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Patient-Reported Outcomes After Multiple-Revision ACL Reconstruction: Good but Not Great.

Ian D Engler1, Matthew J Salzler1, Andrew J Wall2

  • 1Department of Orthopaedics, Tufts Medical Center, Boston, Massachusetts, U.S.A.

Arthroscopy, Sports Medicine, and Rehabilitation
|November 2, 2020
PubMed
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Multiple revision anterior cruciate ligament (ACL) reconstruction offers reasonable outcomes but has a high failure rate. Patients experience diminished activity levels post-surgery but can often return to recreational sports.

Area of Science:

  • Orthopedic surgery
  • Sports medicine
  • Biomechanical engineering

Background:

  • Anterior cruciate ligament (ACL) reconstruction is a common orthopedic procedure.
  • Multiple revisions are complex and associated with higher failure rates.
  • Understanding outcomes and failure factors in repeat ACL surgery is crucial.

Purpose of the Study:

  • Evaluate functional outcomes (patient-reported and objective) after multiple revision ACL reconstruction.
  • Determine failure rates and identify factors associated with failure, specifically posterior tibial slope.

Main Methods:

  • Retrospective chart review of patients undergoing repeat revision ACL reconstruction over 13 years.
  • Failure defined as subjective instability with graft incompetence (physical exam and MRI).

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  • Assessment using International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC-SKF) and Tegner Activity Level Scale.

    • Main Results:

    • 21% of repeat revision ACL reconstructions failed, with a mean time to failure of 27 months.
    • Higher posterior tibial slope was significantly associated with graft failure (13.3˚ vs. 10.1˚).
    • Functional outcomes showed a diminished Tegner score (6.3 vs. 8.3 pre-injury) and IKDC-SKF score of 70.

    Conclusions:

    • Multiple revision ACL reconstruction yields acceptable functional outcomes but carries a significant risk of failure.
    • Elevated posterior tibial slope is a potential factor contributing to revision ACL graft failure.
    • Despite diminished activity levels, most patients can resume recreational sports post-surgery.