Re-revision ACL reconstruction may impact return to sport level
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Key takeaways:
- Re-revision ACL reconstruction was associated with improvements in stability and patient-reported outcomes.
- However, rates of return to sport at pre-injury level ranged from 12.5% to 80%.
According to published results, patients who underwent re-revision ACL reconstruction had low rates of return to sport at their pre-injury level despite improvements in stability and patient-reported outcomes.
Researchers used Medline, PubMed and Cochrane databases to perform a systematic review of 15 studies that reported on 399 patients who underwent re-revision ACL reconstruction with minimum 2-year follow-up. Researchers assessed patient-reported outcomes (PROs) and return to sport rates.
Overall, researchers found PROs improved preoperatively to postoperatively. Mean preoperative Lysholm scores ranged from 38.4 to 73.15, while mean postoperative Lysholm scores ranged from 68 to 87.8. However, researchers determined patients undergoing re-revision may have a low likelihood of returning to sport at their pre-injury level. They found rates of return to sport at pre-injury level ranged from 12.5% to 80% across all studies.
Researchers also found functional outcomes among patients who underwent re-revision were inferior compared with outcomes from patients who underwent primary ACL reconstruction. They noted concomitant knee pathologies were more prevalent among patients who underwent re-revision compared with revision and primary procedures.
Researchers concluded patients undergoing re-revision ACL reconstruction should be cautious about their expectations for returning to sport at their pre-injury level.
Perspective
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What this study highlights are realistic expectations for all surgeons and patients about the return to level-1 sports after re-revision ACL surgery. Studies have shown even after revision ACL surgery, we need to temper our expectations about exactly what activities we can expect to return to safely and without further injury to a knee that clearly is not normal. These discussions are critically important prior to embarking on re-revision. They have shown that further issues and problems with meniscal pathology and cartilage pathology increase in frequency after each revision surgery. It is these problems that are difficult for us to solve that ultimately determine the biologic “happiness” of that knee. The most important part of this study, as well as outcomes from first revision ACL surgery, are we must get it right the first time. After the first ACL reconstruction, that knee is never the same. We must be critical with the variables that as surgeons we control: correct graft for the correct patient, attempt to save every meniscus tear (they help you biomechanically as an ACL surgeon) and tunnel placement of your graft must be perfect. This is your best chance to do the best job possible and return that patient to level-1 sports at a high level.
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