2015 ISAKOS Biennial Congress Paper #0

Outcomes Of Repeat-Revision Anterior Cruciate Ligament Reconstruction vs. Non-Operative Treatment

Adnan Saithna, MD, FRCS, Scottsdale, AZ UNITED STATES
Thomas Fradin, MD, Besançon FRANCE
Ibrahim Haidar, MD, Lyon FRANCE
Johnny Rayes, MD, MSc, FEBOT, Calgary, AB CANADA
Abdo Helou, MD, Lyon FRANCE
Cédric Ngbilo, MD, Lausanne SWITZERLAND
Charles Pioger, MD, Lyon FRANCE
Graeme P. Hopper, MBChB, MSc, MRCSEd, MFSTEd, MD, FRCSGlas (Tr&Orth), Glasgow UNITED KINGDOM
Thais Dutra Vieira, MD, Lyon, Rhone FRANCE
Bertrand Sonnery-Cottet, MD, PhD, Lyon, Rhône FRANCE

Santy Clinic, Lyon, Rhone-Alps, FRANCE

FDA Status Cleared

Summary: 2nd revision ACL reconstruction is associated with significantly better PROMS than non-operative treatment following failure of 1st RACLR

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Abstract:

Purpose

The literature guiding management of failed revision ACL reconstruction (RACLR) is sparse. The aim of this study was to evaluate outcomes of surgical vs non-surgical management of failed 1st RACLR. It was hypothesized that long-term outcomes of 2nd RACLR would be superior with respect to stability, return to sport and patient reported outcome measures (PROMS)

Methods

Patients who experienced failure of 1st RACLR were evaluated. All participants followed the same rehabilitation protocol regardless of whether they underwent non-surgical treatment or 2nd RACLR. Follow-up comprised clinical review and a standardized telephone interview at the end of the study period. PROMS were reported at final follow up.

Results

41 patients with a mean follow up of 104 ± 52.7 months were evaluated. 31 underwent 2nd RACLR and 10 chose non-surgical treatment. There was a high rate of return to sport in both groups but patients undergoing 2nd RACLR had significantly better Tegner (6.35 vs 4.8, p=0.012), Lysholm (88.5 vs 78.3, p=0.0353), KOOS QoL (72.6 vs 56.3, p=0.0490) and KOOS function in sports and recreation (81.4 vs 62.5, p=0.0033). Significantly more patients undergoing 2nd RACLR achieved PASS for KOOS function in sports and recreation than those who underwent non-surgical management (74.2% vs 30%, p=0.015). The most important predictor of failure to achieve a good/excellent Lysholm score in multivariate analysis (including patient, injury and surgery characteristics) was non-surgical management (p=0.0095).

Conclusion

Both 2nd RACLR and non-surgical management of failed 1st RACLR are associated with high rates of return to sport. However, 2nd RACLR is associated with significantly better functional outcome scores with respect to Tegner, Lysholm, KOOS QoL and KOOS function in sports and recreation. In addition, non-surgical treatment was the only significant predictor of failure to achieve a good/excellent Lysholm score at final follow-up, and this is likely due to inferior knee stability in that group.