Re-revision anterior cruciate ligament reconstruction showed more laxity than revision anterior cruciate ligament reconstruction at a minimum 2-year follow-up

Abstract

Purpose This study aimed to compare patient demographics, associated lesions (concurrent meniscal and chondral injuries), and clinical outcomes between revision and re‐revision anterior cruciate ligament reconstructions. Methods Patients who underwent revision or re‐revision anterior cruciate ligament reconstruction between 2008 and 2016 with a minimum 2‐year follow‐up were retrospectively evaluated. Detailed patient demographic data, radiographic preoperative tunnel diameters, posterior tibia slope, and concurrent meniscal and chondral lesion were reviewed. Clinical scores and laxity tests’ results were compared between the groups at the last follow‐up. Results Eighty‐two patients (mean age, 33.8 ± 9.9 years; revision group, n = 62; re‐revision group, n = 20) were included. The re‐revision group showed a higher grade for preoperative arthritis (P < 0.001); more severe preoperative bone defects of the femoral (13.8 ± 2.6 vs 11.7 ± 2.7 mm, P = 0.004) and tibial tunnels (14.6 ± 2.4 vs 13.0 ± 2.3 mm, P = 0.010); and a higher prevalence of subtotal medial meniscectomy (P = 0.008) and chondral defects of the medial (P = 0.006) and lateral femoral condyles (P < 0.001), patella (P = 0.040), and trochlea (P = 0.036). At the final follow‐up, the clinical scores did not differ significantly between the groups. However, the re‐revision group showed more instability in the anterior drawer (P = 0.001), Lachman (P < 0.001), and pivot‐shift (P < 0.001) tests, while a side‐to‐side difference was observed on the Telos stress radiographs (7.1 ± 4.7 vs 4.9 ± 3.7 mm, P = 0.038). Conclusion These findings showed that the patients who underwent re‐revision had poor prognostic factors as compared with those who underwent revision anterior cruciate ligament reconstruction. Although the clinical scores did not differ significantly between the groups, the re‐revision group showed more laxity at the 2‐year follow‐up. Level of evidence Cohort study; IV.

A high tibial slope, allograft use, and poor patient-reported outcome scores are associated with multiple ACL graft failures

“…Multiple ACL graft failures are associated with an atraumatic injury mechanism with a gradual onset of recurrent instability [ 5 , 12 , 16 ]. This was confirmed by the present study, in which an atraumatic injury mechanism was significantly more often observed in the group with multiple compared to single ACL graft failures (45% vs. 22%).…”

“…Therefore, the PTS was considered to be the primary outcome measure and was used for a priori sample size calculation. A recently published study reported a mean PTS of 11.5° ± 3.6° and 13.1° ± 2.4° in patients undergoing revision ACL-R and re-revision ACL-R, respectively [ 5 ]. Accordingly, a total sample size of 92 patients (46 patients per group) was required to achieve a statistical power of 0.8 (effect size, 0.52; level of significance, 0.05).…”

“…Despite a large body of the literature regarding single anterior cruciate ligament (ACL) graft failures, only a few studies emphasizing multiple ACL graft failures have been published [ 1 , 5 , 12 , 13 , 15 , 16 ]. Prior studies have shown that undergoing more than one revision ACL-R is a predictor for worse patient-reported outcomes (PROs) and subsequent graft failures [ 2 , 17 ].…”

“…Prior studies have shown that undergoing more than one revision ACL-R is a predictor for worse patient-reported outcomes (PROs) and subsequent graft failures [ 2 , 17 ]. Additionally, the majority of patients that have sustained multiple ACL graft failures present with meniscal tears and cartilage lesions [ 5 , 12 , 13 , 15 , 16 ], which are well-known negative predictors for long-term knee function. Failure analyses revealed that an increased posterior tibial slope (PTS), static anterior tibial subluxation, and a deep, elliptically shaped, lateral femoral condyle were associated with multiple ACL graft failures [ 1 , 5 , 13 ].…”

“…Failure analyses revealed that an increased posterior tibial slope (PTS), static anterior tibial subluxation, and a deep, elliptically shaped, lateral femoral condyle were associated with multiple ACL graft failures [ 1 , 5 , 13 ]. Consequently, a failure rate of up to 30% after a second revision ACL-R was demonstrated [ 5 ]. Additionally, it has been shown that patients undergoing more than two revision ACL-Rs are almost 26 times more likely to experience subsequent ACL graft failure than patients undergoing first revision ACL-R [ 2 ].…”