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Revision of anterior cruciate ligament reconstruction with a pedicled quadruple hamstring autograft

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Introduction

Results of iterative ACL reconstructions are lower than after primary reconstructions. Our aim was to report the results of a retrospective series of revision using pedicled quadruple hamstring autograft. The hypothesis was that the results were satisfactory and comparable to the literature.

Methods

The study period was from January 2012 to December 2014. Fourteen patients (average age 26) were included. A fascia lata graft was used 12 times for primary reconstruction. Trauma was the cause of failure 12 times. The time interval between primary reconstruction and revision was 6.2 years. Preoperative scores used were LYSHOLM, TEGNER and IKDC. Sagittal stability was measured using the KT-1000 device. X-rays and MRI were performed to confirm the diagnosis, look for preoperative osteoarthritis and evaluate the position of the bony tunnels (Bernard and Hertel). Bone tunnels were in a proper position 14 times.

Results

At 45-month follow-up, improvement of objective IKDC score was significant (85.7% A/B, p < 0.0002) as well as subjective IKDC score (85.5, p < 0.0004). A significant improvement was established for the LYSHOLM score (91.8, p = 0.001) using the Wilcoxon test. The average LYSHOLM score was 92% (p > 0.5), and the average TEGNER score was 5.5 (p = 0.003). The Lachman test found a hard stop in all patients. The pivot shift test was negative for 78.5% of the cases. The laxity measurement found 12 cases with less than 3 mm. One persistent distal hypoesthesia at 2-year follow-up was observed.

Conclusion

The hypothesis was confirmed. This series differs by the cause of failure, which was essentially traumatic, and the initial predominance of a fascia lata graft. These results remain to be confirmed.

Level of evidence

Retrospective case series, level IV.

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Authors and Affiliations

  1. Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg Cedex, France

    Henri Favreau, David Eichler, François Bonnomet, Philippe Adam & Matthieu Ehlinger

  2. Département de Chirurgie Orthopédique, Centre Albert-Trillat, Hôpital de la Croix-Rousse, 103 boulevard de la Croix-Rousse, 69004, Lyon, France

    Sébastien Lustig

  3. Laboratoire ICube, CNRS, UMR 7357, 30 Bd Sébastien Brant, 67400, Illkirch, France

    Philippe Adam & Matthieu Ehlinger

  4. Laboratoire INSERM-UNISTRA UMR 1260, 11 rue Humann, 67085, Strasbourg, France

    Henri Favreau

Authors
  1. Henri Favreau
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  2. David Eichler
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  3. François Bonnomet
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  4. Sébastien Lustig
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Contributions

HF, DE, ME and SL wrote the manuscript. PA and FB reread the manuscript.

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Correspondence to Henri Favreau.

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Favreau, H., Eichler, D., Bonnomet, F. et al. Revision of anterior cruciate ligament reconstruction with a pedicled quadruple hamstring autograft. Eur J Orthop Surg Traumatol 30, 1033–1038 (2020). https://doi.org/10.1007/s00590-020-02661-y

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