Speaker details modifiable predictors of revision ACL reconstruction outcomes
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NASHVILLE, Tenn. — Use of interference screws, high baseline scores, non-smokers and low body mass index predicted positive outcomes in patients who undergo revision ACL reconstruction while “ideal” tibial tunnel predicted worse outcomes, according to a speaker, here.
“Revision ACL reconstruction has consistently had worse outcomes than primary ACL reconstruction. Little level 1 or prospective evidence is available regarding this topic,” Rick W. Wright, MD, chair of the department of orthopaedic surgery at Vanderbilt Health, said during his presentation at the American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America Combined Meeting. “Based on these poor results, Multicenter ACL Revision Study (MARS) group was formed to determine potentially modifiable predictors of outcomes.”
Wright and colleagues analyzed data on 1,234 prospectively enrolled patients (mean age 26 years) who underwent revision ACL reconstruction from 2006 to 2011. To identify outcome predictors, the researchers collected data on demographics, surgical approach, tibial tunnel position, fixation and biological factors. Outcome measures, including IKDC, KOOS, WOMAC and Marx activity rating scores, were collected at baseline and 6 years after surgery.
Overall, 77% of patients (n = 949) completed a phone call follow-up at 6 years. Wright and MARS researchers found surgical approach and biologic enhancement had no influence on outcomes at 6 years.
“Secondary variables that improved outcome included higher baseline scores, not smoking, and lower BMI,” Wright said. “The most consistent drivers of outcome were ideal tibial tunnel predicted worse outcomes and interference screws predicted improved scores.”
Wright said the results of this study raise many questions.
“It is difficult to understand cause and effect for many of these factors. Surgeons need to use this data to help drive decision making in these complex surgical revision cases.”
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Wright RW, et al. Surgical predictors of clinical outcomes six years following revision anterior cruciate ligament reconstruction. Presented at: American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America Combined Meeting; July 7-11, 2021; Nashville, Tennessee.
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