Summary

Our series of ACL one-stage revisions with BPTB allograft shows that this type of graft enables patients to return to sports and to a good quality of life after the final follow-up at minimum 2-years.

Abstract

Purpose

To assess the rate of return to sports and quality of life through different PROMs (IKDC, Lysholm score, Tegner activity scale, Simple Knee Value) and complication rate in a series of patients undergone surgery for one-stage revision ACL reconstruction with BPTB allograft with at least 2 years follow-up.

Methods

Thirty-eight patients with a minimum 2 years follow-up period were retrospectively included in this investigation. The cohort consisted of 38 consecutive patients undergone one-stage revision ACLR from a single University Hospital. The clinical assesment was based on the IKDC score, Lysholm score, Tegner activity scale and Simple Knee Value score. In addition, we recorded the timing for RTS, the rate of allograft re-rupture and the rate of post-surgical complications.

Results

Patients in our series receiving BPTB allografts showed good to excellent PROMs values at a minimum of 2 years follow-up. The median value of IKDC score turned out to be 82.8 (Q1-Q3 75.3-88.2), the median value of Lysholm was 85.5 (Q1-Q3 80.0-91.0) and the median value for Simple Knee Value was 77.5 (Q1-Q3 65.0-85.0). For the Tegner Activity Scale (TAS) we recorded a median value of 8.0 (Q1-Q3 6.0-9.0) before the injury and 6.0 (Q1-Q3 5.0-7.0) after the surgery. The timing for return-to-play (RTP) was between 6 and 9 months for 19 patients (54.3%), between 9 and 12 months for 7 patients (20.0%) and over 12 months for 9 patients (25.7%). Regarding post-surgery complications, we recorded an overall rate of 15.79% in our series, with however minor entity (Clavien-Dindo grade I). Although 39.5% of patients experienced a new knee sprain, allografts re-rupture rate was 10.5% (4 out of 38).

Conclusions

BPTB allografts in one-stage revision ACL surgery enabled patients to return to sports and to a good quality of life after final follow-up. Moreover this type of graft has shown to be a safe choice, being burdened by a low rate of post surgical complication and re-rupture risk. These findings inform shared decision making and can help surgeons to choose this type of graft. In fact in the setting of ACL revision surgery, one of the major issues is to avoid further weakening the patient's knee by taking a new autograft, along with, on the other hand, which allograft to prefer, being a lack of evidence in the literature.