A cross-sectional study comparing the rates of osteoarthritis, laxity, and quality of life in primary and revision anterior cruciate ligament reconstructions

Abstract

Purpose: The purpose of this study was to assess the degree of osteoarthritis, degree of laxity, and quality-of-life (QOL) scores in primary and revision anterior cruciate ligament (ACL) reconstruction.

Methods: This was a cross-sectional study; 25 patients who had undergone revision ACL reconstruction with allografts were identified and compared with 27 randomly selected primary ACL reconstruction patients operated on in the same hospital in the same period with the same technique. The main outcome measure was the International Knee Documentation Committee (IKDC) radiographic osteoarthritis sum score, and secondary outcome measures were Knee injury and Osteoarthritis Outcome Score, IKDC functional outcome measures, anterior laxity, and QOL at follow-up.

Results: The median follow-up was 5.3 years for revision reconstruction patients and 5.1 years for primary reconstruction patients. Radiographic IKDC sum scores for osteoarthritis were found to be significantly worse in revision patients, with a median of 4, compared with primary patients, with a median of 1 (P = .016). Differences were found in meniscal injury (P = .02) and cartilage status (P < .001) before or at the index operation. Significantly worse outcomes were found in the following subscores of the Knee injury and Osteoarthritis Outcome Score: pain (median, 92 v 97; P = .032), symptom (median, 86 v 96; P = .015), activities of daily living (median, 94 v 100; P = .020), sport (median, 50 v 85; P = .006), and QOL (median, 56 v 81; P = .001). IKDC functional outcome measures were the same in both groups except for the pivot-shift test (P = .007). No differences were found in anterior drawer, Lachman, or KT-1000 arthrometer (MEDmetric, San Diego, CA) testing. Present-day health scores on the EQ-5D were worse for revision reconstruction patients (median, 70 v 80; P = .009).

Conclusions: Revision reconstruction patients have more signs of osteoarthritis and worse QOL than primary reconstruction patients, even though they have comparable IKDC success rates and KT-1000 arthrometer laxity test results.

Level of evidence: Level III, retrospective comparative study.