Anterior cruciate ligament revision with Achilles tendon allograft in young athletes

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Background: Return to sport after revision ACL reconstruction is a controversial topic, several studies reported the results of different techniques and graft in sportsman, presenting an incredibly wide range of return to the same pre-injury activity level, from 0% to 100%. The purpose of this study was to evaluate the clinical outcomes and return to sport rate in young athletes after non anatomic double-bundle revision ACL reconstruction with Achilles allograft. Hypothesis: The present revision technique was effective in terms of stability, return to sport and functional outcomes. Material and methods: All the athletes undergone Revision ACL reconstruction with non-irradiated Achilles tendon allograft with a non-anatomical double-bundle technique were included in the study. A split Achilles tendon allograft was used to reproduce the anteromedial (AM) bundle using the over-the-top position, while the posterolateral (PL) bundle was reconstructed through a femoral tunnel located in the anatomical PL footprint. Sport activity, knee function with Lysholm score, knee laxity and re-injury or re-operations were evaluated. Results: Twenty-six athletes (23 males, three females) with a mean age of 23.4 ± 3.6 years were evaluated at a mean follow-up of 6.0 ± 1.6 years. Overall 69% of patients returned to sport both at elite (44%) or county level (56%) after a mean 6.7 ± 1.5 (3–9 range) months. The mean Lysholm score showed a significant improvement from 64.4 ± 8.1 at pre-operative status to 83.8 ± 11.3 at final follow-up (P <.0001). Seven patients (30%) were rated as excellent, nine (39%) as good, five (22%) as fair and 2 (9%) as poor. Three patients (12%) experienced a further graft rupture after a mean 2.6 years, (3.5 months–48 months range) and two had >5 mm side-to-side difference at KT-1000. Therefore, the overall survival rate at mean six years follow-up was 81%. Conclusion: The ACL revision with a double-bundle technique using Achilles tendon allograft was successful in 81% of athletes at six years mean follow-up. Type of study and level of evidence: Retrospective case series, level IV.




Zaffagnini, S., Grassi, A., Marcheggiani Muccioli, G. M., Roberti Di Sarsina, T., Macchiarola, L., Mosca, M., … Marcacci, M. (2018). Anterior cruciate ligament revision with Achilles tendon allograft in young athletes. Orthopaedics and Traumatology: Surgery and Research, 104(2), 209–215.

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