Incidence of concomitant intra- and extra-articular lesions and procedures in patients undergoing primary and subsequent revision single-stage or 2-stage revision anterior cruciate ligament reconstruction: a matched retrospective cohort study

Abstract

Purpose: This study compares the concomitant intra- and extra-articular pathologies in patients undergoing primary anterior cruciate ligament reconstruction (ACLR) to their subsequent single or 2-stage revision ACLR.

Methods: Patients from 2012 to 2021 with minimum two-year follow-up after single-stage revision ACLR were matched with patients who underwent 2-stage revision ACLR by age, sex, and body mass index. Concomitant pathologies and procedures were compared from primary to single or 2-stage revision ACLR. The incidence of concomitant knee pathologies and procedures at the time of primary and revision ACLR was compared between the two groups.

Results: Following primary ACLR, 27 patients had single-stage revision ACLR and 27 had 2-stage revision ACLR. At the time of revision surgery, 2-stage revision ACLR had increased incidence of multi-ligamentous injury and meniscus repair. Rates of chondral injury alone and chondral injury plus concomitant meniscal injury increased significantly from primary to 2-stage revision ACLR. No significant change in the incidence of concomitant pathologies or procedures was found at primary ACLR to single-stage revision ACLR.

Conclusion: Patients with 2-stage revision ACLR are more likely to have concomitant multi-ligamentous pathologies and meniscal repair at the time of revision. Additionally, 25.9% of patients developed chondral pathologies and 18.55% developed both chondral and meniscal lesions from primary ACLR to 2-stage revision ACLR, raising concern about the long-term outcomes of these patients.

Level of evidence: Retrospective Cohort; 3.

Keywords: Concomitant injury; Concomitant procedure; Revision ACLR; Single-stage; Two-stage.