Arch Orthop Trauma Surg (2012) 132:867–874 DOI 10.1007/s00402-012-1481-z 123 KNEE REVISION SURGERY Revision of anterior cruciate ligament reconstruction with patellar tendon allograft and autograft: 2- and 5-year results Hermann O. Mayr · Doerthe Willkomm · Amelie Stoehr · Mathias Schettle · Norbert P. Suedkamp · Anke Bernstein · Robert Hube Received: 28 June 2011 / Published online: 17 February 2012  Springer-Verlag 2012 Abstract Introduction The most common failure reasons of an anterior cruciate ligament (ACL) graft are incorrect posi- tioning of the drill channels and insuYcient Wxation. In many cases, one-stage revision with patellar tendon graft and the appropriate corrections are possible. For previous use of the ipsilateral patellar tendon third, an allograft seems favorable for reconstruction. So far, no study com- pared the results of revision surgery of autologous versus allogenous patellar tendon grafts for revision surgery of the ACL in a 5-year follow-up. Materials and methods A retrospective study was con- ducted to analyze the clinical outcome and stability results 2 years (19.2 § 5.8 months) and 5 years (68.8 § 6.8 months) after revision of ACL reconstruction using middle-third patellar tendon allografts and autografts. The allografts were cleansed by mechanical means only. There were 15 patients in the allograft group and 14 in the auto- graft group. Patients with isolated re-rupture of the ACL graft were included in the study. Clinical results were eval- uated by International Knee Documentation Committee 2000 forms (IKDC), Lysholm score, Tegner activity score, and visual analog scale. Stability was evaluated by means of KT-1000 arthrometer, Lachman test, and pivot-shift test. Location of drill holes was evaluated radiologically. Gonar- thritis was graded according to Kellgren and Lawrence on the basis of radiographs. Results There were no signiWcant diVerences between the two groups in anterior translation, manual examination for stability, IKDC 2000 Wndings, Tegner activity score, or Lysholm score. Extension deWcits were more frequent in the autograft group at the Wrst follow-up (P = 0.010). Lat- eral gonarthritis and femoral tunnel widening were more common in the allograft group at the second follow-up (P = 0.049 and P = 0.023, respectively). Pain on walking downhill was signiWcantly more frequent in the allograft group at the second follow-up (P = 0.027). Conclusions The functional results with allografts that had not undergone irradiation or chemical sterilization were comparable to those with autografts in ACL revision sur- gery. Allografts represent a good alternative to autogenous patellar tendons in revision surgery. Keywords Knee · Anterior cruciate ligament (ACL) · Revision · Allograft · Autograft Introduction Capsuloligamentary injuries of the knee joint are assuming increasing signiWcance, particularly in contact sports and alpine sports [19, 27]. InsuYciency of the anterior cruciate ligament (ACL) causes instability that swiftly leads to men- iscal and cartilaginous degeneration. Surgical treatment of ACL rupture aims to restore the patient’s pre-injury quality of life and sports performance. The femoral malpositioning of the drill channel is the most common failure cause of ACL reconstruction [2, 16]. H. O. Mayr (&) · N. P. Suedkamp · A. Bernstein Department of Orthopedic and Trauma Surgery, Albert Ludwig University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany e-mail: hermann.mayr@uniklinik-freiburg.de D. Willkomm Department of Trauma and Reconstructive Surgery, University Hospital Halle (Saale), Halle, Germany A. Stoehr · M. Schettle · R. Hube OCM Clinic of Orthopedic and Trauma Surgery, Munich, Germany