Quadriceps tendon autograft is becoming increasingly popular in revision ACL reconstruction

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 30; no. 1; pp. 149 - 160
• Main Authors: Winkler, Philipp W., Vivacqua, Thiago, Thomassen, Stephan, Lovse, Lisa, Lesniak, Bryson P., Getgood, Alan M. J., Musahl, Volker
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.01.2022; Springer Nature B.V
• Subjects: Adolescent; Adult; Age; Allografts; Anterior cruciate ligament; Anterior Cruciate Ligament Injuries - surgery; Anterior Cruciate Ligament Reconstruction; Autografts; Biomedical materials; Cartilage; Female; Humans; Knee; Ligaments; Male; Medicine; Medicine & Public Health; Meniscus; Orthopedics; Quadriceps muscle; Reoperation; Retrospective Studies; Revisions; Sports Medicine; Statistical analysis; Tendons - surgery; Time series; Trends; Young Adult; ACL; Lateral extra-articular tenodesis; Revision; Allograft; Anterior cruciate ligament; Quadriceps tendon
• DOI: 10.1007/s00167-021-06478-y
• ISSN: 0942-2056

Purpose To evaluate trends in revision anterior cruciate ligament reconstruction (ACL-R), with emphasis on intra-articular findings, grafts, and concurrent procedures. It was hypothesized that revision ACL-Rs over time show a trend toward increased complexity with increased use of autografts over allografts. Methods This was a two-center retrospective study including patients undergoing revision ACL-R between 2010 and 2020. Demographic and surgical data including intra-articular findings and concurrent procedures were collected and compared for the time periods 2010–2014 and 2015–2020. All collected variables were compared between three pre-defined age groups (< 20 years, 20–30 years, > 30 years), right and left knees, and males and females. A time series analysis was performed to assess trends in revision ACL-R. Results This study included 260 patients with a mean age of 26.2 ± 9.4 years at the time of the most recent revision ACL-R, representing the first, second, third, and fourth revision ACL-R for 214 (82%), 35 (14%), 10 (4%), and 1 (< 1%) patients, respectively. Patients age > 30 years showed a significantly longer mean time from primary ACL-R to most recent revision ACL-R (11.1 years), compared to patients age < 20 years (2.2 years, p  < 0.001) and age 20–30 years (5.5 years, p  < 0.05). Quadriceps tendon autograft was used significantly more often in 2015–2020 compared to 2010–2014 (49% vs. 18%, p  < 0.001). A high rate of concurrently performed procedures including meniscal repairs (45%), lateral extra-articular tenodesis (LET; 31%), osteotomies (13%), and meniscal allograft transplantations (11%) was shown. Concurrent LET was associated with intact cartilage and severely abnormal preoperative knee laxity and showed a statistically significant and linear increase over time ( p  < 0.05). Intact cartilage (41%, p  < 0.05), concurrent medial meniscal repairs (39%, p  < 0.05), and LET (35%, non-significant) were most frequently observed in patients aged < 20 years. Conclusion Quadriceps tendon autograft and concurrent LET are becoming increasingly popular in revision ACL-R. Intact cartilage and severely abnormal preoperative knee laxity represent indications for LET in revision ACL-R. The high rate of concurrent procedures observed demonstrates the high surgical demands of revision ACL-R. Level of evidence Level III.