Evaluating outcomes of revision anterior cruciate ligament reconstruction with rectangular tunnel technique using a bone-patellar tendon-bone graft: A propensity score matching analysis indicating comparable results to primary reconstruction.

Abstract

This study aimed to investigate whether one-stage revision anterior cruciate ligament reconstruction (ACLR) using the rectangular tunnel (RT) technique with a bone-tendon-bone (BTB) graft can achieve outcomes comparable to primary ACLR. It was hypothesized that both one-stage revision and primary ACLR using the RT technique with a BTB graft would provide comparable clinical outcomes. We enroled 935 patients who underwent primary or revision ACLR by a single surgeon between 2012 and 2022. A 1:1 matching analysis was performed to balance demographic and clinical factors between the primary and revision ACLR groups. Matching factors included age, sex, body mass index, follow-up period, pre-injury Tegner activity scale and the presence of meniscus injury. Clinical evaluations were performed both preoperatively and at the final follow-up, including physical examinations and clinical outcome scores (Knee injury and Osteoarthritis Outcome Score [KOOS] and International Knee Documentation Committee [IKDC] Knee Examination Form 2000). Knee joint laxity was assessed using the Lachman and pivot shift tests, along with the knee arthrometer. Continuous and categorical variables were analyzed using an independent t test and Fisher's exact probability test, respectively. Survivorship was assessed by plotting the Kaplan‒Meier survival curves. After matching, 128 patients were assigned to each group, with mean follow-up periods of 41.7 and 44.5 months in the primary and revision groups, respectively. Post-operative assessments showed no significant between-group differences in knee joint laxity or KOOS subscale scores. Based on the IKDC grading, patients were classified as either normal or nearly normal. Kaplan‒Meier survival analysis showed no significant between-group differences in survival rates. Comparable post-operative knee stability and clinical outcomes were observed in both the one-stage revision and primary ACLR groups, highlighting the importance of precise surgical techniques in achieving consistent revision ACLR outcomes and suggesting that the RT technique may contribute to more reliable results in this challenging setting. Level III, retrospective cohort study.