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Double-bundle non-anatomic ACL revision reconstruction with allograft resulted in a low revision rate at 10 years

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This study aimed at reporting the long-term second revision rate and subjective clinical outcomes from a cohort of patients who underwent a double-bundle (DB) ACLR first revision with allograft at a single institution.

Methods

The Institutional database was searched according to the following inclusion criteria: (1) patients that underwent DB-ACL first revision with Achilles tendon allograft, (2) surgery performed between January 2000 and December 2012, (3) age at revision ≥ 18 y/o. Patients’ general information, history, surgical data, and personal contacts were extracted from charts. An online survey platform was implemented to collect responses via email. The survey questions included: date of surgeries, surgical data, date of graft failure and subsequent second ACL revision surgery, any other surgery of the index knee, contralateral ACLR, KOOS score, and Tegner scores.

Results

Eighty-one patients were included in the survival analysis, mean age at revision 32 ± 9.2 y/o, 71 males, mean BMI 24.7 ± 2.7, mean time from ACL to revision 6.8 ± 5.4 years, mean follow-up time 10.7 ± 1.4 years. There were 12 (15%) second ACL revisions during the follow-up period, three females and nine males, at a mean of 4.5 ± 3 years after the index surgery. The overall survival rates were 85% from a second ACL revision and 68% from all reoperations of the index knee. Considering only the successful procedures (61 patients), at final follow-up, the mean values for the KOOS subscales were 84 ± 15.5 for Pain, 88.1 ± 13.6 for Symptoms, 93 ± 11.6 for ADL, 75 ± 24.5 for Sport, and 71 ± 19.6 for Qol. Twenty-nine (48%) patients performed sports activity at the same level as before ACLR failure.

Conclusions

Double-bundle ACL revision with fresh-frozen Achilles allograft yields satisfactory results at long-term follow-up, with an 85% survival rate from a second ACL revision at mean 10 years’ follow-up and good patient-reported clinical scores.

Level of evidence

Level IV.

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Acknowledgements

The authors thank Silvia Bassini for the images and graphical support, and Dr. SSA Margaux Hylton for her contribution to the language revision of the manuscript.

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No funding was received for this work.

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Authors and Affiliations

  1. Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy

    Luca Macchiarola, Nicola Pizza, Vittorio Patania, Alberto Grassi, Giacomo Dal Fabbro & Stefano Zaffagnini

  2. Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Foggia (FG), Viale Luigi Pinto, 1, 71122, Foggia, Italy

    Luca Macchiarola

  3. Humanitas Clinical and Research Center, Rozzano (MI), Via Alessandro Manzoni, 56, 20089, Italy

    Maurilio Marcacci

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  1. Luca Macchiarola
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Macchiarola, L., Pizza, N., Patania, V. et al. Double-bundle non-anatomic ACL revision reconstruction with allograft resulted in a low revision rate at 10 years. Knee Surg Sports Traumatol Arthrosc 31, 340–348 (2023). https://doi.org/10.1007/s00167-022-07151-8

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