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Revision ACL reconstruction using quadriceps or hamstring autografts leads to similar results after 4 years: good objective stability but low rate of return to pre-injury sport level

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Due to the increased importance of revision ACL reconstruction, this study aims to evaluate the outcome 4 years after the surgery, compare two revision strategies and identify factors that influence the results.

Methods

Seventy-nine patients who received a revision ACL reconstruction were retrospectively evaluated. All patients were assessed with an average follow-up of 4.4 years (range 3.3–5.5 years). The results of patients treated with a quadriceps autograft were compared with those treated with a hamstring autograft.

Results

Ninety-seven percent of patients had a KT-1000 side-to-side difference of ≤ 5 mm (mean 1.7 ± 2.0 mm). Pivot-shift test was absent or minor in 95%. In the SLTH-test, 70% of patients reached 90% of the contralateral side. The mean Lysholm score on follow-up was 83 ± 12 (56% excellent/good). The mean IKDC 2000 subjective evaluation score was 81 ± 14 (58% normal/almost normal). The median Tegner activity score was 6 (range 3–10), a median of 2 levels worse than before the first injury. Return to sport rate was 89% but only 34% of patients reached their pre-injury sport level. Most common cause for this reduction was fear of another injury. Three patients suffered a re-rupture. Patients with a hamstring autograft performed pivoting sports more often, but had worse pivot-shift results compared to those with a quadriceps autograft. No significant influence was seen for other parameters. Young, male patients with a high activity level and no chondral damage had the best results.

Conclusion

Through revision ACL reconstruction, the goal of stabilizing the knee can be achieved in the majority of patients. However, a good function and a high activity level are significantly less common in these patients. The main reason for this is fear of a renewed ACL-injury. Both quadriceps and hamstring autografts were able to achieve a good outcome. Young, male, patients with a normal BMI, a high activity level and without cartilage damage seem to benefit the most from revision ACL surgery. The discrepancy between the good laxity restoration and the lower activity rate should therefore be a main point in clinical counseling when deciding for or against revision ACL-Reconstruction.

Level of evidence

III.

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Funding

This clinical study was internally funded. No external or 3rd party financial support was needed.

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Authors and Affiliations

  1. Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany

    Alexander Barié, Yannick Ehmann & Ayham Jaber

  2. Center for Joint Surgery and Sport Injuries, Sportopaedie Heidelberg, Clinic St. Elisabeth Heidelberg, Max Reger Strasse 5-7, 69121, Heidelberg, Germany

    Jürgen Huber & Nikolaus A. Streich

Authors
  1. Alexander Barié
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Contributions

AB and NS were responsible for the idea and conception of the study. All authors planned the study protocol. AB, NS and JH performed all operations and re-operations mentioned in the study. YE was responsible for the organization of all clinical trials as well as data acquisition. AB, NS and YE performed the clinical examination for all study participants. AB, YE and AJ did the statistical analysis and interpreted the results. AB, YE and AJ wrote the Manuscript. All authors read and approved the final manuscript.

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Correspondence to Alexander Barié.

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Conflict of interest

The authors declare that they have no competing interests.

Ethics committee approval and consent to participate

This study has been approved by the appropriate ethics committee in Heidelberg University in Germany (registration number: S-482/14) and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. All persons gave their informed consent prior to their inclusion in the study.

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Barié, A., Ehmann, Y., Jaber, A. et al. Revision ACL reconstruction using quadriceps or hamstring autografts leads to similar results after 4 years: good objective stability but low rate of return to pre-injury sport level. Knee Surg Sports Traumatol Arthrosc 27, 3527–3535 (2019). https://doi.org/10.1007/s00167-019-05444-z

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