Abstract
PurposeTo evaluate and compare knee laxity and functional knee outcome between primary and revision anterior cruciate ligament (ACL) reconstruction in the same cohort of patients.MethodsPatients who underwent primary and revision ACL reconstruction (ACLR) at Capio Artro Clinic, Stockholm, Sweden, from 2000 to 2015, were identified in our local database. Inclusion criteria were: same patients who underwent primary hamstring tendons (HT) and revision bone–patellar tendon–bone (BPTB) autograft ACLR, no associated ligament injuries and no contralateral ACL injuries/reconstructions. The cause of revision ACLR was graft rupture for all patients. The KT-1000 arthrometer, with an anterior tibial load of 134-N, was used to evaluate knee laxity preoperatively and 6-month postoperatively. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was collected preoperatively and at the 1-year follow-up.ResultsA total of 118 patients with primary and revision ACLR arthrometric laxity measurements were available (51.0% males; mean age at primary ACLR 21.7 ± 7.1 years and revision ACLR 24.3 ± 7.5 years). The mean preoperative and postoperative anterior side-to-side (STS) difference values were not significantly different between primary and revision ACLR. However, primary ACLR showed a significantly higher frequency of postoperative anterior STS difference > 5 mm compared with revision ACLR (8.4 vs 5.0%; P = 0.02). The KOOS was available for primary and revision ACLR for 73 patients (55.4% males; mean age at primary ACLR 21.6 ± 7 years and revision ACLR 24.7 ± 7.3 years). Preoperatively, revision ACLR showed significantly higher scores in all KOOS subscales, except for the activity of daily living (ADL) subscale. For the primary ACLR, the improvement from preoperatively to the 1-year follow-up was significantly greater in all KOOS subscales and, the postoperative scores were superior for Pain, ADL and Sports subscales compared with revision ACLR.ConclusionsThe findings of this study showed that anterior knee laxity is restored with revision BPTB autograft ACLR after failed primary HT autograft ACLR, in the same cohort of patients. However, revision ACLR showed a significantly inferior functional knee outcome compared with primary ACLR. It is important for clinicians to inform and set realistic expectations for patients undergoing revision ACLR. Patients must be aware of the fact that having revision ACLR their knee function will not improve as much as with primary ACLR and the final postoperative functional outcome is inferior.Level of evidenceRetrospective cohort study, Level III.
Highlights
The number of anterior cruciate ligament (ACL) reconstructions significantly increased in recent years [19]
The mean improvement from preoperative to 1-year follow-up was significantly greater in all Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales for primary ACL reconstruction (ACLR) compared with revision ACLR: Symptoms (P = 0.001); Pain (P < 0.001); activity of daily living (ADL) (P = 0.002); Sport (P < 0.001); Quality of Life (QOL) (P = 0.006) (Fig. 4)
The findings of this study showed that anterior knee laxity is restored with revision bone–patellar tendon–bone (BPTB) autograft ACLR after failed primary hamstring tendons (HT) autograft ACLR, in the same cohort of patients
Summary
The number of anterior cruciate ligament (ACL) reconstructions significantly increased in recent years [19]. The annual incidence of primary ACL reconstruction (ACLR) is reported to be 34–38/100,000 inhabitants in Norway and Denmark [9, 23]. The 7–10% failure rate of primary ACLR [11]. Data from the Danish knee ligament reconstruction registry showed a revision rate for primary ACLR of 3% 2 years after surgery [23] and of 4.1% 5 years after surgery [22]. According to Paterno et al [30], an athlete in the age between 10 and 25 years who undergoes ACLR has a 15 times greater risk of being injured again in the same knee compared to an athlete with a healthy knee, during the first 12 postoperative months
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