Outcomes after bone grafting in patients with and without ACL revision surgery: a retrospective study

Background: Current literature is lacking of data regarding functional outcomes in patients following bone tunnel grafting with or without revision anterior cruciate ligament (ACL) reconstruction. Therefore, the aim of the present study was to evaluate the clinical outcome in patients with (RACL) or without revision ACL reconstruction (OBG) following bone grafting. Methods: Fifty-nine patients (18 female, 41 male) who underwent bone grafting due to recurrent, symptomatic ACL deficiency following ACL reconstruction between 2011 and 2014 were retrospectively analyzed. In 44 patients (mean age: 30,5 +/- 8,5 years) a staged revision ACL reconstruction (RACL) was performed after bone grafting. 10 patients (mean age: 33.2 +/- 10.3 years) refused to have ACL revision surgery after bone grafting (OBG). Outcome measures included instrumented laxity testing, the International Knee Documentation Committee (IKDC) score, the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm score and Tegner activity scale. Results: After mean period of 33,9 +/- 17.0 months, 54 patients were available for follow up examination. In the RACL group, the Lysholm score was 77,2 +/- 15,5 (range 35-100), the mean IKDC subjective knee score was 69,0 +/- 13,4 (range 39,1-97,7) and the mean Tegner activity score was 4,1 +/- 1,5 (range, 1-9). Similarly, in the OBG group the mean Lysholm score was 72,90 +/- 18,7 (range 50-100), the mean IKDC subjective score was 69,3 +/- 20,0 (range 44,1-100) and the mean Tegner activity score was 4,6 +/- 1,2 (range, 3-6). No significant difference was observed between the two groups. Knee laxity measurements were elevated without revision ACL surgery, however the difference was not significant. Conclusion: Bone tunnel grafting with or without second stage ACL revision surgery showed no significant difference in functional outcome score. Thus, in case of revision ACL instability careful patient selection is necessary and expectations should be discussed openly with the patients.