Background: 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. Materials and Methods: 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. Results: 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. Conclusions: 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.

Introduction: Multi-ligamentous knee injuries (MLKI) are rare orthopedic injuries with diverse approaches to its management protocol. The purpose of this study was to determine the epidemiology of MLKI in our centre and its outcome in single stage reconstruction. Methods: 60 patients who were surgically treated for MLKI between 2014 and 2018 were included in this study, data was collected pre and postoperatively and their Lysholm and IKDC scores were used to evaluate the outcomes. Results: A male predominance was noted in the present study. Road traffic accidents (RTA) were the most common mode of injury (66.7%). ACL & MCL combination constituted the most common injury pattern (36.7%). 41.7% of our patients were treated within 3 weeks from injury and 58.3% were treated 3 weeks after injury and there was no statistically significant difference in their outcomes with a p value > 0.05 for their post op Lysholm scores and post op IKDC scores. Overall, there was a statistically significant difference in outcomes post surgery with regards to pre-operative and post-operative Lysholm and IKDC scores in our patients with a p value < 0.0001, substantiating the need for surgical management of MLKI. With a mean post-operative Lysholm score of 89.11 and mean post operative IKDC score of 85.25, this study showed functionally good results in the patients treated in a single sitting. 28 of 60 patients could get back to their sports activities after atleast 6 months of rehabilitation. Conclusion: MLKI are relatively uncommon injuries eluding a large scale prospective clinical studies and consensus regarding its management. In the present study, a male predominance was noted, high velocity injuries like RTA was the most common mechanism of injury. A combination of ACL & MCL accounted for the most common pattern of injury. We could also conclude that surgical management yields good results irrespective of the time since injury i.e. either early (<3 weeks) or delayed (>3 weeks) surgery. Single stage surgical management of MLKI produce considerably better outcomes compared to staged management. It was also found that surgical management of MLKI with reconstruction could help patients to return to their pre operative level of sports activities with a proper rehabilitation protocol.