Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Sep 18, 2022; 13(9): 812-824
Published online Sep 18, 2022. doi: 10.5312/wjo.v13.i9.812
Revision anterior cruciate ligament reconstruction: Return to sports at a minimum 5-year follow-up
Ezequiel Ortiz, Juan Pablo Zicaro, Ignacio Garcia Mansilla, Carlos Yacuzzi, Matias Costa-Paz
Ezequiel Ortiz, Juan Pablo Zicaro, Ignacio Garcia Mansilla, Carlos Yacuzzi, Matias Costa-Paz, Knee Division, Hospital Italiano de Buenos Aires, Ciudad Autónoma 1181, Buenos Aires, Argentina
Author contributions: Ortiz E and Zicaro JP designed the research study; Ortiz E performed the research; Yacuzzi C and Costa Paz M contributed new reagents; Garcia Mansilla I contributed with analytic tools; Ortiz E and Zicaro JP analyzed the data and wrote the manuscript; All authors have read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Hospital Italiano de Buenos Aires, No. #3213.
Informed consent statement: Patients were required to give informed consent to the study.
Conflict-of-interest statement: All authors report no relevant conflict of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ignacio Garcia Mansilla, MD, Surgeon, Knee Division, Hospital Italiano de Buenos Aires, Peron 4190, Ciudad Autónoma 1181, Buenos Aires, Argentina. ignacio.garciamansilla@hospitalitaliano.org.ar
Received: December 28, 2021
Peer-review started: January 4, 2022
First decision: February 21, 2022
Revised: May 4, 2022
Accepted: August 10, 2022
Article in press: August 10, 2022
Published online: September 18, 2022
Processing time: 262 Days and 11.6 Hours
Abstract
BACKGROUND

Between 43% and 75% of patients who undergo primary anterior cruciate ligament (ACL) surgery return to sport activity. However, after a revision ACL reconstruction (ACLR) the rate of return to sports is variable. A few publications have reported returns to sports incidence between 56% to 100% after revision ACLR.

AIM

To determine return to sports and functional outcomes after a single-stage revision ACLR with a 5-year minimum follow-up at a single institution.

METHODS

All patients operated between 2010 and 2016 with a minimum 5 years of follow-up were included. Type of sport, intensity, frequency, expectation, time to return to sport and failure rate were recorded. Lysholm, Tegner and International Knee Documentation Committee forms were evaluated prior to the first ACLR surgery, at 6 mo after primary surgery and after revision ACLR at 5 years minimum of follow-up. Objective stability was tested with the knee arthrometer test (KT-1000 knee arthrometer, Medmetric Corp).

RESULTS

A total of 41 patients who underwent revision ACLR during that period of time were contacted and available for follow-up. Median patient age at time of revision was 29 years old [interquartile range (IQR): 24.0-36.0], and 39 (95.0%) were male. The median time from revision procedure to follow-up was 70 mo (IQR: 58.0-81.0). Regarding return to sports, 16 (39.0%) were at the same level compared to preinjury period, and 25 patients (61.0%) returned at a lower level. Sixty-three percent categorized the sport as very important and 37.0% as important. One patient (2.4%) failed with a recurrent ACL torn. Mean preoperative Lysholm and subjective International Knee Documentation Committee scores were 58.8 [standard deviation (SD) 16] and 50 (SD 11), respectively. At follow-up, mean Lysholm and subjective International Knee Documentation Committee scores were 89 (SD 8) and 82 (SD 9) (P = 0.0001). Mean Tegner score prior to primary ACLR was 6.7 (SD 1.3), 5.1 (1.5 SD) prior to revision ACLR and 5.6 (1.6 SD) at follow-up (P = 0.0002). Overall, knee arthrometer test measurement showed an average of 6 mm (IQR: 4.0-6.0) side-to-side difference of displacement prior to revision ACLR and 3mm (IQR: 1.5-4.0) after revision.

CONCLUSION

Almost 40.0% of patients returned to preinjury sports level and 60.0% to a lower level. These may be useful when counseling a patient regarding sports expectations after a revision ACLR.

Keywords: Return to sport, Revision anterior cruciate ligament, Arthroscopy, Knee, Functional outcome

Core Tip: This was a retrospective case series with 41 patients seeking to evaluate return to sports and clinical outcomes after revision anterior cruciate ligament reconstruction at 5 years minimum of follow up. Retrospective analyzed data included physical examination, Tegner activity level, Lysholm, International Knee Documentation Committee, type of sport, intensity, frequency, expectation and time to return to sport. Objective stability was tested with the knee arthrometer test. All data were recorded at the base line and after a 5-year minimum follow-up.