Outcomes After 1-Stage Versus 2-Stage Revision Anterior Cruciate Ligament Reconstruction

Revision anterior cruciate ligament reconstruction (ACLR) is becoming increasingly common as the number of primary ACLR cases continues to rise. Despite this, there are limited data on the outcomes of revision ACLR and even less information specifically addressing the differences in 1-stage revision reconstruction versus those performed in a 2-stage fashion after primary reconstruction.

To compare the outcomes, patient satisfaction, and failure rates of 1-stage versus 2-stage revision ACLR.

Cohort study; Level of evidence, 3.

All patients who underwent revision ACLR between 2010 and 2014 by a single surgeon were collected, and skeletally mature patients over the age of 17 years were included. Patients were excluded if they were skeletally immature; had a previous intra-articular infection in the ipsilateral knee; underwent a prior alignment correction procedure, cartilage repair or transplant procedure, or meniscal allograft transplantation; or had an intra-articular fracture. An ipsilateral or contralateral bone-patellar tendon-bone (BPTB) autograft was the graft of choice. A BPTB allograft was considered for patients aged ≥50 years, for any patient with an insufficient ipsilateral or contralateral patellar tendon, or for those who chose not to have the contralateral patellar tendon graft harvested. Patients completed a subjective questionnaire preoperatively and at a minimum of 2 years postoperatively. Magnetic resonance imaging and computed tomography of all knees were performed preoperatively to assess for associated injuries and to evaluate the ACLR tunnel size and location. Patients with malpositioned tunnels that would critically overlap with an anatomically placed tunnel or those with tunnels ≥14 mm in size underwent bone grafting.

A total of 88 patients met the inclusion criteria for this study. There were 39 patients in the 1-stage revision surgery group (19 male, 20 female) and 49 patients in the 2-stage revision surgery group who underwent tunnel bone grafting first (27 male, 22 female). In both groups, the 12-item Short Form Health Survey (SF-12) Physical Component Summary, Western Ontario and McMaster Universities Arthritis Index, Lysholm, and Tegner activity scale scores significantly improved from preoperatively to postoperatively. There was no significant difference in the SF-12 Mental Component Summary score before and after surgery in either group. Furthermore, there was no significant difference in failure rates or other demographic data between the groups. We observed 4 failures in the 1-stage reconstruction group (10.3%) and 3 failures in the 2-stage reconstruction group (6.1%).

In this study, objective outcomes and subjective patient scores and satisfaction were not significantly different between 1-stage and 2-stage revision ACLRs. Both groups had significantly improved objective outcomes and patient subjective outcomes without notable differences in failure rates. Further longitudinal studies comparing 1-stage and 2-stage revision ACLRs over a longer time frame are recommended.