The Journal of Bone and Joint Surgery (American) 83:1131-1143 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.
Revision Anterior Cruciate Surgery with Use of Bone-Patellar Tendon-Bone Autogenous Grafts
Frank R. Noyes, MD and
Sue D. Barber-Westin, BS
Investigation performed at the Cincinnati Sportsmedicine
and Orthopaedic Center and the Deaconess Hospital, Cincinnati, Ohio
Frank R. Noyes, MD
Sue D. Barber-Westin, BS
Deaconess Hospital, 311 Straight Street, Cincinnati, OH 45219.
E-mail address for S.D. Barber-Westin: westinsb{at}aol.com
Although none of the authors has received or will receive benefits
for personal or professional use from a commercial party related
directly or indirectly to the subject of this article, benefits
have been or will be received, but are directed solely to a research
fund, foundation, educational institution, or other nonprofit organization
with which one or more of the authors is associated. Funds were
received in total or partial support of the research or clinical
study presented in this article. The funding source was the Cincinnati
Sportsmedicine Research and Education Foundation.
Commentaries are available with the electronic versions of this
article, on our web site (www.jbjs.org) and on our CD-ROM (call
781-449-9780, ext. 140, to order).
Background: A prospective study was done to
determine the functional results, patient satisfaction, and graft
failure rate after fifty-seven consecutive revision replacements
of the anterior cruciate ligament with use of a bone-patellar
tendon-bone autogenous graft.
Methods: Fifty-four patients (fifty-five
operations) were followed in this study. Concurrent operative procedures
were performed during the revision procedure in thirty-seven knees
(67%). These procedures included repair of a meniscal tear
in twenty knees (36%) and reconstruction of deficient posterolateral
or medial ligament structures in seventeen knees (31%).
Nine knees (16%) had a high tibial osteotomy to correct
varus malalignment before the revision operation. The results were evaluated
with the Cincinnati Knee Rating System.
Results: There were significant improvements in
the scores for pain (p < 0.0001), activities of daily living
(p < 0.01), sports participation (p < 0.001),
patient satisfaction (p < 0.0001), and overall rating of
the knee (p < 0.0001). Thirty-three (60%)
of the replaced ligaments were functional, nine (16%) were
partially functional, and thirteen (24%) had failed.
Conclusions: Many knees (93%) had compounding
problems, including articular cartilage damage, prior meniscectomy,
loss of secondary ligament restraints, varus malalignment, and concomitant
ligament replacement or meniscal repair. Therefore, the results
were generally less favorable than those following primary operations.
The rate of graft failure was three times higher than our previously
reported failure rate after primary replacements of the anterior
cruciate ligament with a bone-patellar tendon-bone
autogenous graft. Even so, symptoms and functional limitations with
regard to daily and sports activities were found to have decreased
and patient satisfaction improved. We advocate correction of varus
malalignment prior to anterior cruciate procedures. Associated posterolateral
ligament deficiencies should be surgically corrected during anterior
cruciate procedures to prevent excessive loading on the graft from
abnormal lateral tibiofemoral joint opening. Meniscal tears, including
complex tears that extend into the avascular zone, can be concurrently
repaired successfully during the revision.
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