Patient Outcomes and Predictors of Success After Revision Anterior Cruciate Ligament Reconstruction

Abstract

Background:Patient outcomes and predictors of success after revision anterior cruciate ligament (ACL) reconstruction are currently limited in the literature. Existing studies either have a small study size or are difficult to interpret because of the multiple surgeons involved in the care of the study sample.Purpose:To determine patient outcomes and predictors of success or failure after a single-stage revision ACL reconstruction by a single fellowship-trained senior surgeon at a single institution.Study Design:Case series; Level of evidence, 4.Methods:A total of 78 patients who underwent revision ACL reconstruction by a single surgeon from 2010 to 2014 were contacted and available for follow-up. The mean time from revision procedure to follow-up was 52 months. Those patients who were able to participate in the study sent in a completed Tegner activity level scale, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, and IKDC Current Health Assessment Form. The patients’ medical records were also thoroughly reviewed.Results:Five patients had subsequent failure after revision surgery. The median Tegner score was 6 at follow-up, and the mean subjective IKDC score was 72.5. There was no statistically significant difference in outcome scores when comparing revision graft type, body mass index, sex, need for bone grafting, and time from failure to revision. Patients with failures after primary ACL reconstruction secondary to a traumatic event were found to have statistically significantly higher IKDC scores (mean, 76.6) after revision when compared with nontraumatic failures (mean, 67.1), even when controlling for confounders (P < .017).Conclusion:Revision ACL reconstruction is effective in improving patient activity levels and satisfaction. However, the subjective IKDC results are quite variable and likely based on multiple factors. Patients with traumatic injuries contributing to graft failure after primary ACL reconstruction had a statistically significantly, although not clinically significant, higher IKDC score after revision surgery compared with nontraumatic failures. These data may be useful when counseling a patient on whether to pursue revision ACL reconstruction surgery.

Revision Anterior Cruciate Ligament Reconstruction in the Nonathlete Population

“…In the present series, patients who remained symptomatic for more than 1 year following the failure of the graft had inferior outcome scores (IKDC) than those who presented early following failure of the graft. Our experience is different from that of Johnson et al who found no significant correlation between the outcome scores and the time interval between failure and revision 26…”

“…There was no significant difference in outcomes between revisions using B-T-B and hamstring grafts in our series. This is similar to the experience of other authors in earlier reports 26272829…”

“…In the nonsportsperson category of patients, there is nil or very low expectation regarding sporting activities and the need for revision ACL reconstruction is related to the symptoms of instability and/or pain that interfere with activities of daily living. Athletes with traumatic re-rupture of the ligament have been said to have better outcomes than patients with gradual failure due to laxity 26. In our study, we found no significant difference (statistical or clinical) between acute traumatic graft failures and gradual failures due to laxity of the graft in nonathletes undergoing revision ACL reconstruction.…”

Operative und konservative Therapie der vorderen Kreuzbandruptur im Sport

“…Abb. 4; [18]). Die Ergebnisse nach Revisionskreuzbandchirurgie sind erwartungsgemäß schlechter als nach Erstoperation [19,20].…”

Fatigue Behavior of Nitinol Anterior Cruciate Ligament Graft and Inappropriate Femoral Tunnel Placement: Single-Stage Revision Anterior Cruciate Ligament Reconstruction Surgery

“…Although ACLR is a common procedure, less than satisfactory outcomes have been reported to occur in up to 25% of patients. 4 The reasons for clinical failure after ACLR are numerous but can be broadly separated into 3 categories: technical, biological, and mechanical failures. Revision ACLR can be performed in 1 or 2 stages.…”