The Durability of Revision Anterior Cruciate Ligament Reconstruction: A Comparison of Patients at <5 Years and ≥5 Years After Revision.

Abstract

Background: Overall outcomes of revision anterior cruciate ligament reconstruction (ACLR) are well documented, although the durability of results, to the best of the authors' knowledge, has not been compared between short-term and midterm follow-up.

Purpose: The primary aim was to assess the durability of revision ACLR outcomes at <5 years after revision (short-term) to outcomes at ≥5 years after revision (midterm). For this study's purposes, durability was defined as not requiring additional revision surgery or the maintenance of good patient-reported outcomes (PROs). The secondary aims were to compare the outcomes between male and female patients, between patients with allografts and those with autografts, and between patients with traumatic mechanisms of a rerupture and those with atraumatic mechanisms of a rerupture.

Study design: Cohort study; Level of evidence, 3.

Methods: This was a retrospective chart review with the prospective collection of PROs in 53 knees that underwent revision ACLR. PROs included scores for the International Knee Documentation Committee subjective knee form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Marx activity rating scale, ACL-Return to Sport after Injury scale, visual analog scale for pain, and satisfaction. The time to return to sport or activity and the incidence of reruptures were collected as well. Data were analyzed via the Mann-Whitney U test, chi-square test, Fisher exact test, and odds ratios.

Results: The mean follow-up from first revision surgery was 5.29 ± 2.96 years (range, 2.0-20.5 years) for the entire cohort. No significant differences in outcomes were found between the short-term (<5 years from revision; 21/53 knees) and midterm (≥5 years from revision; 32/53 knees) groups, except in satisfaction (4.0/5 vs 2.5/5, respectively; P = .014) and requiring second revision surgery (0.0% vs 25.0%, respectively; P = .016). The mechanism of a rupture after primary ACLR leading to revision ACLR was traumatic in 64.7% and atraumatic in 35.3%, but no difference in outcomes was found based on the mechanism of reinjuries (P > .05). When comparing male to female patients, male patients were more active based on the Marx score at the time of follow-up than female patients (7.0 vs 2.0, respectively; P = .046). Patients treated with autografts were younger and had higher KOOS Activities of Daily Living subscores than those treated with allografts, although no other differences were found (P > .05).

Conclusion: Our study demonstrates that revision ACLR offered patients durable results after the failure of primary ACLR from short-term to midterm follow-up. Patient sex and graft choice did not drastically affect postoperative outcomes. Orthopaedic surgeons may decide, based on their clinical acumen, which graft choice is best for the individual patient and be confident that revision ACLR can achieve desirable results for patients, regardless of the reinjury mechanism and sex. Future work on this topic is needed to look at long-term results.