pre-injury level were also evaluated. RESULTS: Inappropriate positioning of the tunnels was the most important reason (54%) for primary graft failure. After revision surgery, anterior knee stability was significantly improved (1.2 (mean) ± 1.2 (SD)mm vs 4.5(mean) ± 1.9 (SD)mm; P < 0.01). Two (4%) patients sustained revision graft ruptures while two (4%) sustained contralateral knee ACL tears. The rate of RTP at the pre-injury level was 67% (36 patients), and mean SANE scores at the time of RTP were higher than before surgery (74.8 ± 13.8 points vs 24.1 ± 16.4; P<0.001). The average time from primary graft failure to revision surgery was shorter (12.2 (mean) ± 4.0 (SD) vs 37.6 (mean) ± 8.8 (SD)months; P < 0.01) and the ratio of major cartilage injury was lower (39% vs 83%; P < 0.05) in the RTP group than that in the non-RTP group. CONCLUSIONS: The time from primary graft failure to revision surgery and the extent of the cartilage injury are major factors in RTP after revision ACL reconstructions.
Authors: Abigail L Campbell; Jon-Michael E Caldwell; Dheeraj Yalamanchili; Lia Sepanek; Keon Youssefzadeh; Carlos A Uquillas; Orr Limpisvasti Journal: Orthop J Sports Med Date: 2021-05-03
Authors: AndrÉ LuÍs Lugnani DE Andrade; Amanda Veiga Sardeli; Bruno Livani; William Dias Belangero Journal: Acta Ortop Bras Date: 2020 Nov-Dec Impact factor: 0.513