Reoperation and Failure Rate at Six Years Following Revision ACL Reconstruction: A MARS Cohort Study

Abstract

Objectives: Revision anterior cruciate ligament (ACL) reconstruction remains a challenge for orthopaedic surgeons, as results are persistently inferior to those of primary reconstructions. There is very limited data regarding outcomes at 6 years following revision ACL surgery. The purpose of this study was to report the rate of reoperation, further revision, and conversion to total knee arthroplasty (TKA) in a large cohort of revision ACL reconstructions Methods: Patients undergoing revision ACL reconstructions were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline demographics, intraoperative surgical technique, and a series of validated patient-reported outcome instruments. Patients were followed up by questionnaire and telephone at 6 years following index revision surgery and asked if they had undergone any further surgical procedures to either knee. If a patient reported having undergone subsequent surgery, operative reports detailing the subsequent procedure(s) were obtained and categorized. Results: Six-year follow-up subsequent surgical data was available for 951/1234 patients (77%). In this available cohort, 556 (58%) were male, mean age was 28 years (range 12-61 years) and mean BMI was 26.1 (range 17.1-47.5). Allograft was used in 510 (54%) cases, BTB autograft in 234 (25%), soft tissue autograft in 174 (18%) and other grafts were used in the remaining 33 (3%). Their index surgery was their first revision ACL reconstruction in 822 (86.4%), in 108 (11.4%) it was their second, and in 21 (2.2%) it was their third or greater. This revision procedure was a mean of 5.7 years (range 0.1-26 years) from their prior ACL reconstruction. At six years following the index revision procedure, 16.2% of the cohort underwent at least 1 subsequent surgical procedure on their index knee. Of the reoperations, 29% were meniscal procedures (71% meniscectomy, 18% repair), 21% were articular cartilage procedures (79% chondroplasty, 15% microfracture, 3% OATS, 3% ACI), 11% were for arthrofibrosis, 9% for hardware removal, and 6% were for a subsequent revision ACL reconstruction. Surprisingly, only 5% reported having undergone a subsequent TKA on their ipsilateral knee. During this same 6-year follow-up period, 6% of the cohort (n=53 patients) underwent a subsequent surgery on their contralateral knee, of which 36 were ACL reconstructions. Conclusion: Our data shows that there is a reoperation rate of greater than 15% following ACL revision, which is an important point of discussion between surgeons and their patients. Of particular interest is that there was a 6% rate of recurrent ACL failure and 5% rate of subsequent TKA in this young cohort 6 years following a revision ACL reconstruction.