Clinical outcomes and return to sport after single-stage revision anterior cruciate ligament reconstruction by bone-patellar tendon autograft combined with lateral extra-articular tenodesis

Eur J Orthop Surg Traumatol. 2023 Jul;33(5):1811-1819. doi: 10.1007/s00590-022-03352-6. Epub 2022 Aug 18.


Purpose: The anterior cruciate ligament reconstruction (ACLR) failure rate continues to increase. Involvement of a young population with a desire to return to sport, explains the increased need for ACLR (revACLR) revision. The aim of this study was to evaluate clinical outcome, complications, failure rate and return to sport of a single-stage revACLR using bone patellar tendon-bone (BTBT) combined with lateral extra-articular tenodesis (LET).

Material and methods: A retrospective analysis was performed on 36 patients who underwent revACLR. Knee stability was assessed by Lachman and Pivot shift test. Objective anterior laxity was determined by KT-2000 arthrometer. The IKDC subjective, Lysholm, ACL-RSI Scores, level of sport activity and Forgotten Joint Score-12 were recorded.

Results: Of 36 patients, we collected data from 17 who underwent single-stage revACLR with autologous BTBT combined with LET, performed using an extra-articular MacIntosh procedure as modified by Arnold-Coker. The side-to-side difference in Lachman test and Pivot shift test significantly improved postoperatively. The subjective IKDC, Lysholm and ACL-RSI significantly improved from 71.4 ± 9.03 to 92 ± 6.9, from 58.3 ± 19.3 to 66.8 ± 27.7 and from 50.4 ± 12.2 to 68.6 ± 24.5, respectively during the post-operative follow-up. Ten patients (58.8%) returned to their desired level of sport. One patient was considered a failure because of the postoperative laxity.

Conclusion: Single-stage revACLR with BPTB combined with LET is a safe procedure that shows good objective and subjective outcomes, and a high rate of return to the same level of sport. Reducing rotational instability and strain on intra-articular reconstructed structures results in a low rate of complications and failure.

Keywords: Anterior cruciate ligament; Bone patellar tendon bone; Lateral extra-articular tenodesis; Revision ACLR; Single-stage revision.

MeSH terms

  • Anterior Cruciate Ligament Injuries* / complications
  • Anterior Cruciate Ligament Injuries* / surgery
  • Anterior Cruciate Ligament Reconstruction* / adverse effects
  • Anterior Cruciate Ligament Reconstruction* / methods
  • Autografts
  • Humans
  • Joint Instability* / etiology
  • Joint Instability* / surgery
  • Knee Joint / surgery
  • Patellar Ligament* / surgery
  • Retrospective Studies
  • Return to Sport
  • Tenodesis* / methods