Long‐Term Failure Rate of Anterior Cruciate Ligament Reconstruction Using All‐Inside 4‐Stranded Semitendinosus Autograft Is 20.5%
Maxime Wolf, Rabih Kortbawi, Benoit De Saint‐Vincent, Mattéo Luisetto, Romain LetartrePurpose
To evaluate outcomes (graft failure, Patient‐Reported Outcome Measures, and knee stability) after primary isolated anterior cruciate ligament (ACL) reconstruction using the all‐inside technique with 4‐stranded semitendinosus autograft fixed between 2 adjustable‐loop cortical suspension devices, with a minimum follow‐up of 10 years.
Methods
Patients who underwent primary isolated ACL reconstruction using the all‐inside 4‐stranded semitendinosus between January 2011 and January 2013, with a minimum of 10‐year follow‐up, were included. Patients completed a standardized questionnaire and were offered a follow‐up consultation. The questionnaire included the Tegner, ACL‐Return to Sport after Injury, Subjective Knee Value, subjective International Knee Documentation Committee, and assessment of graft failure. Clinical evaluations and laxity measurements were conducted during follow‐up consultations.
Results
At a mean follow‐up of 138 months (range: 122‐159), 156 patients completed the questionnaire, and 111 were clinically evaluated. The mean age was 39.6 ± 9.7 years (range: 15‐62). Graft failure occurred in 20.5% of cases (32/156). The mean decrease in Tegner was 1.03 ± 1.23 points, and 51% returned to their preinjury sport level. The median preoperative Tegner was 7.0 (interquartile range: 6.0‐7.0). A higher preoperative Tegner was associated with an increased risk of graft failure ( P = .016). Graft failure occurred in 23% of males and 16.6% of females ( P = .461). Patients with grafts sized ≤8 mm (n = 85) had a failure rate of 17.5%, compared with 23.9% for grafts >8 mm ( P = .441). The mean subjective International Knee Documentation Committee was 85.6 ± 13.5, Subjective Knee Value 79.2 ± 22.1, and ACL‐Return to Sport after Injury 69.5 ± 26.5. Among patients without reported graft failure, 16.5% exhibited >3 mm differential anterior laxity, and 28% had a pivot‐shift score ≥2.
Conclusions
At a minimum 10‐year follow‐up, primary isolated ACL reconstruction using an all‐inside 4‐stranded semitendinosus autograft showed a 20.5% graft failure rate, despite favorable patient‐reported outcomes. A higher preoperative Tegner showed a trend toward increased graft failure.
Level of Evidence
Level IV, retrospective case series.