Bone–patellar tendon–bone allografts are safe and effective grafts for anterior cruciate ligament one-stage revision: A consecutive series of 38 patients with at least 2 years of follow up

Background: Rupture of the anterior cruciate ligament is one of the most common injuries in sports. Although primary reconstruction is a successful procedure, failure is reported to occur in up to 13% of patients. In patients who complain of instability, revision surgery should be proposed and discussed with patients. The issue arising in this setting is the graft choice, being limited from the grafts used in primary surgery. Methods: We retrospectively enrolled 38 consecutive patients who had undergone ACL one-stage revision with bone–patellar tendon–bone (BPTB) allografts from a single center with at least 2 years of follow up. The clinical evaluation was based on PROMs In addition, we recorded the rate of allograft re-rupture and post-surgical complications. Results: Our series showed good PROMs at a minimum of 2 years follow up. Median IKDC, Lysholm, and Simple Knee Value were 82.8, 85.5, and 77.5, respectively. For the Tegner Activity Scale we recorded a median value of 8.0 before injury and 6.0 after surgery. Timing for return-to-play was between 6 and 9 months for 19 patients (54.3%). Regarding post-surgery complications, we recorded an overall rate of 15.79%, with however minor entity (Clavien–Dindo grade I). Allografts re-rupture rate was 10.5%. Conclusion: BPTB allografts in one-stage ACL revision enabled patients to return to sports and to a good quality of life after the final follow up. Moreover, this type of graft has been shown to be a safe choice, being burdened by a low rate of post-surgical complications and re-rupture risk.