Abstract

PurposeTo evaluate trends in revision anterior cruciate ligament reconstruction (ACL-R), with emphasis on intra-articular findings, grafts, and concurrent procedures. It was hypothesized that revision ACL-Rs over time show a trend toward increased complexity with increased use of autografts over allografts.MethodsThis was a two-center retrospective study including patients undergoing revision ACL-R between 2010 and 2020. Demographic and surgical data including intra-articular findings and concurrent procedures were collected and compared for the time periods 2010–2014 and 2015–2020. All collected variables were compared between three pre-defined age groups (< 20 years, 20–30 years, > 30 years), right and left knees, and males and females. A time series analysis was performed to assess trends in revision ACL-R.ResultsThis study included 260 patients with a mean age of 26.2 ± 9.4 years at the time of the most recent revision ACL-R, representing the first, second, third, and fourth revision ACL-R for 214 (82%), 35 (14%), 10 (4%), and 1 (< 1%) patients, respectively. Patients age > 30 years showed a significantly longer mean time from primary ACL-R to most recent revision ACL-R (11.1 years), compared to patients age < 20 years (2.2 years, p < 0.001) and age 20–30 years (5.5 years, p < 0.05). Quadriceps tendon autograft was used significantly more often in 2015–2020 compared to 2010–2014 (49% vs. 18%, p < 0.001). A high rate of concurrently performed procedures including meniscal repairs (45%), lateral extra-articular tenodesis (LET; 31%), osteotomies (13%), and meniscal allograft transplantations (11%) was shown. Concurrent LET was associated with intact cartilage and severely abnormal preoperative knee laxity and showed a statistically significant and linear increase over time (p < 0.05). Intact cartilage (41%, p < 0.05), concurrent medial meniscal repairs (39%, p < 0.05), and LET (35%, non-significant) were most frequently observed in patients aged < 20 years.ConclusionQuadriceps tendon autograft and concurrent LET are becoming increasingly popular in revision ACL-R. Intact cartilage and severely abnormal preoperative knee laxity represent indications for LET in revision ACL-R. The high rate of concurrent procedures observed demonstrates the high surgical demands of revision ACL-R.Level of evidenceLevel III.

Highlights

  • Failure rates of up to 10% and 30% after primary and revision anterior cruciate ligament reconstruction (ACL-R), respectively, highlight the clinical relevance of revision ACL-R in daily clinical practice [12, 24, 37, 42, 44, 49, 57–59]

  • The most important finding of this study was that quadriceps tendon autografts and concurrent lateral extra-articular tenodesis (LET) are becoming increasingly popular in revision ACL-R, especially in younger patients

  • Regression analyses revealed that the use of autografts in the setting of revision ACL-R resulted in improved patient reported outcomes, sports function, and a significantly decreased risk of subsequent graft failure compared to the use of allografts [24]

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Summary

Introduction

Failure rates of up to 10% and 30% after primary and revision anterior cruciate ligament reconstruction (ACL-R), respectively, highlight the clinical relevance of revision ACL-R in daily clinical practice [12, 24, 37, 42, 44, 49, 57–59]. The prospective longitudinal Multicenter ACL Revision Study (MARS) provided high-quality data with a high level of evidence for revision ACL-R and identified numerous independent predictors for the outcomes of revision ACL-R [5,6,7,8, 23,24,25,26,27,28,29,30,31,32,33,34,35,36, 39, 52]. Knee ligament registries represent another valuable source which provide insights into outcomes, failure rates, and descriptive data of revision ACL-R [22, 23]. It seems to be difficult to identify changes in practice patterns in revision

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