Revision anterior cruciate ligament reconstruction in level 1 athletes: similar outcomes with bone-patellar tendon-bone and Hamstring autografts with or without lateral extra-articular tenodesis.

INTRODUCTION

This study reports revision anterior cruciate ligament reconstruction (R-ACLR) outcomes using bone-patellar tendon-bone (BPTB) vs. hamstring tendon (HT) autografts with and without lateral extra-articular tenodesis (LEAT) in a cohort of level 1 athletes.

METHODS

A consecutive cohort of 262 athletes who underwent R-ACLR between 2014 and 2018 were analysed. The decision to add LEAT was based on risk factors for graft failure risk, particularly younger age and generalized hyperlaxity. There were 157 patients in the BPTB cohort (BPTB = 53 vs. BPTB + LEAT = 104) and 105 patients in the HT cohort (HT = 32 vs. HT + LEAT = 73). Return to Play (RTP), ipsilateral/contralateral ACL injuries, and patient-reported outcome measures (International Knee Documentation Committee [IKDC] score, Marx) were assessed at 2 years.

RESULTS

The mean age was 25.4 ± 6.3 years and 84.4% of patients were male. RTP rates (BPTB ± LEAT: 65.2% vs. HT ± LEAT: 62.8%; p = 0.400) and time to RTP (13.3 ± 5.7 vs. 12.4 ± 6.1 months) were comparable. Increasing age was independently associated with reduced odds of RTP, with each additional year associated with a 6.9% reduction in the odds of RTP (odds ratio (OR) 0.93, 95% confidence interval (CI): 0.89-0.98; p = 0.005). There was no statistically significant difference in graft re-injury rates with or without LEAT (BPTB vs. BPTB + LEAT: 1.9% (1/52) vs. 2.9% (3/2.9), p = 0.720) and (HT vs. HT + LEAT: 6.3% (2/30) vs. 1.4% (1/72), p = 0.163). There was no statistically significant difference in IKDC score (BPTB: 83.3 ± 11.7 vs. HT: 83.6 ± 13.9, p = 0.885). Both cohorts demonstrated a reduction in Marx score from their pre-operative levels (BPTB ± LEAT: 10.7 to 8.1 vs. HT ± LEAT: 11.1 to 8.7).

CONCLUSION

This study demonstrated that using ipsilateral BPTB and HT autografts for R-ACLR in level 1 athletes resulted in no statistically significant difference in RTP, re-injury, and patient-reported outcomes. There was also no difference in re-injury rate in the group that received LEAT. Interestingly, although patients in the LEAT group were younger and had a lower incidence of chondral injuries, this did not translate into improved patient-reported outcomes. Notably, all patients' activity levels were substantially reduced after R-ACLR, regardless of the type of graft used. LEVEL OF EVIDENCE 3: Cohort study.