Revision ACL reconstruction may be associated with ‘worrisome’ outcomes at 10 years
Key takeaways:
- Revision ACL reconstruction in younger patients was associated with “worrisome” outcomes at long-term follow-up.
- Many patients had limited range of motion, graft failure, poor function and pain.
DENVER — Younger patients who undergo revision ACL reconstruction may be at risk for limited range of motion, graft failure, poor function and pain at minimum 10-year follow-up, according to presented results.
“This is the first report of an ACL revision cohort with minimum 10-year onsite follow-up, a study which demonstrates worrisome outcomes for patients who are still relatively young,” Laura J. Huston, MS, co-director of sports medicine research at Vanderbilt University Medical Center, said at the American Orthopaedic Society for Sports Medicine Annual Meeting.
Huston and colleagues from the Multicenter ACL Reconstruction Revision Study group analyzed patient-reported outcomes, radiologic measures and physical examinations of 205 patients (mean age, 40.2 years) who underwent revision ACL reconstruction with follow-up between 10 and 16 years.
Outcomes included KOOS pain scores, incidence of structural osteoarthritis, graft failure, range of motion (ROM), ligamentous testing and bilateral KT-1000 assessment.
At follow-up, Huston and colleagues found 20% of patients had KOOS pain scores of less than 70 points, which was defined as symptomatic OA.
“The significant drivers of symptomatic OA at 10 years were found to be grades 3 or 4 chondral pathology in the lateral compartment at the time of revision, having a medial meniscectomy performed prior to the time of revision or having a subsequent surgery,” Huston said.
Huston said 41% to 58% of patients had loss of ROM and 18% of patients had graft failure, with 56% of patients having a Kellgren-Lawrence grade of 3 or 4.
“The significant drivers of higher [Kellgren-Lawrence] KL grade at 10 years are found to be older age, higher baseline BMI, having a medial meniscectomy performed prior to or at the time of revision surgery, having a lateral meniscectomy prior to revision or having a subsequent surgery,” she said.
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Huston LJ, et al. Paper 04. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 10-14, 2024; Denver.