OUTCOMES OF ACL REVISION SURGERY AT MINIMUM OF 2 YEAR FOLLOW-UP

Abstract

Purpose: To describe functional results following revision ACL reconstruction surgery.

Methods: Patients more than 2 years post-operative from revision ACL surgery by the same surgeon were asked to participate. Patient-based evaluation was determined by ACL Quality of Life(QOL) and Lysholm scores while clinical evaluation was based on IKDC and KT1000 Arthrometer scoring. Surgical information and radiographs were reviewed to identify associated pathologies and surgical technique.

Results: Of 18 eligible patients, 15 were available for review(10 male, 5 female). Average age was 29 years(24–52); average follow-up time was 45.6 months(24–120). Primary ACL reconstructions failed due to surgical technique in 3 patients(20%), while trauma led to failure in 11 patients (73%). One patient failed due to previously unrecognized posterolateral instability and required an osteotomy at revision surgery. During revision surgery, 12 patients received a hamstring graft (10 contralateral, 2 ipsilateral) and 3 patients received a tibial posterior allograft. The most frequent concomitant procedures were a partial medial meniscectomy(3) and chondroplasty (5). Based on latest follow-ups, 7 patients had +2 grade on Lachman’s test, 4 patients had +1 grade and 4 patients had a negative grade. IKDC evaluation classified 3 patients as ‘normal’, 4 as ‘nearly normal’, 3 as ‘abnormal’ and 1 as ‘severely abnormal’. Autograft patients had a mean side-to-side difference of 2.8mm while allograft patients had a mean difference of 4.5 mm. Patient-rated Lysholm scores indicated that 4 patients received a ‘good’ score (84–94), 5 patients a ‘fair’ score (65–83) and 3 patients a ‘poor’ score (0–64). The average QOL score was 58.2%(12–96%). Patients characterized as having poor clinical and patient-rated results also had significant articular lesions identified during surgery.

Conclusions: Results of revision surgery do not appear to be as good as previously published reports of primary reconstructions. Consideration must be given to the status of the articular cartilage, as it appears to be an important factor in determining the overall functional result.