Singhal MC, Gardiner JR, Johnson DL. Failure of primary anterior cruciate ligament surgery using anterior tibialis allograft. Arthroscopy. 2007 May;23(5):469-75

PURPOSE: The purpose of this study was to evaluate the outcome of anterior cruciate ligament (ACL) reconstruction via anterior tibialis tendon allograft. METHODS: We performed a retrospective review of 125 consecutive patients who underwent ACL reconstruction via an anterior tibialis tendon allograft. Of these patients, 69 were available for follow-up at a mean of 55 months (range, 42 to 74 months); their mean age was 31.7 years (range, 19 to 69 years). Clinical evaluation consisted of the Lysholm knee score, activity level assessment, and International Knee Documentation Committee assessment.

RESULTS: Of the 69 patients, 16 (23.1%) required revision ACL reconstruction for graft failure. In addition, 26 patients (37.7%) required repeat surgery, including 16 revision ACL reconstructions, 9 arthroscopic meniscal surgeries, and 1 total knee arthroplasty. The mean age of those patients in whom failure occurred was 22.8 years compared with 34 years in those in whom failure did not occur (P = .0039). The failure/reoperation rate of those aged 25 years or under was 55% (17/31), as compared with 24% (9/38) in those aged over 25 years. The mean Lysholm knee score was 85.6 (range, 15 to 100), and the mean activity score was 4.36 (range, 0 to 9). Of the 52 patients who did not require revision ACL surgery, 86.2% rated their knee as normal or nearly normal.

CONCLUSIONS: A reoperation rate of 38% after primary ACL surgery is high. We do not recommend the use of anterior tibialis allograft in young patients (aged < or =25 years) or those who participate frequently in level I ACL-dependent sports.

LEVEL OF EVIDENCE: Level IV, therapeutic case series.

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