Quadriceps tendon autograft useful in revision ACL reconstru
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A Study was conducted 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.

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, right and left knees, and males and females. A time series analysis was performed to assess trends in revision ACL-R.

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, 35, 10 and 1 patients, respectively.

--Patients age?more than?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?less than?20 years (2.2 years) and age 20–30 years (5.5 years).

--Quadriceps tendon autograft was used significantly more often in 2015–2020 compared to 2010–2014 (49% vs. 18%).

--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.

--Intact cartilage (41%), concurrent medial meniscal repairs (39%), and LET (35%) were most frequently observed in patients aged?less than?20 years.

Conclusively, 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.

Source: https://link.springer.com/article/10.1007/s00167-021-06478-y