Revision Anterior Cruciate Ligament Reconstruction in the Nonathlete Population

Abstract

Background: There is considerable literature about revision anterior cruciate ligament (ACL) reconstruction in athletes vut there is little published evidence about the same in the nonathletes. The injury itself may remain underdiagnosed and untreated in nonsports persons. This study highlights the high incidence of ACL injury in the nonathletic patient cohort, revision rates, and the outcomes of revision ACL reconstruction. Materials and Methods: 856 nonathletic patients who underwent primary ACL reconstruction were included in this retrospective study. Patients were asked on phone whether they had undergone revision surgery and whether they had symptoms severe enough to seek reintervention. Clinical assessment and preoperative and postoperative International Knee Documentation Committee (IKDC) and Lysholm scoring were used to followup patients who underwent revision intervention. Results: Clinically, symptomatic revision rate was 5.9% (51 out of 856 patients), and 33 out of these 856 patients (3.9%) underwent revision ACL reconstruction. The reasons for revision were rupture of the previous graft in 21 and laxity (incompetence) of the graft in 12 patients. The mean preoperative and postoperative IKDC scores were 44.1 and 69.8, respectively, and the improvement was statistically significant ( P < 0.001). The IKDC score following revision ACL reconstruction was significantly better in those patients who underwent revision <1 year following the onset of recurrent symptoms ( P = 0.015). Meniscal tears were present in 47.6%, and chondral injuries were seen in 33.3% of patients. The tibial tunnel positioning was abnormal in 70% of patients. Femoral tunnel positioning was aberrant in all the patients. Conclusions: The revision rate of primary ACL reconstruction of 5.9% in nonathletes and revision ACL reconstruction rate of 3.9% are similar to the reported revision rates of 2.9%–5.8% in athletic patients. Similar to athletes, suboptimal tunnel placement is the major contributor to failure in nonathletes also.

Trauma and femoral tunnel position are the most common failure modes of anterior cruciate ligament reconstruction: a systematic review

“…One additional study was found by screening references. A total of 28 studies reporting on failure modes were ultimately included, including 24 cohort studies [1, 3–5, 13, 6, 14, 19–21, 29, 34, 38, 43, 45, 46, 51, 52, 57, 58, 62, 63, 68, 69] and four registry‐based studies [33, 35, 50, 61]. Fourteen of the 24 cohort studies reported age at time of primary reconstruction [1, 3, 5, 13, 19, 21, 22, 29, 39, 43, 51, 52, 54, 58].…”

“…A total of 28 studies reporting on failure modes were ultimately included, including 24 cohort studies [1, 3–5, 13, 6, 14, 19–21, 29, 34, 38, 43, 45, 46, 51, 52, 57, 58, 62, 63, 68, 69] and four registry‐based studies [33, 35, 50, 61]. Fourteen of the 24 cohort studies reported age at time of primary reconstruction [1, 3, 5, 13, 19, 21, 22, 29, 39, 43, 51, 52, 54, 58]. Seven cohort studies and one registry‐based study were identified reporting failure modes specifically on bone–patellar tendon–bone (BPTB) or hamstring (HT) autografts [1, 3, 19, 21, 38, 45, 50].…”

“…One level I study was identified (3%) [41]. There was one level II prospective cohort study (3%) [50], 10 levels III (39%) [3, 27, 33, 38, 45, 52, 57, 61, 68, 69], and 16 level IV observational studies (55%) [1, 3–5, 13, 6, 14, 20, 21, 29, 34, 35, 43, 51, 52, 58, 68]. The methodological quality of non‐comparative studies scored 10.3 out of 16 points using the MINORS criteria (64% of maximum score).…”

Clinical Reliability of Adjustable Femoral Cortical Suspensory Fixation in Anterior Cruciate Ligament Reconstruction and Correlation of Clinical Outcomes With Demographic and Perioperative Factors

“…Secondly, the follow-up time was comparatively short, with the maximum follow-up period being one year. However, according to the literature, a considerable proportion of graft defects occur during the early postoperative period [ 21 ]. Finally, no radiographic analysis of tunnel widening was performed at follow-ups.…”

Techniques for In Vivo Measurement of Ligament and Tendon Strain: A Review

“… 58 , 123 In Sweden, the average cost of surgical management of acute Achilles tendon (AT) ruptures in 2009-2010 was around $10,000. 178 Moreover, revision rates following initial treatment for AT rupture (2%-8%) 89 , 130 and ACL revisions (3-16%) 122 , 176 suggest that more effective treatment offer considerable potential exists for not only reducing costs, but also improving patients’ functional outcome.…”