Summary
The greatest improvement in functional outcomes is observed after primary ACLR. Patients undergoing at least one revision ACLR, specifically mrACLR, had lower pre- and postoperative outcome scores, indicating that primary ACLR may provide the best change for recovery after ACL injury.
Abstract
Background
Graft failure after ACL reconstruction (ACLR) is a debilitating complication often requiring revision surgery. It is widely agreed upon that functional knee outcomes following revision ACLR (rACLR) are inferior to primary reconstruction. However, data is scarce on the multiply revised ACLR (mrACLR) and how its outcomes compare to rACLR.
Purpose
To compare patient-reported knee function in terms of Knee injury and Osteoarthritis Outcome Score (KOOS) preoperatively and 1-year postoperatively following primary ACLR, rACLR, and mrACLR as well as the improvement in KOOS scores from pre- to postoperative states for each procedure.
Methods
Patients undergoing primary ACLR between 2005 and 2020 with minimum of 15 years of age at time of surgery were included in this study from the Swedish National Knee Ligament Registry. The 1-year postoperative KOOS scores and changes in KOOS scores pre- to postoperatively were assessed between the three groups 1) Primary ACLR, 2) rACLR, and 3) mrACLR. All group comparisons were conducted at the 5% significance level.
Results
Of the included patients, 1,407 (5.0%) underwent one rACLR and 42 (0.2%) underwent mrACLR. The postoperative KOOS Function in Sport and Recreation (Sport/Rec) and Quality of Life (QoL) were found to be lower in patients undergoing mrACLR compared to primary ACLR (50.0 +/- 28.6 vs. 63.9 +/- 26.9; p<0.001, and 44.2 +/- 23.6 vs. 58.6 +/- 23.2; p<0.001). Furthermore, patients undergoing rACLR were found to have smaller change in all the KOOS subscales including Sport/Rec (9.0 +/- 28.7 vs. 23.5 +/- 28.5; p<0.001) and QoL (11.8 +/- 23.7 vs. 25.1 +/- 24.2; p<0.001) compared to patients undergoing primary ACLR. Also, the change in the KOOS QoL subscale was lower in patients undergoing mrACLR compared to those with primary ACLR (10.2 +/- 29.1 vs. 25.1 +/- 24.2; p=0.042).
Conclusion
The results of this study suggest that while improvement is seen after primary ACLR, rACLR, and mrACLR, the greatest improvement in functional outcomes is observed after primary ACLR. Patients undergoing at least one revision ACLR, specifically mrACLR, had lower pre- and postoperative outcome scores, indicating that primary ACLR may provide the best change for recovery after ACL injury.