Surgical procedure
bone-patellar tendon-bone, ALL
After patient participation approval by written consent, the ACL revision procedure started with a knee arthroscopy to confirm the patient’s eligibility for the study. When one-stage ACL revision was possible, the patient was randomized per-operatively to ACL revision in combination with ALL reconstruction (+ ALL group) or isolated ACL revision (− ALL). Opaque envelopes with a note of which group the patient was randomized to were used for randomization. In cases of two-stage revision procedures, randomization was performed during the second stage procedure.All surgical procedures were performed by senior surgeons. ACL revision was performed as a single-bundle anatomical reconstruction with the femoral tunnel drilled through an anteromedial portal. The ACL revision tunnel placement aimed for the anteromedial portion of the native ACL on both the femur and the tibia. The bone tunnels and tunnel apertures were assessed for acceptable diameter and placement. Acceptable tunnels were redrilled and reused for a one-stage revision procedure. Unacceptable tunnels were bone grafted and a two-stage ACL revision was performed. The choice of ACL graft and graft fixation took the primary ACL reconstruction into account, if necessary. Therefore, bone-patellar tendon-bone, quadriceps-tendon, and hamstrings-tendon autografts or allografts were used for the ACL revision (Table ALL reconstruction was performed in the + ALL group as a single-strand reconstruction using an iliotibial tract allograft. The graft was prepared as a 10 cm long and 1 cm wide strand. It was whip-stitched 2.5 cm in each end with a FiberWire