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Comparison of concomitant injuries and patient-reported outcome in patients that have undergone both primary and revision ACL reconstruction-a national registry study

Journal article
Authors Eleonor Svantesson
Eric Hamrin Senorski
Frida Kristiansson
E. Alentorn-Geli
Olof Westin
Kristian Samuelsson
Published in Journal of Orthopaedic Surgery and Research
Volume 15
Issue 1
Pages 15
ISSN 1749-799X
Publication year 2020
Published at Institute of Neuroscience and Physiology, Department of Health and Rehabilitation
Institute of Clinical Sciences, Department of Orthopaedics
Pages 15
Language en
Keywords ACL, Anterior cruciate ligament, Reconstruction, Revision, Registry, Outcome, Autograft, Meniscus, Cartilage, cruciate ligament reconstruction, cartilage injuries, graft choice, knee, swedish, predictors, surgery, failure, risk, koos, Orthopedics
Subject categories Orthopedics


Background Anterior cruciate ligament (ACL) revision surgery has been associated with inferior outcome compared with primary ACL reconstruction. However, this has rarely been investigated in a consecutive cohort limited to patients that have undergone both primary and revision ACL reconstruction. This study aimed to assess differences in outcome and concomitant injuries between primary and revision ACL reconstruction in such a cohort, and to identify predictors of the patient-reported outcome after ACL revision. Methods Patients who had undergone both primary and revision ACL reconstruction were identified in the Swedish National Knee Ligament Registry. Patients aged 13-49 years with hamstring tendon primary ACL reconstruction and data on the Knee Injury and Osteoarthritis Outcome Score (KOOS) on at least one occasion (preoperative or one year postoperatively) at both surgeries were eligible. Concomitant injuries and the KOOS were compared between each patient's primary and revision ACL reconstruction. Linear regression analyses were performed to determine predictors of the one-year KOOS after ACL revision. Results A total of 1014 patients were included. Cartilage injuries increased at ACL revision (p < 0.001), as 23.0% had a cartilage injury at ACL revision that was not present at primary ACL reconstruction. The 1-year KOOS was lower after ACL revision compared with primary ACL reconstruction, with the largest difference in the KOOS sports and recreation (5.2 points, SD 32.2, p = 0.002). A posterolateral corner (PLC) injury at ACL revision was a negative predictor of KOOS, with the largest effect on the sports and recreation subscale (beta = - 29.20 [95% CI - 50.71; - 6.69], p = 0.011). The use of allograft for ACL revision was an independent predictor of a poorer KOOS QoL (beta = - 12.69 [95% CI - 21.84; - 3.55], p = 0.0066) and KOOS4 (beta = - 11.40 [95% CI - 19.24; - 3.57], p = 0.0044). Conclusion Patients undergoing ACL revision reported a 1-year outcome that was slightly inferior to the 1-year outcome after their primary ACL reconstruction. An ACL revision was associated with an increase in cartilage injuries. A PLC injury at ACL revision and the use of allograft for ACL revision predicted a clinically relevant poorer KOOS one year after ACL revision.

Page Manager: Webmaster|Last update: 9/11/2012

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