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. 2023 Oct 23;24(1):831.
doi: 10.1186/s12891-023-06954-1.

Poorer patient-reported knee function and quality of life, but not activity level, after revision ACL reconstruction compared with primary ACL reconstruction: a matched-pair analysis with a minimum 5-year follow-up

Firathan Koca  1 , Anders Stålman  1 , Cornelia Vestberg  2 , Riccardo Cristiani  1 , Anne Fältström  3   4
Affiliations

Poorer patient-reported knee function and quality of life, but not activity level, after revision ACL reconstruction compared with primary ACL reconstruction: a matched-pair analysis with a minimum 5-year follow-up

Firathan Koca et al. BMC Musculoskelet Disord. .

Abstract

Background: An appropriate method for comparing knee function and activity level between patients with primary and revision anterior cruciate ligament reconstruction (ACLR) is to perform a matched-group analysis. The aim was to assess and compare knee function, knee-related quality of life and activity level between patients with revision ACLR and primary ACLR at a minimum of 5 years of follow-up.

Methods: Patients aged ≤ 40 years old who underwent revision ACLR between 2010 and 2015 and a matched control group (primary ACLR) (1:1) with age ± 2 years, year of ACLR, sex, and pre-injury sport and Tegner Activity Scale (TAS) were retrospectively identified in our clinic database. The preoperative Knee injury and Osteoarthritis Outcome Score (KOOS) and surgical data were extracted and analyzed. Patients were mailed KOOS and EQ-5D questionnaires at a minimum of 5-years after revision ACLR. Study-specific questions about knee function, limitation in sport, satisfaction, and activity level according to the TAS (all scales of 1-10, 10 best) were also asked by telephone.

Results: Seventy-eight patients with a revision ACLR (mean age ± SD, 29.9 ± 6.0 years) matched with seventy-eight patients with a primary ACLR (30.2 ± 5.8 years) were included. The follow-up for the revision ACLR group was 7.0 ± 1.5 years and for the primary ACLR group 7.7 ± 1.6 years. The revision ACLR group reported poorer KOOS scores in all subscales (p < 0.05) except the Symptoms subscale, poorer EQ-5D VAS (mean 79.2 ± 20.1 vs 86.0 ± 20.1, p = 0.012), and less satisfaction with current knee function (median 7 (6-8) vs 8 (7-9), p < 0.001). Patients with revision ACLR also experienced greater limitation in sports (median 7 (4-8) vs 8 (6-9), p < 0.001). There were no significant differences in the EQ-5D (mean 0.86 ± 0.17 vs 0.89 ± 0.11, p = 0.427), activity level (median 2 (2-5) vs 4 (2-7), p = 0.229), or satisfaction with activity level (median 8 (5-9) vs 8 (6-10), p = 0.281) between the groups.

Conclusions: At a minimum 5-year follow-up, the revision ACLR group reported poorer knee function and quality of life, less satisfaction with knee function and a greater limitation in sports but no differences in activity level and satisfaction with activity level compared with the primary ACLR group.

Keywords: Anterior cruciate ligament; Quality of life; Re-injury; Re-rupture; Reconstruction; Return to sport; Revision; Second knee injury.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of patient enrolment. A Revision ACLR Group and B Primary ACLR group. ACLR, anterior cruciate ligament reconstruction, CACL, contralateral anterior cruciate ligament
Fig. 2
Fig. 2
The proportion of patients attaining a patient-acceptable symptom state on the KOOS subscales during follow-up was examined in both the revision ACLR group (n = 65) and the primary ACLR group (n = 72). ACLR anterior cruciate ligament reconstruction, ADL Activities of Daily Living, KOOS Knee injury and Osteoarthritis Outcome Score, QOL Quality of Life, Sports/Rec Sports/Recreation
See this image and copyright information in PMC

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