Clinical comparison of patients who received hamstring and bone tendon bone autograft in revision anterior cross ligament cases

Objective: This study examines revision anterior cruciate ligament (ACL) surgeries performed at our clinic. Surgical techniques, demographic data, management of intraoperative and early and late postoperative complications, postoperative clinical outcomes, and several parameters including IKDC 2000, Lysholm, and SF-36 scores were thoroughly evaluated and analyzed. The aim of this assessment is to improve the outcomes of revision ACL surgery, reduce complications, and deeply understand the factors affecting these outcomes in physically active individuals. Material and Method: This retrospective study evaluated patients treated for anterior cruciate ligament re-rupture at Dicle University Faculty of Medicine between 2015 and 2023. After obtaining ethical approval, patients' examination findings, injury details, radiological images, and surgical techniques were recorded. Two surgical technique groups, hamstring and bone tendon bone (BTB), were analyzed, and outcomes were evaluated using IKDC, SF-36, and Lysholm scales without additional laboratory or imaging. Results: In this retrospective study, 52% of patients with an average age of 29.2 had left ACL injuries, and 48% had right ACL injuries, mostly resulting from sports injuries. Preoperative findings included 16.7% knee pain, 35.7% meniscopathy, 33.3% positive anterior drawer test, 35.7% positive Lachman test, and 19% chondral lesions. Post-surgery, the rate of the anterior drawer test decreased to 26.2%, Lachman test to 31%, while the rate of chondral lesions remained at 19%. IKDC scores increased from an average preoperative score of 46 to 65.9 postoperatively (p<0.001), Lysholm scores from 42.3 to 79.7 (p<0.001), and physical functioning scores from 38.7 to 80 (p<0.001). Physical role limitation improved from 29.8 to 59.5 (p<0.001), energy/fatigue from 29.9 to 51.9 (p<0.001), and emotional well-being from 47.2 to 54 (p<0.001). Pain scores rose from 35.1 to 51.7 (p<0.001), and overall health from 31.7 to 46.8 (p<0.001). No significant differences were found between the groups in terms of joint motion restriction (p=0.758) and knee pain (p=0.679). In Group 1, 19% had positive Lachman tests, compared to 52.4% in vi Group 2 (p=0.024), with no significant difference in chondral lesions (p=0.432). Preoperative 2000 IKDC scores were 38.9 in Group 1 and 53.1 in Group 2 (p<0.001), with no significant difference in postoperative evaluation (p=0.077). Postoperative emotional role limitation was significantly higher in favor of Group 1 (p=0.006), as were emotional well-being scores (p=0.015). Conclusions: Comparing preoperative and postoperative test results and scores, significant improvements were observed in joint mobility, IKDC and Lysholm scores, physical functionality, and pain conditions after surgical intervention. Significant improvements were also observed in emotional and social functionality areas. Although there were differences in some parameters between groups, surgery generally had positive effects on patients' quality of life. These findings emphasize the effectiveness and importance of surgical interventions in treating anterior cruciate ligament injuries. Consequently, improvements in 2000 IKDC, Lysholm, and SF-36 scores were detected postoperatively in both surgical techniques. Key Words: Anterior cruciate ligament, IKDC 2000, Lysholm, SF-36, Revision anterior cruciate ligament, sports injuries, Hamstring tendon technique, BTB technique