Comparison of the Clinical Outcomes of Revision and Primary ACL Reconstruction: A Matched-Pair Analysis With 3-5 Years of Follow-up

Abstract

Background: There are limited studies designed by matching related factors to compare clinical outcomes and return to sport (RTS) between patients undergoing revision anterior cruciate ligament reconstruction (R-ACLR) and primary ACLR (P-ACLR). Purpose: (1) To compare the outcomes between R-ACLR and P-ACLR in a matched-pair analysis with 3- to 5-year follow-up and (2) to evaluate patient-reported factors for not returning to preinjury-level sport. Study Design: Cohort study; Level of evidence, 4. Methods: Patients who underwent R-ACLR between September 2016 and November 2018 were propensity matched by age, sex, body mass index, passive anterior tibial subluxation, and generalized hypermobility in a 1:1 ratio to patients who underwent P-ACLR during the same period. By combining in person follow-up at 2 years postoperatively and telemedicine interview at the final follow-up (January 2022), knee stability and clinical scores were compared, including International Knee Documentation Committee (IKDC), Lysholm, and Tegner. Status of RTS was requested, specifically whether the patient returned to preinjury level of sport. Patient-reported reasons for not returning were analyzed. Results: There were 63 matched pairs in the present study. Knee stability was similar in terms of KT-2000 arthrometer, Lachman test, and pivot-shift test results between the groups at 2 years of follow-up. At the final follow-up, no significant difference was found between groups for postoperative clinical scores (IKDC, Tegner, and Lysholm) ( P > .05). There was a significant difference in total RTS: 53 (84.1%) in the P-ACLR cohort and 41 (65.1%) in the R-ACLR cohort ( P = .014). No significant difference was shown in terms of RTS at the same level: 35 (55.6%) in P-ACLR and 31 (49.2%) in R-ACLR ( P = .476). Significantly more patients showed fear of reinjury: 26 of 32 (81.3%) in the R-ACLR group as compared with 15 of 28 (53.5%) in the P-ACLR group ( P < .021). Conclusion: R-ACLR resulted in similar clinical scores (IKDC, Tegner, and Lysholm) but significantly lower RTS versus P-ACLR at 3 to 5 years of follow-up. Fear of reinjury was the most common factor that caused sport changes in patients with R-ACLR.

Poorer patient-reported knee function and quality of life, but not activity level, after revision ACL reconstruction compared with primary ACL reconstruction: a matched-pair analysis with a minimum 5-year follow-up

“…However, the same meta-analysis [ 10 ] reported that there were insufficient data of patient-reported scores other than the Lysholm score, such as the IKDC-SKF or the KOOS. In contrast, a previous matched-group analysis based on 63 patients with revision ACLR and primary ACLR was not able to find significant differences in the Lysholm score between the groups at 3 to 5 years of follow-up [ 13 ]. A clinical review from 2019 [ 11 ] concluded that patients with revision ACLR have poorer patient-reported outcomes, but most studies evaluating patient-reported outcomes comparing revision and primary ACLR have small patient samples, a short follow-up and are mostly retrospective.…”

“…A previous study comparing patients with revision ACLR and primary ACLR regarding RTS at nine months after surgery reported that athletes with primary ACLR were more likely to have returned to sport [ 31 ]. Another study, comparing athletes with revision ACLR with matched athletes with primary ACLR, reported that athletes with primary ACLR were more likely to RTS overall (84% vs 65%), but there were no differences between the groups regarding the return to the same activity level (56% vs 49%) 3 to 5 years of follow-up [ 13 ]. In our study, the main reasons for not RTS were fear of re-injury in both groups.…”

“…Fear of re-injury is a common reported cause of quitting sport after ACLR [ 4 , 15 , 16 , 32 ]. A previous study reported that patients with revision ACLR quit sports because of a fear of re-injury to a higher degree compared with athletes with primary ACLR and this was the most common factor that caused changes in sports activity in athletes with revision ACLR [ 13 ].…”

“…A recent study [ 7 ] showed that the same patients report inferior postoperative Knee injury and Osteoarthritis Outcome Score (KOOS) subscale scores after revision ACLR compared with primary ACLR at one year follow-up. Another recent matched-group control study (matching variables: age, sex, body mass index, and generalised hypermobility) found that patients with revision ACLR and primary ACLR reported similar scores on the Lysholm score and Tegner Activity Scale (TAS) at a 3–5-year follow-up but a significantly lower RTS rate after revision ACLR [ 13 ]. However, long-term follow-up (> 5 years) studies comparing differences in knee function, activity level and satisfaction with activity level within and between matched patients with primary and revision ACLR are lacking.…”

Approximately half of pediatric or adolescent patients undergoing revision anterior cruciate ligament reconstruction return to the same level of sport or higher: A systematic review

“…R-ACLRs tend to result in worse outcomes than that of primary operations [5,6]. As such, technical aspects of r-ACLR have been studied extensively in the adult literature over the past several years, including optimal graft selection, tunnelling and fixation strategies, and staging [7][8][9].…”