Mid-term Results of a Single-Stage Revision Anterior Cruciate Ligament Reconstruction: A Retrospective Analysis of 36 Cases

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Abstract

Background. Revision anterior cruciate ligament reconstruction is becoming more and more common in the knee surgery due to the annual increase in the number of primary anterior cruciate ligament reconstructions. Choosing the most suitable graft and determining the staging of the surgical treatment by preoperative assessment of the possibility of performing the most anatomical revision canals and their interposition with the primary canals are the main factors that influence treatment results.

Aim of the study — comparative assessment of the results of using hamstring tendon and peroneus longus tendon autografts in a one-stage revision reconstruction of the anterior cruciate ligament.

Methods. A retrospective analysis of the medical records of 36 patients who underwent revision anterior cruciate ligament reconstruction was performed. The patients were divided into two groups: in the patients of the study group (n = 19) a peroneus longus tendon (PLT) autograft was used, in the comparison group (n = 17) a hamstring tendon autograft (HT) was applied. Subjective and objective evaluation using the KOOS, IKDC, and Lysholm scales was performed, and position of the central entry points of the primary and revision canals was determined.

There were no statistically significant differences in the objective assessment of the knee joint stability. Significantly better results of subjective assessment of the knee function according to the Lysholm and KOOS scales were obtained in the PLT group (p = 0.042 and p<0.001, respectively). Position of revision canals corresponded to the standard values, but position of the femoral canal had a slight cranial and anterior displacement. It was also found that the PLT graft diameter was statistically significantly larger than the HT graft diameter (p<0.001).

Results. There were no statistically significant differences in the objective assessment of the knee joint stability. Significantly better results of subjective assessment of the knee function according to the Lysholm and KOOS scales were obtained in the PLT group (p = 0.042 and p<0.001, respectively). Position of revision canals corresponded to the standard values, but position of the femoral canal had a slight cranial and anterior displacement. It was also found that the PLT graft diameter was statistically significantly larger than the HT graft diameter (p<0.001).

Conclusion. One-stage revision anterior cruciate ligament reconstruction is a safe and effective surgical procedure providing satisfactory objective and subjective clinical results. Use of peroneus longus tendon autograft allows to obtain better results in comparison with the hamstring tendon autograft.

About the authors

Anton S. Gofer

Tsivyan Novosibirsk Research Institute of Traumatology and Orthopaedics

Author for correspondence.
Email: a.hofer.ortho@gmail.com
ORCID iD: 0009-0000-3886-163X
Russian Federation, Novosibirsk

Aleksandr A. Alekperov

Tsivyan Novosibirsk Research Institute of Traumatology and Orthopaedics

Email: alecperov@mail.ru
ORCID iD: 0000-0003-3264-8146
Russian Federation, Novosibirsk

Mikhail B. Gurazhev

Tsivyan Novosibirsk Research Institute of Traumatology and Orthopaedics

Email: tashtagol@inbox.ru
ORCID iD: 0000-0002-6398-9413
Russian Federation, Novosibirsk

Artem K. Avdeev

Tsivyan Novosibirsk Research Institute of Traumatology and Orthopaedics

Email: avdeev.artiom@mail.ru
ORCID iD: 0009-0008-9147-5808
Russian Federation, Novosibirsk

Vitaliy L. Lukinov

Tsivyan Novosibirsk Research Institute of Traumatology and Orthopaedics

Email: vitaliy.lukinov@gmail.com
ORCID iD: 0000-0002-3411-508X

Cand. Sci. (Phys.-Mat.)

Russian Federation, Novosibirsk

Dmitriy V. Rubtsov

Tsivyan Novosibirsk Research Institute of Traumatology and Orthopaedics

Email: rubic.dv@yandex.ru
ORCID iD: 0009-0007-1490-9783
Russian Federation, Novosibirsk

Vitalii V. Pavlov

Tsivyan Novosibirsk Research Institute of Traumatology and Orthopaedics

Email: pavlovdoc@mail.ru
ORCID iD: 0000-0002-8997-7330

Dr. Sci. (Med.)

Russian Federation, Novosibirsk

References

  1. George M.S., Dunn W.R., Spindler K.P. Current concepts review: revision anterior cruciate ligament reconstruction. Am J Sports Med. 2006;34(12):2026-2037. doi: 10.1177/0363546506295026.
  2. Grassi A., Ardern C.L., Marcheggiani Muccioli G.M., Neri M.P., Marcacci M., Zaffagnini S. Does revision ACL reconstruction measure up to primary surgery? A meta-analysis comparing patient-reported and clinician-reported outcomes, and radiographic results. Br J Sports Med. 2016;50(12):716-724. doi: 10.1136/bjsports-2015-094948.
  3. Trojani C., Sbihi A., Djian P., Potel J.F., Hulet C., Jouve F. et al. Causes for failure of ACL reconstruction and influence of meniscectomies after revision. Knee Surg Sports Traumatol Arthrosc. 2011;19(2):196-201. doi: 10.1007/s00167-010-1201-6.
  4. Банцер С.А., Трачук А.П., Богопольский О.Е., Тихилов Р.М., Сушков И.В., Мурга Е.Я. Влияние положения туннелей на результаты транстибиальной реконструкции передней крестообразной связки. Травматология и ортопедия России. 2017;23(3):7-16. doi: 10.21823/2311-2905-2017-23-3-7-16. Bantser S.A., Trachuk A.P., Bogopol’sky O.E., Tikhilov R.M., Sushkov I.V., Murga E.Yа. Effect of Bone Tunnels Positioning on Outcomes of Transtibial Anterior Cruciate Ligament Reconstruction. Traumatology and Orthopedics of Russia. 2017;23(3):7-16. (In Russian). doi: 10.21823/2311-2905-2017-23-3-7-16.
  5. Morgan J.A., Dahm D., Levy B., Stuart M.J. MARS Study Group. Femoral tunnel malposition in ACL revision reconstruction. J Knee Surg. 2012;25(5):361-368. doi: 10.1055/s-0031-1299662.
  6. Niki Y., Matsumoto H., Enomoto H., Toyama Y., Suda Y. Single-stage anterior cruciate ligament revision with bone-patellar tendon-bone: a case-control series of revision of failed synthetic anterior cruciate ligament reconstructions. Arthroscopy. 2010;26(8):1058-1065. doi: 10.1016/j.arthro.2009.12.015.
  7. MARS Group; MARS Group. Effect of graft choice on the outcome of revision anterior cruciate ligament reconstruction in the Multicenter ACL Revision Study (MARS) Cohort. Am J Sports Med. 2014;42(10):2301-2310. doi: 10.1177/0363546514549005.
  8. Nissen K.A., Eysturoy N.H., Nielsen T.G., Lind M. Allograft Use Results in Higher Re-Revision Rate for Revision Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med. 2018;6(6):2325967118775381. doi: 10.1177/2325967118775381.
  9. Гофер А.С., Алекперов А.А., Гуражев М.Б., Авдеев А.К., Павлов В.В., Корыткин А.А. Ревизионная реконструкция передней крестообразной связки: современные подходы к предоперационному планированию (систематический обзор литературы). Травматология и ортопедия России. 2023;29(3): 136-148. doi: 10.17816/2311-2905-2130. Gofer A.S., Alekperov A.A., Gurazhev M.B., Avdeev A.K., Pavlov V.V., Korytkin A.A. Revision Anterior Cruciate Ligament Reconstruction: Current Approaches to Preoperative Planning (Systematic Review). Traumatology and Orthopedics of Russia. 2023;29(3): 136-148. (In Russian). doi: 10.17816/2311-2905-2130.
  10. Сапрыкин А.C., Банцер С.А., Рябинин М.В., Корнилов Н.Н. Современные аспекты предоперационного планирования и выбора хирургической методики ревизионной реконструкции передней крестообразной связки. Гений ортопедии. 2022;28(3): 444-451. doi: 10.18019/1028-4427-2022-28-3-444-451. Saprykin A.S., Bantser S.A., Rybinin M.V., Kornilov N.N. Current Aspects of Preoperative Planning and Selection of Surgical Techniques for Revision Anterior Cruciate Ligament Reconstruction. Genij Ortopedii. 2022;28(3):444-451. (In Russian) doi: 10.18019/1028-4427- 2022-28-3-444-451
  11. Grassi A., Zicaro J.P., Costa-Paz M., Samuelsson K., Wilson A., Zaffagnini S. et al. ESSKA Arthroscopy Committee. Good mid-term outcomes and low rates of residual rotatory laxity, complications and failures after revision anterior cruciate ligament reconstruction (ACL) and lateral extra-articular tenodesis (LET). Knee Surg Sports Traumatol Arthrosc. 2020;28(2):418-431. doi: 10.1007/s00167-019-05625-w.
  12. Alm L., Drenck T.C., Frosch K.H., Akoto R. Lateral extra-articular tenodesis in patients with revision anterior cruciate ligament (ACL) reconstruction and high-grade anterior knee instability. Knee. 2020;27(5):1451-1457. doi: 10.1016/j.knee.2020.06.005.
  13. Dejour D., Saffarini M., Demey G., Baverel L. Tibial slope correction combined with second revision ACL produces good knee stability and prevents graft rupture. Knee Surg Sports Traumatol Arthrosc. 2015;23(10):2846-2852. doi: 10.1007/s00167-015-3758-6.
  14. Napier R.J., Garcia E., Devitt B.M., Feller J.A., Webster K.E. Increased Radiographic Posterior Tibial Slope Is Associated With Subsequent Injury Following Revision Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med. 2019;7(11):23. doi: 10.1177/2325967119879373.
  15. Bernard M., Hertel P., Hornung H., Cierpinski Th. Femoral insertion of the ACL: radiographic quadrant method. Am J Knee Surg. 1997;10(1):14-22.
  16. Tsukada H., Ishibashi Y., Tsuda E., Fukuda A., Toh S. Anatomical analysis of the anterior cruciate ligament femoral and tibial footprints. J Orthop Sci. 2008; 13(2):122-129. doi: 10.1007/s00776-007-1203-5.
  17. Гофер А.С., Алекперов А.А., Гуражев М.Б., Авдеев А.К., Павлов В.В. Оценка структуры неудачных исходов первичных реконструкций передней крестообразной связки: анализ 84 случаев. Современные проблемы науки и образования. 2023;(4):87-87. doi: 10.17513/spno.32736. Режим доступа: https://science-education.ru/ru/article/view?id=32736. Gofer A.S., Alekperov A.A., Gurazhev M.B., Avdeev A.K., Pavlov V.V. Evaluation of the structure of unsuccessful outcomes of primary reconstructions of the anterior cruciate ligament: analysis of 84 cases. Modern problems of science and education. 2023;(4):87-87. (In Russian). doi: 10.17513/spno.32736. Available from: https://science-education.ru/ru/article/view?id=32736
  18. Rahardja R., Zhu M., Love H., Clatworthy M.G., Monk A.P., Young S.W. Factors associated with revision following anterior cruciate ligament reconstruction: A systematic review of registry data. Knee. 2020; 27(2):287-299. doi: 10.1016/j.knee.2019.12.003.
  19. Salem H.S., Axibal D.P., Wolcott M.L., Vidal A.F., McCarty E.C., Bravman J.T. et al. Two-Stage Revision Anterior Cruciate Ligament Reconstruction: A Systematic Review of Bone Graft Options for Tunnel Augmentation. Am J Sports Med. 2020;48(3):767-777. doi: 10.1177/0363546519841583.
  20. Colatruglio M., Flanigan D.C., Long J., DiBartola A.C., Magnussen R.A. Outcomes of 1- Versus 2-Stage Revision Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Am J Sports Med. 2021;49(3):798-804. doi: 10.1177/0363546520923090.
  21. Рыбин А.В., Кузнецов И.А., Румакин В.П., Нетылько Г.И., Ломая М.П. Экспериментально-морфологические аспекты несостоятельности сухожильных ауто- и аллотрансплантатов после реконструкции передней крестообразной связки коленного сустава в раннем послеоперационном периоде. Травматология и ортопедия России. 2016;22(4): 60-75. doi: 10.21823/2311-2905-2016-22-4-60-75. Rybin A.V., Kuznetsov I.A., Rumakin V.P., Netylko G.I., Lomaya M.P. Experimental and Morphological Aspects of failed Tendon Auto- and Allografts after ACL Reconstruction in Early Postoperative Period. Traumatology and orthopedics of Russia. 2016;22(4):60-75 (In Russian). doi: 10.21823/2311-2905-2016-22-4-60-75.
  22. Ahn J.H., Son D.W., Jeong H.J., Park D.W., Lee I.G. One-Stage Anatomical Revision Anterior Cruciate Ligament Reconstruction: Results According to Tunnel Overlaps. Arthroscopy. 2021;37(4):1223-1232. doi: 10.1016/j.arthro.2020.11.029.
  23. Werner B.C., Gilmore C.J., Hamann J.C., Gaskin C.M., Carroll J.J., Hart J.M. et al. Revision Anterior Cruciate Ligament Reconstruction: Results of a Single-stage Approach Using Allograft Dowel Bone Grafting for Femoral Defects. J Am Acad Orthop Surg. 2016;24(8): 581-587. doi: 10.5435/JAAOS-D-15-00572.
  24. Dragoo J.L., Kalisvaart M., Smith K.M., Pappas G., Golish R. Single-stage revision anterior cruciate ligament reconstruction using bone grafting for posterior or widening tibial tunnels restores stability of the knee and improves clinical outcomes. Knee Surg Sports Traumatol Arthrosc. 2019;27(11):3713-3721. doi: 10.1007/s00167-019-05467-6.
  25. Andernord D., Björnsson H., Petzold M., Eriksson B.I., Forssblad M., Karlsson J. et al. Surgical Predictors of Early Revision Surgery After Anterior Cruciate Ligament Reconstruction: Results From the Swedish National Knee Ligament Register on 13,102 Patients. Am J Sports Med. 2014;42(7):1574-1582. doi: 10.1177/0363546514531396.
  26. Barié A., Ehmann Y., Jaber A., Huber J., Streich N.A. Revision ACL reconstruction using quadriceps or hamstring autografts leads to similar results after 4 years: good objective stability but low rate of return to pre-injury sport level. Knee Surg Sports Traumatol Arthrosc. 2019;27(11):3527-3535. doi: 10.1007/s00167-019-05444-z.
  27. Trasolini N.A., Lan R., Bolia I.K., Hill W., Thompson A.A., Mayfield C.K. et al. Knee Extensor Mechanism Complications After Autograft Harvest in ACL Reconstruction: A Systematic Review and Meta-analysis. Orthop J Sports Med. 2023;11(7):23259671231177665. doi: 10.1177/23259671231177665.
  28. Goyal T., Paul S., Choudhury A.K., Sethy S.S. Full-thickness peroneus longus tendon autograft for anterior cruciate reconstruction in multi-ligament injury and revision cases: outcomes and donor site morbidity. Eur J Orthop Surg Traumatol. 2023;33(1):21-27. doi: 10.1007/s00590-021-03145-3.
  29. He J., Tang Q., Ernst S., Linde M.A., Smolinski P., Wu S. et al. Peroneus longus tendon autograft has functional outcomes comparable to hamstring tendon autograft for anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2021;29(9):2869-2879. doi: 10.1007/s00167-020-06279-9.
  30. Shi F.D., Hess D.E., Zuo J.Z., Liu S.J., Wang X.C., Zhang Y. et al. Peroneus Longus Tendon Autograft is a Safe and Effective Alternative for Anterior Cruciate Ligament Reconstruction. J Knee Surg. 2019;32(8):804-811. doi: 10.1055/s-0038-1669951.
  31. Rhatomy S., Asikin A.I.Z., Wardani A.E., Rukmoyo T., Lumban-Gaol I., Budhiparama N.C. Peroneus longus autograft can be recommended as a superior graft to hamstring tendon in single-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2019;27(11): 3552-3559. doi: 10.1007/s00167-019-05455-w.
  32. Phatama K.Y., Hidayat M., Mustamsir E., Pradana A.S., Dhananjaya B., Muhammad S.I. Tensile strength comparison between hamstring tendon, patellar tendon, quadriceps tendon and peroneus longus tendon: a cadaver research. J Arthrosc Joint Surg. 2019;6(2):114-116. doi: 10.1016/j.jajs.2019.02.003.
  33. Spragg L., Chen J., Mirzayan R., Love R., Maletis G. The Effect of Autologous Hamstring Graft Diameter on the Likelihood for Revision of Anterior Cruciate Ligament Reconstruction. Am J Sports Med. 2016;44(6): 1475-1481. doi: 10.1177/0363546516634011.
  34. Snaebjörnsson T., Hamrin Senorski E., Ayeni O.R, Alentorn-Geli E., Krupic F., Norberg F. et al. Graft Diameter as a Predictor for Revision Anterior Cruciate Ligament Reconstruction and KOOS and EQ-5D Values: A Cohort Study From the Swedish National Knee Ligament Register Based on 2240 Patients. Am J Sports Med. 2017;45(9):2092-2097. doi: 10.1177/0363546517704177.

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2. Fig. 2. Position of the central attachment point of the native ACL on the tibia (E); Y — line drawn through the most prominent point of the medial edge of the tibial plateau; X — line drawn through the extreme point of the anterior edge of the tibial plateau, perpendicular to the line Y; EX — distance from the anterior edge of the tibial plateau (43.8%); EY — distance from the medial edge of the tibial plateau (48.9%)

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3. Fig. 3. Position of the central attachment point of the native ACL on the femur: t — line corresponding to the Blumensaat’s line; h — line passing through the extreme point of the posterior edge of the lateral femoral condyle, perpendicular to the line t; Gh (%) — distance from the deepest point of the medial edge of the lateral femoral condyle (29.9%); Gt (%) — distance from the Blumensaat’s line (30.1%)

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4. Fig. 4. Average position of the central entry points into the primary canals (marked in red) and revision canals (marked in green) of the tibial condyle

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5. Fig. 5. Average position of the central entry points into the primary canals (marked in red) and revision canals (marked in green) of the femur

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6. Fig. 1. Flowchart of the study design

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