The Journal of Bone and Joint Surgery (American). 2007;89:196-213.
doi:10.2106/JBJS.G.00310
© 2007 The Journal of Bone and Joint Surgery, Inc.
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Revision Anterior Cruciate Ligament Reconstruction with Doubled Semitendinosus and Gracilis Tendons and Lateral Extra-Articular Reconstruction

Surgical Technique

Andrea Ferretti, MD1, Fabio Conteduca, MD1, Edoardo Monaco, MD1, Angelo De Carli, MD1 and Carmelo D'Arrigo, MD1

1 Orthopaedic Unit and "Kirk Kilgour" Sports Injury Center, Sant'Andrea Hospital, University "La Sapienza," Via Lidia 73, 00179 Rome, Italy. E-mail address for A. Ferretti: aferretti51{at}virgilio.it. E-mail address for E. Monaco: edoardo.monaco{at}tin.it

Investigation performed at the Orthopaedic Unit and "Kirk Kilgour" Sports Injury Center, Sant'Andrea Hospital, University "La Sapienza," Rome, Italy

The original scientific article in which the surgical technique was presented was published in JBJS Vol. 88-A, pp. 2373-9, November 2006

DISCLOSURE: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

The line drawings in this article are the work of Emily G. Shaw of Illustrating Medicine (illustratingmedicine.com).

BACKGROUND: The outcome of revision anterior cruciate ligament reconstruction has only rarely been reported. The purpose of this study was to evaluate the results of revision anterior cruciate ligament surgery with use of an autogenous doubled semitendinosus and gracilis graft in association with an extra-articular procedure.

METHODS: Between 1997 and 2003, thirty patients underwent a repeat reconstruction of a previously reconstructed torn anterior cruciate ligament with use of a doubled semitendinosus and gracilis graft combined with an extra-articular reconstruction. Primary reconstruction had been done with an autogenous patellar tendon graft in twenty-six patients and with a prosthetic ligament in four patients; the average time from the primary reconstruction to the revision was five years. Functional outcomes, graft survival, and radiographic outcomes were evaluated at a mean of five years. A graft was considered to have failed when a revision was done or when the side-to-side difference on KT-1000 arthrometer testing was >5 mm and/or the pivot-shift test grade was greater than a trace.

RESULTS: One patient underwent another revision reconstruction because of graft failure at three years postoperatively. The mean International Knee Documentation Committee (IKDC) subjective knee score for the remaining twenty-nine patients was 84 ± 12 points, and the mean Lysholm knee score was 90 ± 10 points. The side-to-side difference as measured with the KT-1000 arthrometer with maximum manual force was <3 mm in twenty patients (of the twenty-eight who returned for follow-up), between 3 and 5 mm in six patients, and >5 mm in two patients. The result of the pivot shift examination was normal in fifteen patients, slightly positive in eleven patients, and positive in two patients. Twenty-five percent of the patients showed no radiographic signs of degenerative joint disease.

CONCLUSIONS: Revision anterior cruciate ligament reconstruction with use of an autogenous doubled semitendinosus and gracilis graft combined with an extra-articular procedure provided satisfactory functional outcomes, with a failure rate of 10%.

LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

ORIGINAL ABSTRACT CITATION: "Revision Anterior Cruciate Ligament Reconstruction with Doubled Semitendinosus and Gracilis Tendons and Lateral Extra-Articular Reconstruction" (2006;88:2373-9).


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Related articles in JBJS:

Revision Anterior Cruciate Ligament Reconstruction with Doubled Semitendinosus and Gracilis Tendons and Lateral Extra-Articular Reconstruction
Andrea Ferretti, Fabio Conteduca, Edoardo Monaco, Angelo De Carli, and Carmelo D'Arrigo
JBJS 2006 88: 2373-2379. [Abstract] [Full Text]