Patient-Reported Outcomes After Multiple-Revision ACL Reconstruction: Good but Not Great

Abstract

Purpose: To evaluate the patient-reported and objective functional outcomes of patients undergoing multiple-revision anterior cruciate ligament (ACL) reconstruction surgery. The secondary purpose was to determine failure rates and factors associated with failure, with a focus on posterior tibial slope.

Methods: All patients who underwent a repeat revision ACL reconstruction with a single surgeon over a 13-year period were identified. Chart data were obtained, including radiographic findings, operative details and findings, and postoperative examination findings. Failure was defined as subjective instability with evidence of graft incompetence on physical examination and MRI. Patients completed the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC-SKF) and Tegner Activity Level Scale. Patients who had outcomes scores completed a minimum of 2 years postoperatively were included.

Results: Fourteen patients were available for follow-up; 12 underwent secondary revision procedures, and 2 underwent tertiary revisions. Three patients (21%) had subsequent failure of the revision graft with mean time to failure of 27 months. Posterior tibial slope was significantly higher in the failures than in the nonfailures (13.3˚; 95% CI 10.1-16.6 versus 10.1˚; 95% CI 6.7-11.4; P = 0.049). Eleven patients completed outcomes measures at a mean of 42 months postoperatively (range 24-79 months). The mean Tegner activity score was 6.3 at follow-up, compared with 8.3 prior to the original ACL injury. The mean IKDC-SKF score was 70 at follow-up.

Conclusion: Multiple revision ACL reconstruction surgery appears to have reasonable functional outcomes but is associated with a relatively high failure rate. Activity level following repeat revision surgery is diminished compared to the preinjury state, but most patients are able to return to recreational sports.

Level of evidence: Therapeutic Study, Level IV.

Fig 1

Tibial tunnel position. Tibial tunnel positioning was calculated by measuring the center of the tunnel from the anterior edge of the tibial plateau (A) as a percentage of the total anteroposterior tibial plateau distance (TP).

Fig 2

Posterior tibial slope. Posterior tibial slope was calculated as the angle (PTS) between the perpendicular (A) of the proximal tibial diaphyseal axis (PTA) and the line between the most superior points of the anterior and posterior margins of the tibial plateau (B).