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Patient-Reported Outcomes After Multiple-Revision ACL Reconstruction: Good but Not Great.

ABSTRACT: Purpose:To evaluate the patient-reported and objective functional outcomes of patients undergoing multiple-revision anterior cruciate ligament (ACL) reconstruction surgery. The secondary purpose was to determine failure rates and factors associated with failure, with a focus on posterior tibial slope. Methods:All patients who underwent a repeat revision ACL reconstruction with a single surgeon over a 13-year period were identified. Chart data were obtained, including radiographic findings, operative details and findings, and postoperative examination findings. Failure was defined as subjective instability with evidence of graft incompetence on physical examination and MRI. Patients completed the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC-SKF) and Tegner Activity Level Scale. Patients who had outcomes scores completed a minimum of 2 years postoperatively were included. Results:Fourteen patients were available for follow-up; 12 underwent secondary revision procedures, and 2 underwent tertiary revisions. Three patients (21%) had subsequent failure of the revision graft with mean time to failure of 27 months. Posterior tibial slope was significantly higher in the failures than in the nonfailures (13.3?; 95% CI 10.1-16.6 versus 10.1?; 95% CI 6.7-11.4; P = 0.049). Eleven patients completed outcomes measures at a mean of 42 months postoperatively (range 24-79 months). The mean Tegner activity score was 6.3 at follow-up, compared with 8.3 prior to the original ACL injury. The mean IKDC-SKF score was 70 at follow-up. Conclusion:Multiple revision ACL reconstruction surgery appears to have reasonable functional outcomes but is associated with a relatively high failure rate. Activity level following repeat revision surgery is diminished compared to the preinjury state, but most patients are able to return to recreational sports. Level of Evidence:Therapeutic Study, Level IV.

SUBMITTER: Engler ID

PROVIDER: S-EPMC7588625 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Patient-Reported Outcomes After Multiple-Revision ACL Reconstruction: Good but Not Great.

Engler Ian D ID Salzler Matthew J MJ Wall Andrew J AJ Johnson William R WR Makani Amun A Shields Margaret V MV Gill Thomas J TJ

Arthroscopy, sports medicine, and rehabilitation 20200902 5

<h4>Purpose</h4>To evaluate the patient-reported and objective functional outcomes of patients undergoing multiple-revision anterior cruciate ligament (ACL) reconstruction surgery. The secondary purpose was to determine failure rates and factors associated with failure, with a focus on posterior tibial slope.<h4>Methods</h4>All patients who underwent a repeat revision ACL reconstruction with a single surgeon over a 13-year period were identified. Chart data were obtained, including radiographic ...[more]

PMID: 33134992

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Project description:BackgroundSubchondral bone injuries, or bone bruises, are commonly observed on magnetic resonance imaging (MRI) after anterior cruciate ligament (ACL) injury. The current relationship between bone bruise volume and postsurgical outcomes remains poorly understood.PurposeTo examine the influence of bone bruise volume on self-reported and objective functional outcomes at the time of return to play and 2 years following ACL reconstruction.Study designCohort study; Level of evidence, 3.MethodsClinical, surgical, and demographic data were obtained for a sample of convenience utilizing a single-surgeon ACL database (n = 1396). For 60 participants, femoral and tibial bone bruise volumes were estimated from preoperative MRI. Data obtained at the time of return to play included International Knee Documentation Committee (IKDC-2000) score, ACL-Return to Sport after Injury (ACL-RSI) score, and performance on an objective functional performance battery. Two-year follow-up data included graft reinjury rate, level of return to sport/activity, and self-reported knee function using the Single Assessment Numeric Evaluation (SANE). The forward stepwise linear regression was used to determine the relationship between bone bruise volume and patient function.ResultsThe distribution of bone bruise injuries was as follows: lateral femoral condyle (76.7%), lateral tibial plateau (88.3%), medial femoral condyle (21.7%), and medial tibial plateau (26.7%). Mean total bone bruise volume of all compartments was 7065.7 ± 6226.6 mm3. At the 2-year follow up, there were no significant associations between total bone bruise volume and time of return to play (P = .832), IKDC-2000 score (P = .200), ACL-RSI score (P = .370), or SANE score (P = .179).ConclusionThe lateral tibial plateau was the most frequent site to sustain bone bruise injury. Preoperative bone bruise volume was not associated with delayed time to return to sport or self-reported outcomes at time of return to play or at 2 years postoperatively.RegistrationNCT03704376 (ClinicalTrials.gov identifier).

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Patient-Reported Outcomes After Multiple-Revision ACL Reconstruction: Good but Not Great.

Publications

Patient-Reported Outcomes After Multiple-Revision ACL Reconstruction: Good but Not Great.

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