Download PDF
J Knee Surg 2023; 36(06): 613-621
DOI: 10.1055/s-0041-1740927
Original Article

Comparison of Clinical Outcomes after Revision Anterior Cruciate Ligament Reconstruction using a Bone-patellar Tendon-bone Autograft and that Using a Double-Bundle Hamstring Tendon Autograft

Hiroki Katagiri
1   Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
2   Department of Orthopedic Surgery, Saitama Medical Center, Dokkyo Medical University, Koshigaya, Saitama, Japan
,
Yusuke Nakagawa
1   Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
,
Kazumasa Miyatake
1   Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
,
Nobutake Ozeki
3   Department of Orthopedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
,
Yuji Kohno
3   Department of Orthopedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
,
Masaki Amemiya
3   Department of Orthopedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
,
Ichiro Sekiya
1   Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
,
Hideyuki Koga 
1   Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Purpose The purpose of this study was to compare clinical outcomes between revision anterior cruciate ligament reconstruction (ACLR) using a bone-patellar tendon-bone (BPTB) autograft and that using a double-bundle hamstring tendon (HT) autograft.

Methods Consecutive cases of revision ACLRs were reviewed. The Lysholm knee scale and Knee Osteoarthritis Outcome Score (KOOS) were recorded at the final follow-up. The pivot shift test, Lachman test, and anterior knee laxity measurement using an arthrometer were evaluated before revision ACLR and at final follow-up. Contralateral knee laxity was also evaluated, and side-to-side differences noted. The Lysholm knee scale, KOOS, the pivot shift test, Lachman test, and anterior knee laxity were compared between HT versus BPTB autograft recipient groups using the Mann–Whitney test or the t-test.

Results Forty-one patients who underwent revision ACLR and followed up for at least 2 years were included. The graft source was a BPTB autograft in 23 patients (BPTB group) and a double-bundle HT autograft in 18 patients (HT group). The mean postoperative follow-up period was 44 ± 28 months in the BPTB group and 36 ± 18 in the HT group (p = 0.38). The HT group had significantly higher KOOS in the pain subscale (less pain) than the BPTB group at the final follow-up (BPTB group 84.2 vs. HT group 94.4; p = 0.02). The BPTB group showed significantly smaller side-to-side difference in anterior knee laxity (superior stability) than the HT group (0.3 vs. 2.6 mm; p < 0.01). The percentage of patients with residual anterior knee laxity in the BPTB group was significantly lower than that in the HT group (9.5% vs. 46.7%; odds ratio, 8.3; p = 0.02).

Study Design This was a level 3 retrospective study.

Conclusion Revision ACLR with a BPTB autograft was associated with superior results regarding restoration of knee joint stability as compared with that with a double-bundle HT autograft, whereas double-bundle HT autograft was superior to BPTB autograft in terms of patient-reported outcomes of pain. The rest of the patient-reported outcomes were equal between the two groups.

Keywords

revision anterior cruciate ligament reconstruction - autograft source - bone-patellar tendon-bone autograft - double-bundle hamstring tendon autograft - clinical outcomes


Publication History

Received: 04 January 2021

Accepted: 16 November 2021

Article published online:
24 December 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Lind M, Menhert F, Pedersen AB. Incidence and outcome after revision anterior cruciate ligament reconstruction: results from the Danish registry for knee ligament reconstructions. Am J Sports Med 2012; 40 (07) 1551-1557
    CrossrefPubMedGoogle Scholar
  • 2 Wright RW, Gill CS, Chen L. et al. Outcome of revision anterior cruciate ligament reconstruction: a systematic review. J Bone Joint Surg Am 2012; 94 (06) 531-536
    CrossrefPubMedGoogle Scholar
  • 3 Wright RW, Johnson L, Brophy RH, Bogunovic L, Matava MJ, Smith MV. Revision anterior cruciate ligament reconstruction outcomes at a minimum of 5-year follow-up: a systematic review. J Knee Surg 2019; 32 (03) 218-221
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Kvist J, Kartus J, Karlsson J, Forssblad M. Results from the Swedish national anterior cruciate ligament register. Arthroscopy 2014; 30 (07) 803-810
    CrossrefPubMedGoogle Scholar
  • 5 Ding DY, Zhang AL, Allen CR. et al; MARS Group. Subsequent surgery after revision anterior cruciate ligament reconstruction: rates and risk factors from a multicenter cohort. Am J Sports Med 2017; 45 (09) 2068-2076
    CrossrefPubMedGoogle Scholar
  • 6 Group M. MARS Group. Meniscal and articular cartilage predictors of clinical outcome after revision anterior cruciate ligament reconstruction. Am J Sports Med 2016; 44 (07) 1671-1679
    CrossrefPubMedGoogle Scholar
  • 7 Liechti DJ, Chahla J, Dean CS. et al. Outcomes and risk factors of rerevision anterior cruciate ligament reconstruction: a systematic review. Arthroscopy 2016; 32 (10) 2151-2159
    CrossrefPubMedGoogle Scholar
  • 8 Cooper DE, Dunn WR, Huston LJ. et al; MARS Group. Physiologic preoperative knee hyperextension is a predictor of failure in an anterior cruciate ligament revision cohort: a report from the MARS Group. Am J Sports Med 2018; 46 (12) 2836-2841
    CrossrefPubMedGoogle Scholar
  • 9 Allen CR, Anderson AF, Cooper DE. et al; MARS Group. Surgical predictors of clinical outcomes after revision anterior cruciate ligament reconstruction. Am J Sports Med 2017; 45 (11) 2586-2594
    CrossrefPubMedGoogle Scholar
  • 10 Cerulli G, Placella G, Sebastiani E, Tei MM, Speziali A, Manfreda F. ACL reconstruction: choosing the graft. Joints 2013; 1 (01) 18-24
    PubMedGoogle Scholar
  • 11 Magnussen RA, Trojani C, Granan LP. et al; MARS Group, SFA Revision ACL Group. Patient demographics and surgical characteristics in ACL revision: a comparison of French, Norwegian, and North American cohorts. Knee Surg Sports Traumatol Arthrosc 2015; 23 (08) 2339-2348
    CrossrefPubMedGoogle Scholar
  • 12 Cristiani R, Sarakatsianos V, Engström B, Samuelsson K, Forssblad M, Stålman A. Increased knee laxity with hamstring tendon autograft compared to patellar tendon autograft: a cohort study of 5462 patients with primary anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27 (02) 381-388
    CrossrefPubMedGoogle Scholar
  • 13 Gifstad T, Foss OA, Engebretsen L. et al. Lower risk of revision with patellar tendon autografts compared with hamstring autografts: a registry study based on 45,998 primary ACL reconstructions in Scandinavia. Am J Sports Med 2014; 42 (10) 2319-2328
    CrossrefPubMedGoogle Scholar
  • 14 Schuette HB, Kraeutler MJ, Houck DA, McCarty EC. Bone-patellar tendon-bone versus hamstring tendon autografts for primary anterior cruciate ligament reconstruction: a systematic review of overlapping meta-analyses. Orthop J Sports Med 2017; 5 (11) 2325967117736484
    CrossrefPubMedGoogle Scholar
  • 15 Koga H, Zaffagnini S, Getgood AM. et al. ACL graft selection: state of the art. J ISAKOS Joint Disord. Orthopaed Sports Med 2018; 3: 177-184
    PubMedGoogle Scholar
  • 16 Pinczewski LA, Lyman J, Salmon LJ, Russell VJ, Roe J, Linklater J. A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Am J Sports Med 2007; 35 (04) 564-574
    CrossrefPubMedGoogle Scholar
  • 17 Hefti F, Müller W, Jakob RP, Stäubli HU. Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1993; 1 (3-4): 226-234
    CrossrefPubMedGoogle Scholar
  • 18 Clinch J, Deere K, Sayers A. et al. Epidemiology of generalized joint laxity (hypermobility) in fourteen-year-old children from the UK: a population-based evaluation. Arthritis Rheum 2011; 63 (09) 2819-2827
    CrossrefPubMedGoogle Scholar
  • 19 Roos EM, Lohmander LS. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 2003; 1: 64
    CrossrefPubMedGoogle Scholar
  • 20 Nwachukwu BU, Chang B, Voleti PB. et al. Preoperative short form health survey score is predictive of return to play and minimal clinically important difference at a minimum 2-year follow-up after anterior cruciate ligament reconstruction. Am J Sports Med 2017; 45 (12) 2784-2790
    CrossrefPubMedGoogle Scholar
  • 21 Sanders TL, Kremers HM, Bryan AJ. et al. Is anterior cruciate ligament reconstruction effective in preventing secondary meniscal tears and osteoarthritis?. Am J Sports Med 2016; 44 (07) 1699-1707
    CrossrefPubMedGoogle Scholar
  • 22 Kim DK, Park G, Kadir KBHMS, Kuo LT, Park WH. Comparison of knee stability, strength deficits, and functional score in primary and revision anterior cruciate ligament reconstructed knees. Sci Rep 2018; 8 (01) 9186
    CrossrefPubMedGoogle Scholar
  • 23 Smith HC, Vacek P, Johnson RJ. et al. Risk factors for anterior cruciate ligament injury: a review of the literature-part 2: hormonal, genetic, cognitive function, previous injury, and extrinsic risk factors. Sports Health 2012; 4 (02) 155-161
    CrossrefPubMedGoogle Scholar
  • 24 Smith HC, Vacek P, Johnson RJ. et al. Risk factors for anterior cruciate ligament injury: a review of the literature - part 1: neuromuscular and anatomic risk. Sports Health 2012; 4 (01) 69-78
    CrossrefPubMedGoogle Scholar
  • 25 Oh JY, Kim KT, Park YJ. et al. Biomechanical comparison of single-bundle versus double-bundle anterior cruciate ligament reconstruction: a meta-analysis. Knee Surg Relat Res 2020; 32 (01) 14
    CrossrefPubMedGoogle Scholar
  • 26 Mascarenhas R, Cvetanovich GL, Sayegh ET. et al. Does double-bundle anterior cruciate ligament reconstruction improve postoperative knee stability compared with single-bundle techniques? A systematic review of overlapping meta-analyses. Arthroscopy 2015; 31 (06) 1185-1196
    CrossrefPubMedGoogle Scholar
  • 27 Ueki H, Nakagawa Y, Ohara T. et al. Risk factors for residual pivot shift after anterior cruciate ligament reconstruction: data from the MAKS group. Knee Surg Sports Traumatol Arthrosc 2018; 26 (12) 3724-3730
    CrossrefPubMedGoogle Scholar
  • 28 Cristiani R, Forssblad M, Engström B, Edman G, Stålman A. Risk factors for abnormal anteroposterior knee laxity after primary anterior cruciate ligament reconstruction. Arthroscopy 2018; 34 (08) 2478-2484
    CrossrefPubMedGoogle Scholar
  • 29 Kim SJ, Choi CH, Lee SK, Lee W, An H, Jung M. Minimum two-year follow-up of anterior cruciate ligament reconstruction in patients with generalized joint laxity. J Bone Joint Surg Am 2018; 100 (04) 278-287
    CrossrefPubMedGoogle Scholar
  • 30 Webster KE, Feller JA. Younger patients and men achieve higher outcome scores than older patients and women after anterior cruciate ligament reconstruction. Clin Orthop Relat Res 2017; 475 (10) 2472-2480
    CrossrefPubMedGoogle Scholar
  • 31 Xie X, Liu X, Chen Z, Yu Y, Peng S, Li Q. A meta-analysis of bone-patellar tendon-bone autograft versus four-strand hamstring tendon autograft for anterior cruciate ligament reconstruction. Knee 2015; 22 (02) 100-110
    CrossrefPubMedGoogle Scholar
  • 32 Lyman S, Omori G, Nakamura N. et al. Development and validation of a culturally relevant Japanese KOOS. J Orthop Sci 2019; 24 (03) 514-520
    CrossrefPubMedGoogle Scholar
  • 33 Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM. Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res (Hoboken) 2011; 63 (Suppl. 11) S208-S228
    CrossrefPubMedGoogle Scholar
  • 34 Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 1985; (198) 43-49
    PubMedGoogle Scholar
  • 35 Kahlenberg CA, Nwachukwu BU, Ferraro RA, Schairer WW, Steinhaus ME, Allen AA. How are we measuring patient satisfaction after anterior cruciate ligament reconstruction?. Orthop J Sports Med 2016; 4 (12) 2325967116673971
    CrossrefPubMedGoogle Scholar
  • 36 Magnussen R, Reinke EK, Huston LJ. et al; MOON Knee Group. Anterior and rotational knee laxity does not affect patient-reported knee function 2 years after anterior cruciate ligament reconstruction. Am J Sports Med 2019; 47 (09) 2077-2085
    CrossrefPubMedGoogle Scholar
  • 37 Kocher MS, Steadman JR, Briggs KK, Sterett WI, Hawkins RJ. Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction. Am J Sports Med 2004; 32 (03) 629-634
    CrossrefPubMedGoogle Scholar
  • 38 Sernert N, Kartus J, Köhler K. et al. Analysis of subjective, objective and functional examination tests after anterior cruciate ligament reconstruction. A follow-up of 527 patients. Knee Surg Sports Traumatol Arthrosc 1999; 7 (03) 160-165
    CrossrefPubMedGoogle Scholar