Revision anterior cruciate surgery with use of bone-patellar tendon-bone autogenous grafts

Background: A prospective study was done to determine the functional result s, patient satisfaction, and graft failure rate after fifty-seven consecuti ve revision replacements of the anterior cruciate ligament with use of a bo ne-patellar tendon-bone autogenous graft. Methods: Fifty-four patients (fifty-five operations) were followed in this study. Concurrent operative procedures were performed during the revision p rocedure in thirty-seven knees (67%). These procedures included repair of a meniscal tear in twenty knees (36%) and reconstruction of deficient poster olateral or medial ligament structures in seventeen knees (31%). Nine knees (16%) had a high tibial osteotomy to correct varus malalignment before the revision operation. The results were evaluated with the Cincinnati Knee Ra ting System. Results: There were significant improvements in the scores for pain (p < 0. 0001), activities of daily living (p < 0.01), sports participation (p < 0.0 01), patient satisfaction (p < 0.0001), and overall rating of the knee (p < 0.0001). Thirty-three (60%) of the replaced ligaments were functional, nin e (16%) were partially functional, and thirteen (24%) had failed. Conclusions: Many knees (93%) had compounding problems, including articular cartilage damage, prior meniscectomy, loss of secondary ligament restraint s, varus, malalignment, and concomitant ligament replacement or meniscal re pair. Therefore, the results were generally less favorable than those follo wing primary operations. The rate of graft failure was three times higher t han our previously reported failure rate after primary replacements of the anterior cruciate ligament with a bone-patellar tendon-bone autogenous graf t. Even so, symptoms and functional limitations with regard to daily and sp orts activities were found to have decreased and patient satisfaction impro ved. We advocate correction of varus malalignment prior to anterior cruciat e procedures. Associated posterolateral ligament deficiencies should be sur gically corrected during anterior cruciate procedures to prevent excessive loading on the graft from abnormal lateral tibiofemoral joint opening. Meni scal tears, including complex tears that extend into the avascular zone, ca n be concurrently repaired successfully during the revision.