Subsequent Surgery After Revision Anterior Cruciate Ligament Reconstruction: Rates and Risk Factors From a Multicenter Cohort

Abstract

Background While revision ACL reconstruction (rACLR) can be performed to restore knee stability and improve patient activity level, outcomes after these surgeries are reported to be inferior to primary ACL reconstruction. Further reoperation after rACLR can have an even more profound effect on patient satisfaction and outcome. However, there is a current lack of information regarding the rate and risk factors for subsequent surgery after rACLR. Purpose To report the rate of reoperation, procedures performed, and risk factors for reoperation two years after rACLR. Study Design Cohort Study, Level of Evidence 2 Methods 1205 patients who underwent rACLR were enrolled in the Multicenter ACL Revision Study (“MARS”) between 2006 and 2011, comprising the prospective cohort. Two-year questionnaire follow-up was obtained on 989 (82%), while telephone follow-up was obtained on 1112 (92%). If a patient reported having a subsequent surgery, operative reports detailing the subsequent procedure(s) were obtained and categorized. Multivariate regression analysis was performed to determine independent risk factors for reoperation. Results Of the 1112 patients included in the analysis, 122 patients (11%) underwent a total of 172 subsequent procedures on the ipsilateral knee at 2-year follow-up. Of the reoperation procedures, 27% were meniscus procedures (69% meniscectomy, 26% repair), 19% were subsequent rACLR, 17% were cartilage procedures (61% chondroplasty, 17% microfracture, and 13% mosaicplasty), 11% were hardware removal, and 9% were procedures for arthrofibrosis. Multivariate analysis revealed that patients under 20 years old had twice the odds of patients aged 20–29 to have a reoperation. Use of allograft at the time of rACLR (OR 1.79, p=0.007) was a significant predictor for reoperations at 2 years while staged revision (bone grafting of tunnels before rACLR) (OR 1.93, p=0.052) trended toward significance. Patients with grade IV cartilage damage seen during rACLR were 78% less likely to undergo subsequent operations within 2 years. Sex, BMI, smoking history, Marx activity score, technique for femoral tunnel placement and meniscal tear or meniscal treatment at the time of rACLR showed no significant effect on reoperation rate. Conclusion There is a significant reoperation rate following rACLR at two years (11%) with meniscal procedures most commonly involved. Independent risk factors for subsequent surgery on the ipsilateral knee include age<20 years old and use of allograft tissue at the time of rACLR.

A high tibial slope, allograft use, and poor patient-reported outcome scores are associated with multiple ACL graft failures

“…An overall reoperation rate of 11% after revision ACL-R has been reported by the MARS group. Meniscal, revision ACL-R, and cartilage procedures accounted for 27%, 19%, and 17%, respectively, in the MARS cohort [ 33 ]. Interestingly, another study by the MARS group demonstrated that patients undergoing more than two revision ACL-Rs are 4.7 times more likely to require subsequent surgery compared to patients undergoing a first-time revision ACL-R [ 2 ].…”

Outcomes, Including Graft Tears, Contralateral Anterior Cruciate Ligament Tears, and All-Cause Ipsilateral Knee Operations, are Similar for Adult-type, Transphyseal, and Partial Transphyseal Anterior Cruciate Ligament Reconstruction Using Hamstring Autograft in Pediatric and Adolescent Patients

“…It is well-known that graft failures in youth exceed those of the general population. 19 , 27 , 28 , 29 , 30 However, there are limited data comparing outcomes by type of hamstring autograft reconstruction technique, based on physeal status, within pediatric populations. 25 Much of the existing data report on outcomes of individual techniques.…”

Revision ACL Reconstruction in Adolescent Patients

“… 49 However, the MARS group has reported higher rates of reoperation after 2-stage revision (odds ratio = 1.93) compared with single-stage revision, and higher rates of another ACL graft rupture (5% vs 2%), although neither finding was statistically significant. 14 In the current study, 4 of 32 patients met the criteria (based on radiography and magnetic resonance imaging) for bone grafting and underwent a 2-stage technique; 1 of these patients had revision graft failure at <2 years after completion of her 2-stage revision. No literature is available addressing bone tunnel grafting in the pediatric population; this may be explained by the adjustment of tunnel placement upon revision in the pediatric population, which may be less common in the adult population.…”