Abstract
Most orthopaedic sports medicine specialists believe that clinical outcomes after revision ACL reconstruction (RevACLR) compare unfavorably to primary reconstruction (PriACLR), however, there are no prospective cohort studies. Our hypothesis is that modifiable independent predictors of RevACLR outcomes can be identified from a large multicenter cohort to potentially improve the RevACLR outcomes in the future. Initially we focused on the mechanism of reinjury, mode of failure, and graft choices of MARS surgeons. The MARS Group is an AOSSM sponsored, academic and private practice multi-center prospective cohort study of patients undergoing RevACLR. All surgeons completed training sessions, obtained IRB approval, and comply with standardized manual of operations. Patient enrollment began in 2007 and requires completing a series of validated patient-oriented questionnaires (KOOS, MARX, IKDC, SF-36, & WOMAC). Surgeons document mechanism and mode of failure, method of RevACLR, and all intraarticular injuries and treatment. As of Nov 1, 2007 60 surgeons have enrolled 90 patients. Median age for the cohort was 26 years with 52 (58%) males. This was the 1st revision for 72 (77%). Mechanism of reinjury was 63 (70%) traumatic and 36 (29%) atraumatic. Mode of failure as deemed by the revising surgeon was 5 (6%) biologic, 22 (24%) technical, 27 (30%) traumatic, or 27 (30%) combination. Graft choice for RevACLR was 38 (42%) autograft [53% BTB, 37% HS (st+g), 10% HS (st only)] and 52 (58%) allograft [65% BTB, 29% tibialis anterior/posterior, 4% achilles tendon, 2% HS]. For the majority of patients this was their first RevACLR. The cause of failure of PriACLR was believed to be most commonly trauma with technical issues a contributing factor. Allografts are a slightly more common graft choice for RevACLR with allograft BTB the single most common RevACLR graft chosen. If graft choice and technical aspects of RevACLR are subsequently proven independent predictors of patient outcome at planned longitudinal two-year follow-up, these can be modifiable in the future to improve RevACLR outcomes.
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