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Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (5): 857-863. doi: 10.19723/j.issn.1671-167X.2021.05.008

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Mid-to-long term clinical outcomes and predictors after anterior cruciate ligament revision

JIANG Yan-fang,WANG Jian,Yong-WANG Jian,LIU Jia,PEI Yin,LIU Xiao-peng,AO Ying-fang,MA Yong()   

  1. Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
  • Received:2021-06-24 Online:2021-10-18 Published:2021-10-11
  • Contact: Yong MA E-mail:huidong01@sina.com

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Abstract:

Objective: To assess the mid-to-long term clinical outcomes after anterior cruciate ligament (ACL) revision surgery and to analyze their predictors. Methods: The medical records of 235 patients undergoing ACL revision surgery between Jan. 2001 and Dec. 2015 at Department of Sports Medicine, Peking University Third Hospital were reviewed. Data were collected including demographic information, information related to revision surgery (time and cause of graft failure, date of revision surgery, surgical technique, combined injuries and management, etc.), as well as information related to primary ACL reconstruction (time, cause and mechanism of first-time ACL rupture, date of primary ACL reconstruction, surgical technique, combined injuries and management, etc.). Patients were followed up at least 2 years after revision surgery for clinical outcomes [Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) subjective knee score]. Post-revision surgeries on the involved knee and the contralateral knee joint were also documented. Multivariate regression model was used to analyze the predictors of clinical outcomes after ACL revision surgery. Results: A total of 166 (70.63%) patients were followed up at a mean of (4.44±2.40) years (2.03-14.63 years). Clinical outcomes improved significantly at the last follow-up from pre-operative level, with the Lysholm, Tegner, and IKDC scores improving from 70.51±21.25, 3.39±1.77, 63.78±15.04 to 88.64±14.36, 4.67±1.739, 80.23±13.31 (P<0.05), respectively. Three (1.81%) patients experienced infection while 39 (23.49%) patients underwent surgery after revision surgery during the follow-up. Compared with that those occurred during sports, graft failure that occurred during daily activities or due to surgical technical errors that led to poorer clinical outcomes, with the Lysholm, Tegner, and IKDC scores of 9.90 (95%CI: 1.49-18.31), 1.41 (95%CI: 0.10-2.72), 10.35 (95%CI: 0.17-20.54), and 8.53 (95%CI: 1.31-15.75), 1.28 (95%CI: 0.14-2.43), 9.39 (95%CI: 1.03-17.74) lower, respectively. Compared with antero-medial portal, transtibial technique for placement of the femoral bone tunnel showed poorer Lysholm scores of 11.18 (95%CI: 4.73-17.63, P=0.001). Concurrent repair of medial meniscus yielded higher IKDC scores of 11.06 (95%CI: 1.21-20.92, P=0.029) than those with intact medical meniscus. Other factors showed no significant effect. Conclusion: ACL revision surgery is able to restore knee stability and improve knee function. Graft failure caused by sports, concurrent repair of medical meniscus and antero-medial portal technique predicts better outcomes after revision surgery.

Key words: Anterior cruciate ligament injuries, Anterior cruciate ligament reconstruction, Reoperation, Treatment outcome, Prognosis

CLC Number: 

  • R686.5

Figure 1

Patient selection flowchart ACL, anterior cruciate ligament; PCL, posterior cruciate ligament; VAS, visual analogue scale; IKDC, International Knee Documentation Committee."

Table 1

Baseline characteristics between patients included and excluded"

Baseline characteristics Included (n=166) Excluded (n=69) P value
Gender, n(%) 0.324
Male 128 (77.11) 49 (71.01)
Female 38 (22.89) 20 (28.99)
Professional athletes, n(%) 15 (9.04) 10 (14.49) 0.217
Age at revision/years, x ?±s 27.55±7.60 27.04±7.55 0.639
BMI/(kg/m2), x ?±s 25.19±3.73 24.31±3.21 0.090
Interval between primary ACLR and revision/years, M (range) 2.78 (0.40-18.40) 3.17 (0.40-16.99) 0.895
Side, n(%) 0.919
Left knee 82 (49.40) 34 (49.28)
Right knee 84 (50.60) 35 (50.72)
Hospital of primary ACLR, n(%) 0.761
Peking University Third Hospital 81 (48.80) 36 (52.17)
Other hospitals 85 (51.20) 33 (47.83)
Technique at primary ACLR, n(%) 0.209
Single-bundle 70 (42.17) 35 (50.72)
Double-bundle 10 (6.02) 1 (1.45)
Unknown 86 (51.81) 33 (47.83)
Graft at primary ACLR, n(%) 0.122
Autografts 79 (47.59) 44 (63.77)
Hamstring 76 (45.78) 37 (53.62)
BPTB 2 (1.20) 5 (7.25)
Hybrid graft 1 (0.60) 2 (2.90)
Allograft 17 (10.24) 6 (8.70)
Artificial ligament 7 (4.22) 2 (2.90)
Hybrid autograft and allograft 2 (1.20) 0
Unknown 61 (36.74) 17 (24.64)
Cause of graft failure, n(%) 0.025
Sports 73 (43.98) 30 (43.48)
Daily activities 29 (17.47) 22 (31.88)
Traffic accident 4 (2.40) 0
Technical 60 (36.14) 17 (24.64)
Technique at revision, n(%) 0.521
Single-bundle 165 (99.40) 68 (98.55)
Double-bundle 1 (0.60) 1 (1.45)
Graft at revision, n(%) 0.078
Autograft 164 (98.80) 66 (95.65)
Hamstring 109 (65.66) 37 (53.62)
BPTB 52 (31.33) 24 (34.78)
Quadriceps 3 (1.81) 3 (4.35)
Others 0 2 (2.90)
Allograft 2 (1.20) 3 (4.35)

Table 2

Patient reported outcomes before and after ACL revision surgery (n=160)"

Patient-reported outcomes Pre-operation Last follow-up P value
Tegner 3.39±1.77 4.67±1.73 <0.001
IKDC 63.78±15.04 80.23±13.31 <0.001
Lysholm 70.51±21.25 88.64±14.36 <0.001

Table 3

Predictors of clinical outcomes after ACL revision surgery"

[1] Lind M, Menhert F, Pedersen AB. Incidence and outcome after revision anterior cruciate ligament reconstruction: Results from the Danish registry for knee ligament reconstructions [J]. Am J Sports Med, 2012, 40(7):1551-1557.
doi: 10.1177/0363546512446000
[2] Hettrich CM, Dunn WR, Reinke EK, et al. The rate of subsequent surgery and predictors after anterior cruciate ligament reconstruction: Two- and 6-year follow-up results from a multicenter cohort [J]. Am J Sports Med, 2013, 41(7):1534-1540.
doi: 10.1177/0363546513490277 pmid: 23722056
[3] Wasserstein D, Khoshbin A, Dwyer T, et al. Risk factors for recurrent anterior cruciate ligament reconstruction: A population study in Ontario, Canada, with 5-year follow-up [J]. Am J Sports Med, 2013, 41(9):2099-2107.
doi: 10.1177/0363546513493580 pmid: 23857886
[4] Maletis GB, Inacio MC, Funahashi TT. Analysis of 16 192 ante-rior cruciate ligament reconstructions from a community-based registry [J]. Am J Sports Med, 2013, 41(9):2090-2098.
doi: 10.1177/0363546513493589
[5] Leroux T, Wasserstein D, Dwyer T, et al. The epidemiology of revision anterior cruciate ligament reconstruction in Ontario, Canada [J]. Am J Sports Med, 2014, 42(11):2666-2672.
doi: 10.1177/0363546514548165
[6] Group M. Predictors of clinical outcome following revision anterior cruciate ligament reconstruction [J]. J Orthop Res, 2020, 38(6):1191-1203.
doi: 10.1002/jor.v38.6
[7] Yan X, Yang XG, Feng JT, et al. Does revision anterior cruciate ligament (ACL) reconstruction provide similar clinical outcomes to primary ACL reconstruction? A systematic review and meta-analysis [J]. Orthop Surg, 2020, 12(6):1534-1546.
doi: 10.1111/os.v12.6
[8] Ma Y, Ao YF, Yu JK, et al. Failed anterior cruciate ligament reconstruction: Analysis of factors leading to instability after primary surgery [J]. Chin Med J (Engl), 2013, 126(2):280-285.
[9] Grossman MG, ElAttrache NS, Shields CL, et al. Revision ante-rior cruciate ligament reconstruction: Three- to nine-year follow-up [J]. Arthroscopy, 2005, 21(4):418-423.
pmid: 15800521
[10] O’Neill DB. Revision arthroscopically assisted anterior cruciate ligament reconstruction with previously unharvested ipsilateral autografts [J]. Am J Sports Med, 2004, 32(8):1833-1841.
doi: 10.1177/0363546504264585
[11] Garofalo R, Djahangiri A, Siegrist O. Revision anterior cruciate ligament reconstruction with quadriceps tendon-patellar bone autograft [J]. Arthroscopy, 2006, 22(2):205-214.
doi: 10.1016/j.arthro.2005.08.045
[12] 任忠明, 谢国庆, 金文孝, 等. 关节镜下前交叉韧带重建术后失败行翻修术的近中期临床疗效 [J]. 武警医学, 2020, 31(8):654-656.
[13] Granan LP, Inacio MC, Maletis GB, et al. Intraoperative findings and procedures in culturally and geographically different patient and surgeon populations: An anterior cruciate ligament reconstruction registry comparison between Norway and the USA [J]. Acta Orthop, 2012, 83(6):577-582.
doi: 10.3109/17453674.2012.741451
[14] Griffith TB, Allen BJ, Levy BA, et al. Outcomes of repeat revision anterior cruciate ligament reconstruction [J]. Am J Sports Med, 2013, 41(6):1296-1301.
doi: 10.1177/0363546513482568 pmid: 23605223
[15] Noyes FR, Barber-Westin SD. Anterior cruciate ligament revision reconstruction: Results using a quadriceps tendon-patellar bone autograft [J]. Am J Sports Med, 2006, 34(4):553-564.
doi: 10.1177/0363546505281812
[16] Ohly NE, Murray IR, Keating JF. Revision anterior cruciate ligament reconstruction: Timing of surgery and the incidence of meniscal tears and degenerative change [J]. J Bone Joint Surg Br, 2007, 89(8):1051-1054.
pmid: 17785744
[17] Trojani C, Sbihi A, Djian P, et al. Causes for failure of ACL reconstruction and influence of meniscectomies after revision [J]. Knee Surg Sports Traumatol Arthrosc, 2011, 19(2):196-201.
doi: 10.1007/s00167-010-1201-6
[18] Widener DB, Wilson DJ, Galvin JW, et al. The prevalence of meniscal tears in young athletes undergoing revision anterior cruciate ligament reconstruction [J]. Arthroscopy, 2015, 31(4):680-683.
doi: 10.1016/j.arthro.2014.10.006
[19] Group M. Meniscal and articular cartilage predictors of clinical outcome after revision anterior cruciate ligament reconstruction [J]. Am J Sports Med, 2016, 44(7):1671-1679.
doi: 10.1177/0363546516644218
[20] Wegrzyn J, Chouteau J, Philippot R, et al. Repeat revision of anterior cruciate ligament reconstruction: A retrospective review of management and outcome of 10 patients with an average 3-year follow-up [J]. Am J Sports Med, 2009, 37(4):776-785.
doi: 10.1177/0363546508330141 pmid: 19336620
[21] Wright RW, Gill CS, Chen L, et al. Outcome of revision anterior cruciate ligament reconstruction: A systematic review [J]. J Bone Joint Surg Am, 2012, 94(6):531-536.
doi: 10.2106/JBJS.K.00733 pmid: 22438002
[22] Yoon KH, Lee HW, Park JY, et al. Clinical outcomes and the failure rate of revision anterior cruciate ligament reconstruction were comparable between patients younger than 40 years and patients older than 40 years: A minimum 2-year follow-up study [J]. Arthroscopy, 2020, 36(9):2513-2522.
doi: 10.1016/j.arthro.2020.06.012
[23] 运行, 魏钰, 李众利, 等. 前交叉韧带翻修术中期疗效研究 [J]. 中国修复重建外科杂志, 2021, 35(1):58-63.
[24] Group M, Wright RW, Huston LJ, et al. Predictors of patient-reported outcomes at 2 years after revision anterior cruciate ligament reconstruction [J]. Am J Sports Med, 2019, 47(10):2394-2401.
doi: 10.1177/0363546519862279 pmid: 31318611
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