Revision Anterior Cruciate Ligament Reconstruction Outcomes in Younger Patients: Medial Meniscal Pathology and High Rates of Return to Sport Are Associated With Third ACL Injuries

Webster, Kate E.; Feller, Julian A.; Kimp, Alexander J.; Whitehead, Timothy S.

doi:10.1177/0363546517751141

Cited by 50 publications

(54 citation statements)

References 38 publications

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“…11,13,14 Several studies identified young age as a risk factor for second ACL injuries, with injury rates in the range of 20% to 35%. [15][16][17][18] Webster et al 19 questioned whether young age in indeed a risk factor or a proxy for higher exposure to risk activity like returning to soccer or other pivoting sports. The very high rate of further ACL injuries in soccer players who return to play in our study is a further indication in support of that reasoning.…”

Section: Discussionmentioning

confidence: 99%

High Risk of Further Anterior Cruciate Ligament Injury in a 10-Year Follow-up Study of Anterior Cruciate Ligament-Reconstructed Soccer Players in the Swedish National Knee Ligament Registry

Sandon

Engström

Forssblad

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Section: Discussionmentioning

confidence: 99%

High Risk of Further Anterior Cruciate Ligament Injury in a 10-Year Follow-up Study of Anterior Cruciate Ligament-Reconstructed Soccer Players in the Swedish National Knee Ligament Registry

Sandon

Engström

Forssblad

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…This range of variability is consistent with data published for ACL reconstruction and not as high as in some series reporting outcomes of ACLR in young athletes participating in pivoting sports. [58][59][60] Comparative studies only reported graft rupture rates at shorter durations of follow-up. Although it is promising to note a lack of significant difference in graft rupture rates in the comparative studies, they were associated with a high risk of bias with respect to MINORS criteria and specific limitations included a lack of randomization, a small study population, and an absence of a sample size 50 and Henle et al, 36 do not report the rehabilitation protocol followed.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Arthroscopic Primary Anterior Cruciate Ligament Repair: A Systematic Review from the Scientific Anterior Cruciate Ligament Network International Study Group

Kandhari

Vieira

Ouanezar

et al. 2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Purpose: To perform a systematic review of contemporary studies reporting clinical outcomes of primary anterior cruciate ligament (ACL) repair to determine whether these studies demonstrate any significant benefit of ACL repair and whether there is evidence of a deterioration of mid-term outcomes as seen in historical data. Methods: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A PubMed search using the keywords "repair" AND "Anterior Cruciate Ligament" was performed (limits: English language, publication date between January 1, 2014, and January 13, 2019). All identified studies reporting clinical outcomes of arthroscopic ACL repair were included. Critical appraisal was conducted using the Cochrane Risk of Bias Tool for Randomized Clinical Trials and the Methodological Index for Non-Randomized Studies. Basic parameters of each study including population characteristics, repair technique, physical examination findings, and clinical outcome scores were recorded and evaluated. Results: Nineteen eligible studies were identified (including 5 comparative studies). None of the comparative studies showed any significant difference between repair and reconstruction groups with respect to International Knee Documentation Committee (IKDC), Lysholm, Tegner, side-to-side laxity difference, Lachman, pivot shift tests, or graft rupture rates. Four non-comparative studies reported outcomes at medium-to long-term follow up (range of mean follow up 43.3-79 months) with a mean Lysholm score between 85.3 and 100, mean IKDC subjective score between 87.3 and 100, and mean Tegner activity score between 5 and 7. Conclusions: Comparative studies identified no significant differences between ACL repair and reconstruction with respect to Lysholm, IKDC, side-to-side laxity difference, pivot shift grade, or graft rupture rates. However, these studies had major limitations including small numbers and short durations of follow up. Case series demonstrated that excellent outcomes can be achieved at medium-to long-term follow up with the SAR technique. Level of Evidence: IV; Systematic review of Level II to IV investigations. See related article on page 613 H istorical results of open primary repair of the anterior cruciate ligament (ACL) have been characterized in the literature by good initial clinical outcomes, 1-6 with a significant deterioration at midterm follow-up and high rates of additional surgery (64%), including reoperation for ACL reconstruction (13%

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“… 42 Meniscal pathology has been shown to increase the risk of poor outcomes 43 , 44 and graft rupture in the setting of revision ACL reconstruction. 30 Cartilage pathology has also been shown to worsen outcomes in this setting, with increased pain, stiffness and functional limitation. 43 , 44 …”

Section: Discussionmentioning

confidence: 99%

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

Engler

Salzler

Wall

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To evaluate the patient-reported and objective functional outcomes of patients undergoing multiple-revision anterior cruciate ligament (ACL) reconstruction surgery. The secondary purpose was to determine failure rates and factors associated with failure, with a focus on posterior tibial slope. Methods All patients who underwent a repeat revision ACL reconstruction with a single surgeon over a 13-year period were identified. Chart data were obtained, including radiographic findings, operative details and findings, and postoperative examination findings. Failure was defined as subjective instability with evidence of graft incompetence on physical examination and MRI. Patients completed the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC-SKF) and Tegner Activity Level Scale. Patients who had outcomes scores completed a minimum of 2 years postoperatively were included. Results Fourteen patients were available for follow-up; 12 underwent secondary revision procedures, and 2 underwent tertiary revisions. Three patients (21%) had subsequent failure of the revision graft with mean time to failure of 27 months. Posterior tibial slope was significantly higher in the failures than in the nonfailures (13.3˚; 95% CI 10.1-16.6 versus 10.1˚; 95% CI 6.7-11.4; P = 0.049). Eleven patients completed outcomes measures at a mean of 42 months postoperatively (range 24-79 months). The mean Tegner activity score was 6.3 at follow-up, compared with 8.3 prior to the original ACL injury. The mean IKDC-SKF score was 70 at follow-up. Conclusion Multiple revision ACL reconstruction surgery appears to have reasonable functional outcomes but is associated with a relatively high failure rate. Activity level following repeat revision surgery is diminished compared to the preinjury state, but most patients are able to return to recreational sports. Level of Evidence Therapeutic Study, Level IV.

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Revision Anterior Cruciate Ligament Reconstruction Outcomes in Younger Patients: Medial Meniscal Pathology and High Rates of Return to Sport Are Associated With Third ACL Injuries

Cited by 50 publications

References 38 publications

High Risk of Further Anterior Cruciate Ligament Injury in a 10-Year Follow-up Study of Anterior Cruciate Ligament-Reconstructed Soccer Players in the Swedish National Knee Ligament Registry

High Risk of Further Anterior Cruciate Ligament Injury in a 10-Year Follow-up Study of Anterior Cruciate Ligament-Reconstructed Soccer Players in the Swedish National Knee Ligament Registry

Clinical Outcomes of Arthroscopic Primary Anterior Cruciate Ligament Repair: A Systematic Review from the Scientific Anterior Cruciate Ligament Network International Study Group

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

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