Modifiable and non-modifiable risk factors affecting surgical failure after revision ACL reconstruction: a cohort...

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomechanical Engineering

Background:

• Limited research exists on factors influencing revision anterior cruciate ligament (ACL) reconstruction outcomes.
• Understanding revision ACL reconstruction failure is crucial for improving clinical results and patient counseling.
• This study analyzes factors contributing to surgical failure in revision ACL reconstruction.

Purpose of the Study:

• To identify demographic, perioperative, intraoperative, and postoperative factors associated with surgical failure in revision ACL reconstruction.
• To provide insights for optimizing surgical techniques and patient selection for revision ACL reconstruction.
• To enhance preoperative counseling by clarifying risk factors for revision ACL reconstruction failure.

Main Methods:

• Retrospective review of 58 patients undergoing single-bundle revision ACL reconstruction (2010-2020) with ≥2-year follow-up.
• Patients classified into non-failure (NF) and failure (F) groups based on graft re-tear, laxity, or rotational instability.
• Comparative and multivariate regression analyses performed on patient data to determine failure predictors.

Main Results:

• The failure group (F) had a higher incidence of multiple revision surgeries (P=0.001), increased preoperative osteoarthritis grade (P=0.001), and shallower femoral tunnel depth (P=0.002).
• Surgical failure was independently associated with multiple revision surgeries, preoperative osteoarthritis, and femoral tunnel depth.
• The failure group exhibited poorer subjective and objective clinical outcomes at final follow-up.

Conclusions:

• Surgical failure in revision ACL reconstruction is influenced by both non-modifiable (multiple revisions, osteoarthritis) and modifiable (femoral tunnel depth) factors.
• Identifying these factors can guide surgeons in managing complex cases and improving revision ACL reconstruction success rates.
• Femoral tunnel depth represents a critical modifiable factor that surgeons can optimize during revision ACL reconstruction procedures.