Summary
Double-bundle ACL revision with fresh frozen Achilles' allograft yields satisfactory results at long-term follow-up, with an 85% overall survival rate at mean 10 years follow-up and good patient-reported clinical scores.
Abstract
Purpose
This study was aimed to report the long-term second revision rate and subjective clinical outcomes from a cohort of patients who underwent a double-bundle (DB) ACLR 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 revision with Achille’s 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 questions of the survey 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, 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. Overall, there were 12 (15%) second ACL revisions during the follow-up period, three females and nine males, at a mean 4.5±3 years after the index surgery. The overall survival rates were 68% for all reoperations, 85% for a second revision. 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% overall survival rate at mean 10 years follow-up and good patient-reported clinical scores.