ISAKOS: 2019 Congress in Cancun, Mexico
ISAKOS

2019 ISAKOS Biennial Congress ePoster #705

 

Clinical Outcomes After Revision Anterior Cruciate Ligament Reconstruction: Based on the Cause of Failure

Daisuke Araki, MD, PhD, Kobe, Hyogo JAPAN
Takehiko Matsushita, MD, Kobe, Hyogo JAPAN
Yuichi Hoshino, MD, PhD, Kobe, Hyogo JAPAN
Noriyuki Kanzaki, MD, PhD, Kobe, Hyogo JAPAN
Ryosuke Kuroda, MD, PhD, Kobe, Hyogo JAPAN

Kobe University Graduate School of Medicine, Kobe, Hyogo, JAPAN

FDA Status Not Applicable

Summary

The clinical outcomes after revision ACL reconstruction based on the cause of failure were investigated based on the cuse of failure. The revision ACL reconstruction could restore knee instability with fairly good clinical results. However, the activity level tended to decrease before second injury. In particular, the cases, which had no clear re-injuries, had lower clinical outcomes.

Abstract

Introduction

Anterior cruciate ligament (ACL) reconstruction has become one of the common orthopaedic procedures. However, it has been reported that 8 % had unsatisfactory results due to recurrent instability or graft failure. Therefore, the purpose of this study is to investigate the clinical outcomes after revision ACL reconstruction based on the cause of failure.

Methods

Eighty patients (31 females and 49 males, average age 24.3 years old), who underwent revision ACL reconstruction with minimum 2 year follow-up from 2002 to 2016, were included in this study. We investigated the period from primary ACL reconstruction to re-injury, the mechanism of re-injury, the graft type of the primary and revision ACL reconstruction, the side-to-side difference of the KT-1000 measurements, the Lysholm scores, and the Tegner Activity Levels. Based on the mechanism of re-injury, we divided into the traumatic group (Group T) and the non-traumatic group (Group N).

Results

The mean period from the primary ACL reconstruction to re-injury was 41.5 months. At the primary ACL reconstructions, the hamstrings tendon autografts were used for 68 patients, the bone-patellar tendon-bone autografts were used for 11 patients and the artificial ligament was used for 1 patient. At the revision ACL reconstruction, the hamstrings tendon autografts were used for 43 patients, the bone-patellar tendon-bone autografts were used for 37 patients. Although seventy-one patients had the traumatic injury histories (Group T), 9 patients received recurrent instability without any injury (Group N). At the 2-year follow up after revision ACL reconstruction, the average KT-1000 measurements were recovered from 6.5 mm to 1.9 mm and the mean Lysholm score was 85.7. However, the Tegner activity level was significantly lower than before the re-injury from 7.0 to 5.5. In particular, the KT-1000 measurements of Group N were significantly higher than that of Group T (Group N: 5.5 mm, Group T: 1.4 mm) and the Lysholm score of Group N was also significantly lower than that of group T (Group N: 66.1, Group T: 81.2). In addition, the Tegner activity level of Group N was lower than that of Group T (Group N: 3.8, Group T: 5.7).

Conclusion

This study indicated that the revision ACL reconstruction could restore knee instability with fairly good clinical results. However, the activity level tended to decrease before second injury. In particular, the cases, which had no clear re-injuries, had lower clinical outcomes.