Good Short-Term Clinical Outcomes and Low Rates of Return to Sports after Repeat Revision ACL Reconstruction

Abstract

AbstractRepeat revision anterior cruciate ligament reconstruction (ACL-R) is a rare, demanding procedure and, as such, has not been well studied. Most of the available literature shows improved functional outcomes compared with preoperative state but inferior results when compared with primary ACL-R, particularly regarding return to preinjury level of sports. The purpose of this study was to assess functional outcomes in patients who had undergone repeat revision ACL-R. The secondary aims were to register return to sports, associated meniscal and/or chondral lesions, and evaluate radiological anatomical parameters. Nine patients between 2011 and 2017 were evaluated, who had a minimum follow-up of 2 years. Median age at repeat ACL-R was 32 years (interquartile range [IQR], 30–34 years) and the median follow-up was 27 months (IQR, 24–39 months). Data collected prior to surgery and at last follow-up included patient demographics, operative findings, physical examination findings including pivot shift and KT-1000 arthrometer measurement; Lysholm and International Knee Documentation Committee (IKDC) subjective scores; and return to sports and level using the Tegner score. Knee Injury and Osteoarthritis Outcome Score (KOOS) subjective score and radiographic anatomical parameters were recorded at last follow-up. Mean IKDC and Lysholm score improvement was 25 points (confidence interval [CI] 12–37) and 25 points (CI 11–39), respectively (p < 0.001). The median postoperative KOOS score was pain: 93 (IQR, 64–96); symptoms: 94 (IQR, 83–97); activities of daily life: 96 (IQR, 90–100); sports: 75 (IQR, 50–90); and quality of life: 50 (IQR, 43–81). Postoperative median side-to-side KT-1000 arthrometer difference was 2 mm (IQR, 1–8 mm). The median radiographic posterior tibial slope was 10 degrees (IQR, 9–10). One patient was considered a failure at 16 months postoperative. Only 44% (four out of nine) patients were able to return to their sports. None of these patients had a cartilage injury, while three out of five patients who did not return to their sports had International Cartilage Regeneration & Joint Preservation Society grade III or IV cartilage injury. Patients should be counseled on the challenging outcomes of repeat revision ACL-R. This is Level IV, therapeutic case series.