Return to Sport After ACL Revision Reconstruction: Is It Advisable?

Abstract

The majority of patients who undergo anterior cruciate ligament (ACL) revision reconstruction do so in order to resume sports activities, and patients’ expectations appear to be nearly as high as those who undergo primary ACL reconstruction. Unfortunately, these patients frequently have associated problems from meniscectomy, articular cartilage damage, chronic neuromuscular deficiencies, swelling, and arthritic pain. The question of whether return to preinjury strenuous activity levels in ACL revision knees is advisable in light of the complexities involved requires analysis of existing investigations. We reviewed 20 modern clinical studies to determine return to sport (RTS) and subsequent graft failure/reinjury rates and whether symptoms were incurred during sports participation. The follow-up time periods were short to mid-term (range, 1–7.5 years), and return to preinjury sport activity levels varied widely, from 13% to 100%. Objective criteria to resume sports activities were provided only in four studies. Failure rates of ACL revision grafts ranged from 0% to 24%, and many failures were atraumatic in nature. Seven studies were conducted by survey only, and in these instances the graft failure rates may be higher than those reported. The effect of the graft selected for the revision procedure on RTS and failure rates could not be determined. Only two studies determined if patients were able to participate in sports without knee-related problems. The question of whether patients are able to participate in sports for many years after ACL revision reconstruction remains unanswered. We advise the return to low-impact activities after ACL revision in the majority of cases, especially in patients who have undergone meniscectomy or in whom arthritic damage or symptoms are present.