Comparison of Return-to-Sport and Patient-Reported Outcomes Between Primary and Revision ACL Reconstruction: An...

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Reconstructive Surgery

Background:

• Anterior cruciate ligament (ACL) injuries are common sports injuries globally.
• Primary ACL reconstruction (PACLR) is standard, but graft failure may require revision ACL reconstruction (RACLR).
• RACLR is thought to yield inferior return to sport (RTS) and patient-reported outcomes (PROs) compared to PACLR.

Purpose of the Study:

• To compare RTS and PROs between PACLR and RACLR.
• Hypothesized that RACLR would result in significantly lower RTS rates and inferior PROs compared to PACLR.

Main Methods:

• Systematic review of comparative studies on PACLR versus RACLR.
• Searched PubMed and Cochrane Library for studies reporting RTS or PROs (IKDC, KOOS, Lysholm, Tegner).
• Analyzed data using risk difference for RTS and mean difference for PROs, applying random- or fixed-effects models.

Main Results:

• Included 22 studies with 24,773 patients (22,767 PACLR, 2006 RACLR).
• No significant difference in overall RTS rates, but PACLR showed higher rates of returning to the same level of sports (RTS-S).
• PACLR was superior in all PROs (IKDC, Lysholm, Tegner) and all 5 KOOS domains, particularly Sport/Recreation and Quality of Life.

Conclusions:

• RACLR demonstrates similar overall RTS but significantly lower RTS-S and worse PROs compared to PACLR.
• Revision surgery restores daily function but has limitations in sports performance and quality of life.
• Further research is needed to precisely quantify disparities in RTS and PROs between PACLR and RACLR.