Several techniques for revision of anterior cruciate ligament (ACL) reconstruction and different types of grafts have been used over the years. These include single-bundle techniques, double-bundle techniques, and single-bundle techniques with external tenodesis. We also distinguish between the use of autografts and grafts from donors, or allografts.
The choice of surgical technique and graft type is strongly influenced by the progression of damage characterizing these patients (meniscal, chondral, or ligamentous), the surgical decisions made during the initial surgery (graft used, orientation, and number of bone tunnels), or any complications that occurred.
The use of a specific type of graft is heavily dependent on its availability: it is likely that the first-choice graft for some surgeons may be unavailable because it has already been used. The use of allografts is now commonly accepted by the scientific community, with the Achilles tendon standing out for its biomechanical properties and size. Unlike autografts, it does not damage the patient's ligamentous tissue, which is thus preserved.
Since osteoarthritis is one of the most debated consequences of anterior cruciate ligament revision, an analysis of the results is essential to provide a clearer understanding of the risks and benefits associated with the different types of procedures.
Age between 18 and 50 years at the time of surgery;
Male and female gender;
Patients who have undergone revision of anterior cruciate ligament reconstruction with a single-bundle "Over-The-Top" technique and external tenodesis using Achilles tendon allograft, with or without associated procedures, at least 2 years post-surgery;
A radiograph taken immediately before or after the surgery of the affected knee;
Patients no longer accessible;
Patients who deny consent to participate in the study;
Advanced knee osteoarthritis (Outerbridge grade III-IV) at the time of surgery;
Severe obesity (BMI > 35);
Patients will be recruited from all subjects who underwent revision of anterior cruciate ligament reconstruction with the single-bundle "Over-The-Top" technique and external tenodesis using Achilles tendon allograft at the SC Orthopedic and Traumatology Clinic II of the Rizzoli Orthopedic Institute, at least 2 years after the surgical procedure and the clinical-radiological reassessment proposed in this study, between 1/1/2000 and 31/12/2022 at the Rizzoli Orthopedic Institute. This reassessment is part of standard clinical practice.
Cohort
Prospective
Not listed
Lysholm Knee Score
It is a validated measurement scale that assesses knee functionality through 8 items, allowing the evaluation of the knee's condition in relation to the functional demands of daily activities. This assessment tool is used to evaluate the outcomes of surgery in patients who have undergone surgery for ligamentous or meniscal knee injuries. The final score is obtained by summing the various scores from the different items, ranging from 0 to 100. The scores are divided into subgroups: Excellent (95-100); Good (84-94); Fair (65-83); Poor (\<64).
Physical examination
A standard physical examination will be performed, and the classic painful points related to meniscal pathology will be assessed.
Anterior drawer test
it allows the assessment of the anterior translation of the tibia relative to the femur with the knee flexed at 90 degrees. An increase in this translation suggests a lesion of the neo-ACL. It is quantified on a scale from 0 to 3.
Lachman test
it allows the assessment of the anterior translation of the tibia relative to the femur with the knee flexed at 30 degrees. An increase in this translation suggests a lesion of the neo-ACL. It is quantified on a scale from 0 to 3.
Pivot shift test
it is a clinical maneuver used to assess the rotational instability of the knee under examination. The test is performed by applying a stress in internal rotation-valgus and flexion; the occurrence of a "shift" or "clunk" of the tibia suggests a lesion of the neo-ACL associated with rotational instability. It is quantified on a scale from 0 to 3.
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Stefano Zaffagnini
Lead sponsor
Istituto Ortopedico Rizzoli
Sponsor institution
