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Thirty-year Experience with ACL reconstruction using Patellar Tendon: A Critical Evaluation of Revision and Reoperation

      Introduction

      To describe and analyze a single surgeon's experience with primary and revision single-bundle ACLR over a 30-year focusing on incidence and risk factors for revision and reoperation.

      Methods

      Patients who underwent ACLR from 1986 to 2016 were identified from a prospectively maintained database. Covariates of interest included age, sex, time, and graft selection. Outcomes of particular interests included reoperation rates after primary/revision ACLR, and rate of revision ACLR.

      Results

      A total of 2450 ACL reconstructions (mean age, 29 years; 58% male) were reviewed. Among primary ACL reconstructions performed (n = 2225), 68% had BTB autograft and 30% had a BTB allograft. Patients undergoing autograft and allograft ACLR had an average age of 22 and 37 years, respectively (P < .05). The rate of personal ACLR revision was 1.8% (n = 40) for primary cases and 3.5% (n = 7) for revision cases. There was a higher revision rate among female (2.6%) than male patients (1.2%), particularly in patients under 20 years of age. There was a higher revision rate among primary allograft (2.7%) than autograft (1.3%) reconstruction, with a greater difference in patients under 30. Low dose irradiation for sterilization did not affect allograft revision rates. The non-revision reoperation rate following primary ACLR was 12.0%; the 5-year reoperation rate was 8.5%. The non-revision reoperation rate was lower for primary cases reconstructed with allograft versus autograft (9% vs 13%) (P = 0.004). Four-hundred twenty-four patients (19%) underwent concomitant meniscal repair and, among these, 13% required revision meniscal surgery. The rate of contralateral ACLR was 5.3%, predominantly in patients under 25.

      Conclusion

      This information is useful in the informed consent process, for perioperative decision making regarding graft choice, and for identifying patients who are at risk for injuring the uninvolved knee. Allograft ACLR can produce sustainable results with low complication rates in appropriately selected patients.