Revision ACL reconstruction with autograft: long-term functional outcomes and influencing factors

Abstract

Purpose: To present the long-term functional outcomes of revision anterior cruciate ligament (ACL) reconstruction with autograft and factors that influence the outcomes.

Methods: Retrospective study of 51 consecutive revision ACL reconstructions performed using autograft under the care of a single surgeon with interference screw fixation. Bone-patellar tendon-bone graft was used in 35 (69%) and hamstring tendons in 16 (31%). The subjective IKDC activity level and Lysholm Knee functional scores were collected at mean follow-up of 9.0 years (range 5.17-14.75 years).

Results: Five (9.8%) had re-ruptured and one patient had a total knee replacement. Functional scores were available for 43 patients (84.3%). Twenty-eight had IKDC activity level I or II (65%), level III in 12 (28%) and level IV in 3 (7%). The average Lysholm score was 86.2 ± 12.88, and there is a statistically significant relationship with age (95% CI: - 0.88, - 0.60) (P < 0.05). For each additional 10 years of age, there is a reduction of 5.18 points. No statistically significant effect of sex has been detected. The mean Lysholm score was lower in patients who had partial medial meniscectomy (77.33), although this was not statistically significant (P = 0.06). Regression analysis of the Lysholm score means by chondral damage category adjusted for age, showed that the Grade 3 or 4 group shows a reduction of about 25 points for every 10 years increase in age (95% CI; P = 0.05).

Conclusion: Revision ACL reconstruction with autograft affords satisfactory long-term outcomes. Expectations should be carefully managed in patients with increasing age associated with severe chondral damage and previous medial meniscectomy.

Keywords: Anterior cruciate ligament; Functional outcomes; Revision surgery.