Thirty-Year Experience With ACL Reconstruction Using Patellar Tendon: A Critical Evaluation of Revision and Reoperation

Abstract

Background:During the preoperative discussion prior to anterior cruciate ligament reconstruction (ACLR), patients are often interested in data regarding rates of revision reconstruction, reoperation, concomitant pathologic changes, and future contralateral ACL injury.Purpose:To analyze a single surgeon’s experience with primary and revision ACLR over a 30-year interval, focusing on incidence and risk factors for revision and reoperation.Study Design:Case series; Level of evidence, 4.Methods:Patients who underwent ACLR from 1986 to 2016 were identified from a prospectively maintained database. Covariates of interest included age, sex, time, and graft selection. Outcomes of interest included revision and reoperation rates.Results:A total of 2450 ACLRs (mean patient age, 29 years; 58% male) were reviewed. Among primary ACLRs performed (n = 2225), 68% entailed bone–patellar tendon–bone (BTB) autograft and 30% entailed BTB allograft. Patients undergoing ACLR with autograft and allograft had a mean age of 22 and 37 years, respectively. The rate of revision ACLR was 1.8% and 3.5% for primary and revision cases, respectively. An increased rate of revision was noted among females compared with males (2.6% vs 1.2%) and among allografts compared with autografts (2.7% vs 1.3%). Low-dose irradiation did not affect allograft revision rates. The nonrevision reoperation rate following primary ACLR was 12%. The nonrevision reoperation rate was lower among primary cases reconstructed with allograft than autograft (9% vs 13%). Seventeen percent of cases involved concomitant meniscal repair and, among these, 13% required revision meniscal surgery. The rate of contralateral ACLR was 5.3%Conclusion:This information is useful in the informed consent process, for perioperative decision making regarding graft choice, and for identifying patients who are at risk for injuring the uninvolved knee.

Performance and Return to Sport After Anterior Cruciate Ligament Reconstruction in Professional Baseball Players

“…2,7,25 However, there have been several studies to date that have shown an increased failure rate, increased knee laxity, and a heightened immune response in allografts compared with autografts. 21,30 –32 It is therefore interesting that 10 professional baseball players in this study underwent primary ACLR using allografts. Notably, 1 of these 10 players underwent revision ACLR during this study period, while only 2 of 114 players who underwent primary ACLR using an autograft underwent revision ACLR during the study period.…”

A Hybrid Transtibial Technique Combines the Advantages of Anteromedial Portal and Transtibial Approaches: A Prospective Randomized Controlled Trial

“…18,23 While good to excellent results have been reported with the traditional TT technique, recent clinical data support improved outcomes with more anatomic aperture positions. 9,29…”

“…18,23 While good to excellent results have been reported with the traditional TT technique, recent clinical data support improved outcomes with more anatomic aperture positions. 9,29 As the aperture limitations of the TT technique have become clearer, the AM portal approach has gained popularity by eliminating tibial tunnel constraint on the femoral drill guide. This approach allows more anatomic femoral aperture positioning but sacrifices many of the benefits of the TT technique.…”

One sixth of primary anterior cruciate ligament reconstructions may undergo reoperation due to complications or new injuries within 2 years

“…In most cases, the reason for screw removal is pain over the proximal tibia. Previous studies have reported hardware removal in a range of between 0.6 and 0.7% and 12.7% of primary ACLRs [ 5 , 7 , 20 ]. Differences regarding the incidence of hardware removal may be due to different surgical techniques.…”