Revision Anterior Cruciate Ligament Reconstruction in the Nonathlete Population

There is considerable literature about revision anterior cruciate ligament (ACL) reconstruction in athletes vut there is little published evidence about the same in the nonathletes. The injury itself may remain underdiagnosed and untreated in nonsports persons. This study highlights the high incidence of ACL injury in the nonathletic patient cohort, revision rates, and the outcomes of revision ACL reconstruction.

856 nonathletic patients who underwent primary ACL reconstruction were included in this retrospective study. Patients were asked on phone whether they had undergone revision surgery and whether they had symptoms severe enough to seek reintervention. Clinical assessment and preoperative and postoperative International Knee Documentation Committee (IKDC) and Lysholm scoring were used to followup patients who underwent revision intervention.

Clinically, symptomatic revision rate was 5.9% (51 out of 856 patients), and 33 out of these 856 patients (3.9%) underwent revision ACL reconstruction. The reasons for revision were rupture of the previous graft in 21 and laxity (incompetence) of the graft in 12 patients. The mean preoperative and postoperative IKDC scores were 44.1 and 69.8, respectively, and the improvement was statistically significant (P < 0.001). The IKDC score following revision ACL reconstruction was significantly better in those patients who underwent revision <1 year following the onset of recurrent symptoms (P = 0.015). Meniscal tears were present in 47.6%, and chondral injuries were seen in 33.3% of patients. The tibial tunnel positioning was abnormal in 70% of patients. Femoral tunnel positioning was aberrant in all the patients.

The revision rate of primary ACL reconstruction of 5.9% in nonathletes and revision ACL reconstruction rate of 3.9% are similar to the reported revision rates of 2.9%-5.8% in athletic patients. Similar to athletes, suboptimal tunnel placement is the major contributor to failure in nonathletes also.