Revision Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Autograft: 5- to 9-year Follow-up

Background: The results of revision anterior cruciate ligament reconstruction are limited in the current literature, and no studies have previously documented the outcome of revision anterior cruciate ligament reconstruction using solely hamstring tendon grafts.

Hypothesis: Revision anterior cruciate ligament reconstruction with 4-strand hamstring tendon graft affords acceptable results and is comparable to reported outcomes with the bone-patellar tendon-bone graft.

Study Design: Case series; Level of evidence, 4.

Methods: Fifty-seven consecutive revision anterior cruciate ligament reconstructions with the hamstring tendon graft and interference screw fixation were assessed a mean time of 89 months (range, 60-109 months) after surgery. Assessment included the International Knee Documentation Committee knee ligament evaluation, instrumented laxity testing, and radiologic examination.

Results: Of the 50 knees reviewed, 5 (10%) had objective failure of the revision anterior cruciate ligament reconstruction. Of the 45 patients with functional grafts, knee function was normal or nearly normal in 33 patients (73%). An overall grade of normal or nearly normal was found in 56% of patients. The mean side-to-side difference on manual maximum testing was 2.5 mm (range, -1 to 4 mm). Degenerative changes on radiographs were identified in 23% of patients at the time of surgery, increasing to 56% of patients at review. The status of the articular cartilage at the time of revision surgery was the most significant contributor to successful outcome.

Conclusion: Revision anterior cruciate ligament reconstruction with hamstring tendon graft and interference screw fixation affords acceptable results at a minimum of 5 years' follow-up. Good objective results can be obtained, but subjectively, the results appear inferior to those of primary anterior cruciate ligament reconstruction in the literature, which may be related to the high incidence of articular surface damage in this patient population. We recommend that, when available, hamstring tendon autografts should be considered for revision anterior cruciate ligament reconstruction.