Surgical Predictors of Clinical Outcome 6 Years After Revision ACL Reconstruction

MARS Group¹; Rick W Wright^{2

1}, Laura J Huston^{2

1}, Amanda K Haas^{3

1}, Jacquelyn S Pennings^{2

1}, Christina R Allen^{4

1}, Daniel E Cooper^{5

1}, Thomas M DeBerardino^{6

1}, Warren R Dunn^{7

1}, Brett Brick A Lantz^{8

1}, Kurt P Spindler^{9

1}, Michael J Stuart^{10

1}, Annunziato Ned Amendola^{11

1}, Christopher C Annunziata^{12

1}, Robert A Arciero^{13

1}, Bernard R Bach Jr^{14

1}, Champ L Baker 3rd^{15

1}, Arthur R Bartolozzi^{16

1}, Keith M Baumgarten^{17

1}, Jeffrey H Berg^{18

1}, Geoffrey A Bernas^{19

1}, Stephen F Brockmeier^{20

1}, Robert H Brophy^{3

1}, Charles A Bush-Joseph^{14

1}, J Brad Butler 5th^{21

1}, James L Carey^{22

1}, James E Carpenter^{23

1}, Brian J Cole^{14

1}, Jonathan M Cooper^{24

1}, Charles L Cox^{2

1}, R Alexander Creighton^{25

1}, Tal S David^{26

1}, David C Flanigan^{27

1}, Robert W Frederick^{28

1}, Theodore J Ganley^{29

1}, Charles J Gatt Jr^{30

1}, Steven R Gecha^{31

1}, James Robert Giffin^{32

1}, Sharon L Hame^{33

1}, Jo A Hannafin^{34

1}, Christopher D Harner^{35

1}, Norman Lindsay Harris Jr^{36

1}, Keith S Hechtman^{37

1}, Elliott B Hershman^{38

1}, Rudolf G Hoellrich^{8

1}, David C Johnson^{39

1}, Timothy S Johnson^{39

1}, Morgan H Jones^{40

1}, Christopher C Kaeding^{27

1}, Ganesh V Kamath^{25

1}, Thomas E Klootwyk^{41

1}, Bruce A Levy^{42

1}, C Benjamin Ma^{43

1}, G Peter Maiers 2nd^{41

1}, Robert G Marx^{34

1}, Matthew J Matava^{3

1}, Gregory M Mathien^{44

1}, David R McAllister^{33

1}, Eric C McCarty^{45

1}, Robert G McCormack^{46

1}, Bruce S Miller^{23

1}, Carl W Nissen^{47

1}, Daniel F O'Neill^{48

1}, Brett D Owens^{49

1}, Richard D Parker^{9

1}, Mark L Purnell^{50

1}, Arun J Ramappa^{51

1}, Michael A Rauh^{19

1}, Arthur C Rettig^{41

1}, Jon K Sekiya^{23

1}, Kevin G Shea^{52

1}, Orrin H Sherman^{53

1}, James R Slauterbeck^{54

1}, Matthew V Smith^{3

1}, Jeffrey T Spang^{25

1}, Steven J Svoboda^{55

1}, Timothy N Taft^{25

1}, Joachim J Tenuta^{56

1}, Edwin M Tingstad^{57

1}, Armando F Vidal^{58

1}, Darius G Viskontas^{59

1}, Richard A White^{60

1}, James S Williams Jr^{61

1}, Michelle L Wolcott^{62

1}, Brian R Wolf^{63

1}, James J York^{64

1}

Affiliations

¹ Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.
² Vanderbilt University, Nashville, TN, USA.
³ Washington University in St Louis, St Louis, MO, USA.
⁴ Yale University, New Haven, CT, USA.
⁵ W.B. Carrell Memorial Clinic, Dallas, TX, USA.
⁶ UT Health, San Antonio, TX, USA.
⁷ Fondren Orthopedic Group, Houston, TX, USA.
⁸ Slocum Research and Education Foundation, Eugene, OR, USA.
⁹ Cleveland Clinic, Cleveland, OH, USA.
¹⁰ Mayo Clinic, Rochester, MN, USA.
¹¹ Duke University, Durham, NC, USA.
¹² Commonwealth Orthopaedics & Rehabilitation, Arlington, VA, USA.
¹³ University of Connecticut Health Center, Farmington, CT, USA.
¹⁴ Rush University Medical Center, Chicago, IL, USA.
¹⁵ The Hughston Clinic, Columbus, GA, USA.
¹⁶ 3B Orthopaedics, University of Pennsylvania Health System, Philadelphia, PA, USA.
¹⁷ Orthopedic Institute, Sioux Falls, SD, USA.
¹⁸ Town Center Orthopaedic Associates, Reston, VA, USA.
¹⁹ State University of New York at Buffalo, Buffalo, NY, USA.
²⁰ University of Virginia, Charlottesville, VA, USA.
²¹ Orthopedic and Fracture Clinic, Portland, OR, USA.
²² University of Pennsylvania, Philadelphia, PA, USA.
²³ University of Michigan, Ann Arbor, MI, USA.
²⁴ HealthPartners Specialty Center, St Paul, MN, USA.
²⁵ University of North Carolina Medical Center, Chapel Hill, NC, USA.
²⁶ Synergy Specialists Medical Group, San Diego, CA, USA.
²⁷ The Ohio State University, Columbus, OH, USA.
²⁸ The Rothman Institute/Thomas Jefferson University, Philadelphia, PA, USA.
²⁹ Children's Hospital of Philadelphia, Philadelphia, PA, USA.
³⁰ University Orthopaedic Associates LLC, Princeton, NJ, USA.
³¹ Princeton Orthopaedic Associates, Princeton, NJ, USA.
³² Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, ON, Canada.
³³ University of California Los Angeles, Los Angeles, CA, USA.
³⁴ Hospital for Special Surgery, New York, NY, USA.
³⁵ University of Texas Health Center, Houston, TX, USA.
³⁶ Grand River Health, Rifle, CO, USA.
³⁷ Miami Orthopedics and Sports Medicine Institute, Coral Gables, FL, USA.
³⁸ Lenox Hill Hospital, New York, NY, USA.
³⁹ National Sports Medicine Institute, Leesburg, VA, USA.
⁴⁰ Brigham and Women's Hospital, Boston, MA, USA.
⁴¹ Forte Sports Medicine and Orthopedics, Indianapolis, IN, USA.
⁴² Orlando Health, Orlando, FL, USA.
⁴³ University of California, San Francisco, CA, USA.
⁴⁴ Knoxville Orthopedic Clinic, Knoxville, TN, USA.
⁴⁵ University of Colorado Denver School of Medicine, Denver, CO, USA.
⁴⁶ University of British Columbia/Fraser Health Authority, Vancouver, BC, Canada.
⁴⁷ Connecticut Children's Medical Center, Hartford, CT, USA.
⁴⁸ The Alpine Clinic, Plymouth, NH, USA.
⁴⁹ Warren Alpert Medical School, Brown University, Providence, RI, USA.
⁵⁰ Valley Ortho, Aspen, CO, USA.
⁵¹ Beth Israel Deaconess Medical Center, Boston, MA, USA.
⁵² Stanford University, Palo Alto, CA, USA.
⁵³ NYU Hospital for Joint Diseases, New York, NY, USA.
⁵⁴ UNC Health Southeastern, Lumberton, NC, USA.
⁵⁵ MedStar Orthopaedic and Sports Center, Washington, DC, USA.
⁵⁶ Albany Medical Center, Albany, NY, USA.
⁵⁷ Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, WA, USA.
⁵⁸ The Steadman Clinic, Vail, CO, USA.
⁵⁹ Fraser Orthopaedic Institute, New Westminster, Vancouver, BC, Canada.
⁶⁰ Fitzgibbon's Hospital, Marshall, MO, USA.
⁶¹ Cleveland Clinic, Euclid, OH, USA.
⁶² University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁶³ University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
⁶⁴ Luminis Health Orthopedics, Pasadena, MD, USA.

PMID: 39503722
PMCID: PMC11796288
DOI: 10.1177/03635465241288227

Surgical Predictors of Clinical Outcome 6 Years After Revision ACL Reconstruction

MARS Group et al. Am J Sports Med. 2024 Nov.

. 2024 Nov;52(13):3286-3294.

doi: 10.1177/03635465241288227.

Authors

Affiliations

¹ Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.
² Vanderbilt University, Nashville, TN, USA.
³ Washington University in St Louis, St Louis, MO, USA.
⁴ Yale University, New Haven, CT, USA.
⁵ W.B. Carrell Memorial Clinic, Dallas, TX, USA.
⁶ UT Health, San Antonio, TX, USA.
⁷ Fondren Orthopedic Group, Houston, TX, USA.
⁸ Slocum Research and Education Foundation, Eugene, OR, USA.
⁹ Cleveland Clinic, Cleveland, OH, USA.
¹⁰ Mayo Clinic, Rochester, MN, USA.
¹¹ Duke University, Durham, NC, USA.
¹² Commonwealth Orthopaedics & Rehabilitation, Arlington, VA, USA.
¹³ University of Connecticut Health Center, Farmington, CT, USA.
¹⁴ Rush University Medical Center, Chicago, IL, USA.
¹⁵ The Hughston Clinic, Columbus, GA, USA.
¹⁶ 3B Orthopaedics, University of Pennsylvania Health System, Philadelphia, PA, USA.
¹⁷ Orthopedic Institute, Sioux Falls, SD, USA.
¹⁸ Town Center Orthopaedic Associates, Reston, VA, USA.
¹⁹ State University of New York at Buffalo, Buffalo, NY, USA.
²⁰ University of Virginia, Charlottesville, VA, USA.
²¹ Orthopedic and Fracture Clinic, Portland, OR, USA.
²² University of Pennsylvania, Philadelphia, PA, USA.
²³ University of Michigan, Ann Arbor, MI, USA.
²⁴ HealthPartners Specialty Center, St Paul, MN, USA.
²⁵ University of North Carolina Medical Center, Chapel Hill, NC, USA.
²⁶ Synergy Specialists Medical Group, San Diego, CA, USA.
²⁷ The Ohio State University, Columbus, OH, USA.
²⁸ The Rothman Institute/Thomas Jefferson University, Philadelphia, PA, USA.
²⁹ Children's Hospital of Philadelphia, Philadelphia, PA, USA.
³⁰ University Orthopaedic Associates LLC, Princeton, NJ, USA.
³¹ Princeton Orthopaedic Associates, Princeton, NJ, USA.
³² Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, ON, Canada.
³³ University of California Los Angeles, Los Angeles, CA, USA.
³⁴ Hospital for Special Surgery, New York, NY, USA.
³⁵ University of Texas Health Center, Houston, TX, USA.
³⁶ Grand River Health, Rifle, CO, USA.
³⁷ Miami Orthopedics and Sports Medicine Institute, Coral Gables, FL, USA.
³⁸ Lenox Hill Hospital, New York, NY, USA.
³⁹ National Sports Medicine Institute, Leesburg, VA, USA.
⁴⁰ Brigham and Women's Hospital, Boston, MA, USA.
⁴¹ Forte Sports Medicine and Orthopedics, Indianapolis, IN, USA.
⁴² Orlando Health, Orlando, FL, USA.
⁴³ University of California, San Francisco, CA, USA.
⁴⁴ Knoxville Orthopedic Clinic, Knoxville, TN, USA.
⁴⁵ University of Colorado Denver School of Medicine, Denver, CO, USA.
⁴⁶ University of British Columbia/Fraser Health Authority, Vancouver, BC, Canada.
⁴⁷ Connecticut Children's Medical Center, Hartford, CT, USA.
⁴⁸ The Alpine Clinic, Plymouth, NH, USA.
⁴⁹ Warren Alpert Medical School, Brown University, Providence, RI, USA.
⁵⁰ Valley Ortho, Aspen, CO, USA.
⁵¹ Beth Israel Deaconess Medical Center, Boston, MA, USA.
⁵² Stanford University, Palo Alto, CA, USA.
⁵³ NYU Hospital for Joint Diseases, New York, NY, USA.
⁵⁴ UNC Health Southeastern, Lumberton, NC, USA.
⁵⁵ MedStar Orthopaedic and Sports Center, Washington, DC, USA.
⁵⁶ Albany Medical Center, Albany, NY, USA.
⁵⁷ Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, WA, USA.
⁵⁸ The Steadman Clinic, Vail, CO, USA.
⁵⁹ Fraser Orthopaedic Institute, New Westminster, Vancouver, BC, Canada.
⁶⁰ Fitzgibbon's Hospital, Marshall, MO, USA.
⁶¹ Cleveland Clinic, Euclid, OH, USA.
⁶² University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁶³ University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
⁶⁴ Luminis Health Orthopedics, Pasadena, MD, USA.

PMID: 39503722
PMCID: PMC11796288
DOI: 10.1177/03635465241288227

Abstract

Background: Revision anterior cruciate ligament (ACL) reconstruction has been documented to have inferior outcomes compared with primary ACL reconstruction. The reasons why remain unknown.

Purpose: To determine whether surgical factors performed at the time of revision ACL reconstruction can influence a patient's outcome at 6-year follow-up.

Study design: Cohort study; Level of evidence, 2.

Methods: Patients who underwent revision ACL reconstruction were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline patient characteristics, surgical technique and pathology, and a series of validated patient-reported outcome instruments: Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) subjective form, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Marx activity rating score. Patients were followed up for 6 years and asked to complete the identical set of outcome instruments. Regression analysis was used to control for baseline patient characteristics and surgical variables to assess the surgical risk factors for clinical outcomes 6 years after surgery.

Results: A total of 1234 patients were enrolled (716 men, 58%; median age, 26 years), and 6-year follow-up was obtained on 79% of patients (980/1234). Using an interference screw for femoral fixation compared with a cross-pin resulted in significantly better outcomes in 6-year IKDC scores (odds ratio [OR], 2.2; 95% CI, 1.2-3.9; P = .008) and KOOS sports/recreation and quality of life subscale scores (OR range, 2.2-2.7; 95% CI, 1.2-4.8; P < .01). Use of an interference screw compared with a cross-pin resulted in a 2.6 times less likely chance of having a subsequent surgery within 6 years. Use of an interference screw for tibial fixation compared with any combination of tibial fixation techniques resulted in significantly improved scores for IKDC (OR, 1.96; 95% CI, 1.3-2.9; P = .001); KOOS pain, activities of daily living, and sports/recreation subscales (OR range, 1.5-1.6; 95% CI, 1.0-2.4; P < .05); and WOMAC pain and activities of daily living subscales (OR range, 1.5-1.8; 95% CI, 1.0-2.7; P < .05). Use of a transtibial surgical approach compared with an anteromedial portal approach resulted in significantly improved KOOS pain and quality of life subscale scores at 6 years (OR, 1.5; 95% CI, 1.02-2.2; P≤ .04).

Conclusion: There are surgical variables at the time of ACL revision that can modify clinical outcomes at 6 years. Opting for a transtibial surgical approach and choosing an interference screw for femoral and tibial fixation improved patients' odds of having a significantly better 6-year clinical outcome in this cohort.

Keywords: anterior cruciate ligament reconstruction; outcomes; revision; surgical predictors.

PubMed Disclaimer

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: This project was funded by grant No. 5R01-AR060846 from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases. All author disclosures are listed in the Appendix (available in the online version of this article). AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

**Figure 1.**
Patient enrollment flow diagram. IRB, institutional review board; MTF, Musculoskeletal Transplant Foundation.

See this image and copyright information in PMC

References

1. Boyle C, Pagoti R, Eng KH, McMahon SE, Nicholas R. Revision ACL reconstruction with autograft: long-term functional outcomes and influencing factors. Eur J Orthop Surg Traumatol. 2019;29(1):157-161. - PubMed
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Surgical Predictors of Clinical Outcome 6 Years After Revision ACL Reconstruction

Affiliations

Surgical Predictors of Clinical Outcome 6 Years After Revision ACL Reconstruction

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical