Revision Anterior Cruciate Ligament Reconstruction in Military Personnel

Abstract

This study aims to report the clinical and functional outcomes of revision anterior cruciate ligament (ACL) reconstruction in a young, active duty military population. Patients undergoing revision ACL reconstruction were enrolled in an institutional clinical database and followed prospectively. The primary outcomes were patients' scores on a timed run, as compared with recorded scores before reinjury. Secondary outcomes included scores on the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC), the International Knee Documentation Committee subjective (IKDC subjective), the Short Form - 36 health survey (SF-36) version 2, the Single Assessment Numeric Evaluation (SANE), and the Tegner activity scale. A total of 13 patients were identified who met the inclusion criteria and had complete follow-up. The mean age at revision ACL reconstruction was 20.5 years (range, 19-22 years), and mean follow-up was 40.2 months (range, 13-66 months). All patients underwent a single stage revision ACL reconstruction with ipsilateral bone-patellar tendon-bone autograft, ipsilateral hamstring autograft, or bone-tendon-bone allograft. Mean physical readiness test (PRT) score at final follow-up was not statistically different than documented preinjury PRT score (77.9 vs. 85.5, p > 0.05), nor was the mean run time (7:12 vs. 6:43/mile, p > 0.05). Significant improvements exceeding published minimal clinically important differences were seen in SANE score, SF-36 physical component summary score, KOOS sports and recreation, KOOS quality of life, WOMAC pain score, and WOMAC function score. Patients undergoing revision ACL reconstruction at our facility show good recovery of baseline physical performance as measured by the semiannual PRT and timed run test, and significant improvements in patient-reported outcome scores. Level of Evidence Level IV, case series.

Outcomes of 1- Versus 2-Stage Revision Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis

“…The weighted mean Tegner scores at preoperative evaluation and final follow-up for the 4 studies 1,15,17,27 that presented these scores were 6.0 and 6.2, respectively. In addition, 4 of the 7 studies 11,15,23,27 reported 1-stage revision failure rates, with a weighted mean of 7.5% after surgery.…”

“…Two studies compared outcomes of 1- versus 2-stage revision ACLR. 14,15 Four studies 5,7,20,21 reported outcomes after 2-stage revision ACLR, and the remaining 7 studies 1,11,17,22-24,27 documented outcomes after 1-stage ACLR. Three studies included primary ACLRs as comparison groups to their chosen revision method, and these primary ACLRs are not included in this review.…”

“…The mean clinical follow-up for these 9 studies was 3.3 years. Among the 6 studies 1,11,14,22,24,27 that included IKDC scores, the mean weighted score at final follow-up was 66.6. Of the 3 studies 1,22,27 that noted pre- and postoperative IKDC score changes, the mean weighted change in IKDC scores was 16.6.…”

Recognizing the better autograft and the factors influencing outcomes of revision anterior cruciate ligament reconstruction

“…[19] Quadriceps tendon and hamstring being the most preferred autograft for revision, both are reported to be associated with anterior knee pain and donor site morbidity influencing the functional outcome. [2,20,21] The literature is limited in terms of comparison of the autografts in revision ACLR. However, the QT graft is reported to have a better functional Lysholm score in comparison to both the STG and BPTB in primary ACLR.…”

Injectable Hyaluronic Acid Hydrogel Containing Platelet Derivatives for Synovial Fluid Viscosupplementation and Growth Factors Delivery

“…[ 5 ] To restore important viscoelastic and lubricant properties of SF, exogenous hyaluronic acid (HA) can be injected into OA joint. [ 6 ] This treatment was termed “viscosupplementation” and was based on the discovery that viscoelastic properties, and consequently shock absorption and lubricant functions of SF, depend on the concentration and molecular weight (Mw) of HA [ 7 ] and that both of them are significantly decreased in OA SF. [ 8–13 ] Unfortunately, the effect of the viscosupplementation is only temporary due to fast degradation of exogenous HA, [ 14–16 ] which is likewise associated with OA.…”