Paper 14: Impact of harvesting second ipsilateral extensor mechanism graft for revision acl reconstruction on patient-related outcomes and return to sport

Objectives: Graft choice for revision anterior cruciate ligament reconstruction (rACLR) remains controversial and is often guided by patient-related factors, surgeon preference, and shared decision-making. Ipsilateral versus contralateral extensor mechanism autograft harvests may be considered, each with technical and anatomic risks and benefits. The purpose of this study was to investigate the relationship between extensor mechanism autograft harvest site in rACLR and patient-related outcomes and return to sport.
Methods: A retrospective cohort study of patients undergoing rACLR following a primary bone-patellar tendon-bone (BTB) autograft ACLR was conducted from 2019-2024. Skeletally mature patients with at least 12 months of post-operative follow-up were stratified by revision autograft type: ipsilateral quadriceps tendon (QT) versus contralateral BTB autograft. Patients were excluded if they had a concomitant fracture, multi-ligamentous knee injuries or a meniscus repair that required modification to the standard post-operative protocol. Outcomes assessed included patient-related outcomes (SANE, PROMIS, IKDC), return-to-sport testing, and the timing and rate of return to sport.
Results: Forty-two patients undergoing rACLR met inclusion criteria: 24 contralateral BTB autograft versus 18 ipsilateral QT autograft harvests. Demographic characteristics were similar between groups, with no significant differences in sex distribution (p = .34), age (BTB: 23.1 +- 8.1 years vs. QT: 22.6 +- 5.8 years, p = .80), BMI (23.8 +- 2.3 vs. 24.4 +- 2.2, p = .43, respectively), laterality (p = .54), or activity level (Table 1).Patient-reported outcome measures (PROMs) demonstrated no statistically significant differences between groups (Table 2). The mean SANE score was higher in the BTB group (60.5 +- 23.1) compared with the QT group (44.4 +- 27.3), but this did not reach statistical significance (p = .14). Similarly, there were no significant differences in IKDC (67.9 +- 14.9 vs. 62.1 +- 14.0, p = .34, respectively), Marx activity (Km) level (11.9 +- 5.5 vs. 9.4 +- 6.1, p = .32), PROMIS-10 (60.5 +- 8.0 vs. 54.2 +- 9.9, p = .12), PROMIS V1 (52.6 +- 8.5 vs. 55.7 +- 4.0, p = .27), or PROMIS V2 (47.8 +- 8.8 vs. 45.4 +- 4.7, p = .41).Overall, 67.6% of patients returned to sport, with no difference between BTB (68.4%) and QT (66.7%) autograft cohorts (p = 1.00) (Figure 1). The proportion of patients returning to their prior level of play was similarly low across groups (BTB: 40.0% vs. Quad: 50.0%).
Conclusions: Return to sport rates within one year of rACLR are low, regardless of extensor mechanism autograft harvest site. Demographic characteristics and post-operative patient-reported outcomes following rACLR with contralateral BTB autograft versus ipsilateral QT autograft are similar in a single institution cohort. This data may inform patient counseling and shared decision making for patients undergoing rACLR following primary BTB autograft ACLR failure.