Outcomes Following Single-Stage Revision Anterior Cruciate Ligament Reconstruction versus Two-Stage Revision with Tunnel Bone Grafting

Abstract

Objectives:Revision anterior cruciate ligament reconstruction (ACLR) is becoming increasingly common as the number of primary ACLR cases continues to rise. Despite this, there is limited data discussing the outcomes of revision ACLR, and even less information specifically addressing the differences in single-stage revision reconstructions versus those performed in a two stage fashion after reconstruction tunnel bone grafting. Our goal was to compare the outcomes, patient satisfaction and failure rates of single-stage versus two-stage revision ACLR.Methods:Following Institutional Review Board approval, a retrospective analysis of prospectively collected data was performed. All patients undergoing a revision ACLR between 2010 and 2014 by a single surgeon were collected, and skeletally mature individuals over the age of 17 were included. Patients were excluded if they were skeletally immature, had a previous intraarticular infection in the ipsilateral knee, underwent a prior alignment correction procedure, cartilage repair or transplant procedure, meniscal allograft transplantation, or had an intra-articular fracture. Patients completed a subjective questionnaire preoperatively and at a minimum two years postoperatively. MRI and CT scans of all knees were obtained preoperatively to assess for associated injuries and to evaluate ACL reconstruction tunnel size and location. Patients with malpositioned tunnels which would critically overlap with an anatomically placed tunnel or those with tunnels >14 mm in size underwent bone grafting.Results:A total of 88 patients met inclusion criteria for this study. There were 39 patients in the single-stage revision surgery group (19 males, 20 females), and 49 patients in the staged revision surgery group who underwent a first-stage tunnel bone grafting (27 males, 22 females). In both groups, the SF-12 PCS, the WOMAC score, the Lysholm score, and the Tegner activity scale significantly improved from preoperative to postoperative status. There was no significant difference in the SF-12 MCS score before and after surgery in either group. Furthermore, there was no significant difference in failure rates or other demographic data between groups. We observed four failures in the one-stage procedure group (10.3%) and three failures in the staged reconstruction group (6.1%).Conclusion:In this study, objective outcomes and subjective patient scores and satisfaction were not significantly different between one-stage and two-stage ACL revision surgeries. Both procedures resulted in significantly improved outcomes and patient subjective outcomes without notable differences in failure rates. Further longitudinal studies comparing one-stage and two-stage ACL revision over a longer time frame are recommended.