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Single-stage, two-stage revision ACL reconstruction yielded similar outcomes
Researchers noted a cutoff point must be defined for when to perform two-stage vs single-stage revision ACL reconstruction.
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There was significant improvement in outcomes and subjective scores among patients who underwent single-stage or two-stage revision ACL reconstruction in study results.
“Patients seem to do just as well at a minimum 2-year follow-up having undergone a two-stage revision ACL reconstruction when compared to a one-stage revision and statistically there are no differences in the patient subjective outcome scores that we evaluated,” Justin J. Mitchell, MD, of the Department of Sports Medicine at Gundersen Health System, in La Crosse, Wisconsin, told Orthopedics Today.
One-stage vs. two-stage
Mitchell, who presented the findings at a meeting, Robert F. LaPrade, MD, PhD, and their colleagues identified patients who were undergoing either single-stage (n=39 patients) or two-stage (n=49 patients) revision ACL reconstruction and had them complete the Lysholm score, Tegner activity scale, WOMAC scale, SF-12 physical and mental component summary and patient satisfaction survey preoperatively and at 2 years postoperatively, minimum.
Mitchell noted there were significant improvements in outcomes from preoperatively to postoperatively in either group, as well when the investigators compared both groups’ results.
“From a patient satisfaction standpoint and from the perspective of subjective patient-reported outcomes, there was no difference between cohorts in any of the scores,” Mitchell said at the meeting.
The single-stage and two-stage groups showed no differences in failure rate or mean time to failure. However, patients who underwent a two-stage procedure had some carryover of pathology from the first stage to the second stage, according to Mitchell.
“Patients did develop new lesions between the first stage and the secondary stage,” Mitchell said. “Up to 25% of our initial cohort did demonstrate a secondary lesion during their second stage procedure, which is obviously a concern.”
Cut-off period
Because a two-stage revision ACL reconstruction involves a second surgical intervention and a prolonged rehabilitation between the first stage to the second stage, Mitchell said he was surprised by the similar outcomes both groups had at the latest follow-up.
“When you are doing a two-stage revision ACL reconstruction procedure, the patient is typically undergoing 4 months to 6 months of rehabilitation and recovery prior to proceeding with the second stage,” Mitchell told Orthopedics Today. “It is surprising to me and I think it is an important finding, that people in the two-stage cohort end up doing about the same, because this is obviously a different recovery than just a one-stage surgery.”
Mitchell noted the cutoff point at which surgeons should consider performing a two-stage procedure vs. a single-stage revision ACL reconstruction still needs to be defined.
“When you talk to experienced surgeons, there is no general consensus as to when you should and when you should not attempt a single-stage vs. two-stage revision, so we believe that more clearly defining that is of some importance,” he said. – by Casey Tingle
Reference:
Mitchell JJ, et al. Am J Sports Med. 2017;doi:10.1177/0363546517698684.
For more information:
Justin J. Mitchell, MD, can be reached at Gundersen Health System, 1900 South Ave., La Crosse, WI 54601; email: justinjmitchell@gmail.com.
Disclosure: Mitchell reports no relevant financial disclosures.