Revision anterior cruciate ligament reconstruction with ipsi- or contralateral hamstring tendon grafts

  • Claudio LegnaniEmail author
  • Giuseppe Peretti
  • Enrico Borgo
  • Stefania Zini
  • Alberto Ventura
Original Article • KNEE - ARTHROPLASTY



With the increasing number of primary anterior cruciate ligament (ACL) reconstructions, the need for revision ACL surgery has risen over the past few years. The purpose of the present study is to retrospectively compare the clinical outcome of ipsilateral versus contralateral hamstring tendon autografts for ACL revision surgery, specifically with regard to patient satisfaction, post-operative functional outcomes, and return to sports.


Between 2004 and 2011, 64 patients underwent ACL revision surgery. Forty-five were successfully recontacted and retrospectively reviewed at an average follow-up of 6.3 years. Twenty-two subjects underwent revision ACL reconstruction with ipsilateral autogenous hamstring tendon grafts; in 23 subjects contralateral hamstring were used for reconstruction. Clinical, arthrometric, and functional evaluations were performed. The Tegner activity level, Knee Injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) Subjective Knee Form were used. Objective evaluation included range of motion, Lachman test, pivot shift test and KT-1000 instrumented laxity testing.


No major complications were reported. Follow-up examination showed that there were no significant differences in the IKDC and KOOS scores between the groups. No differences in anterior tibial translation as measured with KT-1000 arthrometer were reported between the groups, although there was a trend for more of the patients undergoing ipsilateral DGST reconstruction to have a glide on the pivot shift test. The percentage of patients returning to pre-injury level was high in both groups.


The use of contralateral hamstring tendon autografts for ACL revision surgery produced similar subjective and objective outcomes at 6-years follow-up compared to revision with ipsilateral hamstring tendon autografts. Patients undergoing revision surgery with contralateral autografts experienced a quicker return to sports compared to patients who underwent ipsilateral DGST revision surgery.


Anterior cruciate ligament ACL revision surgery Ipsilateral Contralateral 


Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Kamath GV, Redfern JC, Greis PE, Burks RT (2011) Revision anterior cruciate ligament reconstruction. Am J Sports Med 39:199–217CrossRefPubMedGoogle Scholar
  2. 2.
    Colosimo AJ, Heidt RS Jr, Traub JA, Carlonas RL (2001) Revision anterior cruciate ligament reconstruction with a reharvested ipsilateral patellar tendon. Am J Sports Med 29:746–750PubMedGoogle Scholar
  3. 3.
    Kamath GV, Redfern JC, Greis PE, Burks RT (2011) Revision anterior cruciate ligament reconstruction. Am J Sports Med 39:199–217CrossRefPubMedGoogle Scholar
  4. 4.
    Kartus J, Stener S, Lindahl S, Eriksson BI, Karlsson J (1998) Ipsi or contralateral patellar tendon graft in anterior cruciate ligament revision surgery. A comparison of two methods. Am J Sports Med 26:499–504PubMedGoogle Scholar
  5. 5.
    Noyes FR, Barber-Westin SD (2001) Revision anterior cruciate surgery with use of bone-patellar tendon-bone autogenous grafts. J Bone Joint Surg Am 83-A:1131–1143CrossRefPubMedGoogle Scholar
  6. 6.
    Garofalo R, Djahangiri A, Siegrist O (2006) Revision anterior cruciate ligament reconstruction with quadriceps tendon-patellar bone autograft. Arthroscopy 22:205–214CrossRefPubMedGoogle Scholar
  7. 7.
    Noyes FR, Barber-Westin SD (2006) Anterior cruciate ligament revision reconstruction: results using a quadriceps tendon-patellar bone autograft. Am J Sports Med 34:553–564CrossRefPubMedGoogle Scholar
  8. 8.
    Ferretti A, Monaco E, Caperna L, Palma T, Conteduca F (2013) Revision ACL reconstruction using contralateral hamstrings. Knee Surg Sports Traumatol Arthrosc 21:690–695CrossRefPubMedGoogle Scholar
  9. 9.
    Kartus J, Magnusson L, Stener S, Karlsson J (1999) Complications following arthroscopic anterior cruciate ligament reconstruction. A 2–5-year follow-up of 604 patients with special emphasis on anterior knee pain. Knee Surg Sports Traumatol Arthrosc 7:2–8CrossRefPubMedGoogle Scholar
  10. 10.
    Rubinstein RA Jr, Shelbourne KD, Van Meter CD, McCarroll JC, Rettig AC (1994) Isolated autogenous bone-patellar tendon-bone graft side morbidity. Am J Sports Med 22:324–327CrossRefPubMedGoogle Scholar
  11. 11.
    Shelbourne KD, Benner RW, Gray T (2014) Return to sports and subsequent injury rates after revision anterior cruciate ligament reconstruction with patellar tendon autograft. Am J Sports Med 42:1395–1400CrossRefPubMedGoogle Scholar
  12. 12.
    Peterson RK, Shelton WR, Bomboy AL (2001) Allograft versus autograft patellar tendon anterior cruciate ligament reconstruction: a 5-year follow-up. Arthroscopy 17:9–13CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France 2017

Authors and Affiliations

  • Claudio Legnani
    • 2
    Email author
  • Giuseppe Peretti
    • 2
    • 3
  • Enrico Borgo
    • 1
  • Stefania Zini
    • 4
  • Alberto Ventura
    • 1
  1. 1.Sports Traumatology and Minimally Invasive Articular Surgery CenterSan Siro Clinical InstituteMilanItaly
  2. 2.IRCCS Galeazzi Orthopaedic InstituteMilanItaly
  3. 3.Department of Biomedical Sciences for HealthUniversity of MilanMilanItaly
  4. 4.Scuola di Specializzazione in Ortopedia e Traumatologia, Policlinico Universitario P. GiacconePalermoItaly

Personalised recommendations