Revision anterior cruciate ligament reconstruction: Return to sports at a minimum 5-year follow-up

Table 1 Demographics

Demographics	Results (N = 41)
Yr, median (IQR)	29 (24-36)
Male, n (%)	39 (95)
Follow up (mo) (IQR)	70 (58-81)
Period (a)	2010-2016
Injury mechanism prior revision ACLR
Traumatic	26 (63.4%)
Atraumatic	15 (36.6%)
Time between (mo)
ACL Primary surgery and retear	22 (22-39)
Revision ACLR and return to sport	13 (11-15)
Failure	1 (2.4%)

IQR: Interquartile range; ACLR: Anterior cruciate ligament reconstruction; ACL: Anterior cruciate ligament.

Table 2 Surgical technique and concomitant lesions

Graft	n (%)	Surgical technique	n (%)	Augmentation	n (%)
Primary ACL
Hamstring	29 (70.7)	Monotunnel	36 (87.0)	-	-
BPTB	11(26.8)	Anatomic	5 (12.0)	-	-
Allograft	1 (2.4)
Revision ACLR
Hamstring	10 (24.3)	Anatomic	41 (100)	Lemaire	15 (36.0)
BTB	29 (70.3)			Allograft	2 (4.8)
Allograft	5 (2.0)			No Augmentation	24 (58.0)
Concomitant lesions
Both meniscus	9 of 41 (21.0)
Medial meniscus	26 of 41 (66.0)
Meniscectomy	20 (77.0)
Meniscal suture	5 (19.0)
Meniscal transplantation	1 (4.0)
Lateral meniscus
Meniscectomy	14 of 41 (34.0)
Chondral lesions	5 (12.0)

BTB: Bone tendon bone; ACL: Anterior cruciate ligament; ACLR: Anterior cruciate ligament reconstruction; BPTB: Bone patellar tendon bone.

Table 3 Return to sport rate after primary anterior cruciate ligament surgery and before revision anterior cruciate ligament reconstruction after a 5-yr minimum follow-up

	Return to sports rate
	Primary ACLR, %	Revision ACLR, %
Total return	95.0	100
Same level	31.7	39.0
Lower level	63.4	61.0

ACLR: Anterior cruciate ligament reconstruction.

Table 4 Activity sports impact and time evolution

Impact sport and Tegner	Prior to primary ACLR, n (%)	At 5 yr revision ACLR, n (%)
Low	1 (2.4)	2 (4.8)
Moderate	5 (12.2)	20 (48.7)
High	35 (85.3)	19 (46.3)

ACLR: Anterior cruciate ligament reconstruction.

Table 5 Tegner, Lysholm and subjective International Knee Documentation Committee scores prior to revision anterior cruciate ligament reconstruction and at the 5-yr follow-up

	Preoperative	SD	5 yr postoperative	SD	Delta	SD	95%CI	P value
Tegner	6.7	(1.3)	5.6	(1.6)	-1.170	(1.8)	-1.739 to -0.602	0.002
Lysholm	58.8	(16.0)	89.0	(8.0)	30.121	(17.0)	24.736 to 35.507	< 0.001
IKDC	50.0	(11.0)	82.0	(9.0)	31.475	(15.0)	26.649 to 36.300	< 0.001

χ² test was used to estimate the P value. SD: Standard deviation; IKDC: International Knee Documentation Committee; CI: Confidence interval.

Table 6 Comparing our series with the literature for the Lysholm, Tegner and International Knee Documentation Committee scores

Ref.	N	Years	F-up in yr	RTS	IKDC	Lysholm	Tegner	KT-1000, mm ± SD	KOOS
Battaglia et al[28], 2007	63	31	6.1	42 (66%) same level	G/E 36%; P 17%; F 11%	-	-	< 3	-
Diamantopoulos et al[29], 2008	107	39	6	39 (36%) same level	G/E 57%; P 34%; F 7%	88.5 ± 12.4	6.3 ± 1.8	0.93 ± 1.15	-
Gifstad et al[30], 2013	56	26	7.5	7 (13%) same level	-	80 ± 15	6 ± 4	3.3 ± 2.7	70 ± 21
Shelbourne et al[31], 2014	259	22	7.2	178 (68%) same level	Subjective 76 ± 18.3	-	-	2.3 ± 1.7	-
Ortiz et al, 2022	41	29	5.8	61% same level & 39% lower level	G/E 43%; P 53%; F 4%	89 ± 8	5.6 ± 1.6	3 ± 1.2	-

N: Number of patients; F-up: Follow up; RTS: Return to sport; IKDC: International Knee Documentation Committee; G/E: Good to excellent; P: Poor; F: Fair; SD: Standard deviation; KOOS: Knee Injury and Osteoarthritis Outcome Score.

Table 7 Five representative cases

Case	Sex	Years	Time between in min				Graft choice		Augmentation at revision ACLR	Concomitant lesions
			Primary ACLR and retear	Revision ACLR and last evaluation, F-up	Return to sport		Primary	Revision
					To Primary ACLR	To Revision ACLR	ACLR	ACLR
1	Male	30	36	126	17	20	Hamstring	BPTB	Lemaire	Medial meniscus tear
2	Male	42	12	131	14	13	Hamstring	BPTB	Lemaire	Medial meniscus tear
3	Male	29	48	107	13	11	Hamstring	BPTB	Lemaire	Chondral lesions
4	Male	35	22	115	10	14	Hamstring	BPTB	-	Chondral lesions
5	Female	28	13	103	14	16	Hamstring	BPTB	-	Medial meniscus tear

ACLR: Anterior cruciate ligament reconstruction; BPTB: Bone patellar tendon bone; F-up: Follow-up.

Table 8 Return to sport was considered to be the return to their sport prior to the last injury, at the same level or below the previous level

Case	Sex	Years	Return to sport		Type of Sports			Training frequency
			After					Days per week
			Primary ACLR	Revision ACLR	Prior ACLR	Prior revision ACLR	After revision ACLR	Prior revision ACLR	After revision ACLR
1	Male	30	Lower level	Lower level	Soccer	Running	Running	2	1
2	Male	42	Same level	Same level	Soccer	Soccer	Tennis	2	1
3	Male	29	Lower level	Same level	Soccer	Running	Soccer	2	2
4	Male	35	Lower level	Same level	Soccer	Soccer	Soccer	2	2
5	Female	28	Lower level	Same level	Martial arts	Tennis	Tennis	2	2

ACLR: Anterior cruciate ligament reconstruction.

Table 9 Motivation was classified as very important, important, moderately important, minimally important or not important and expectation was classified as return to the same sport level, return to a lower level or not returning to the same sport

Case	Sex	Year	Motivation	Expectation
				After primary ACLR	After revision ACLR
1	Male	30	Important	Same level	Lower level
2	Male	42	Very important	Same level	Same level
3	Male	29	Very important	Same level	Lower level
4	Male	35	Very important	Same level	Lower level
5	Female	28	Very important	Same level	Same level

ACLR: Anterior cruciate ligament reconstruction.

Table 10 Knee function and sports activity level

Case	Sex	Year	Tegner		Lysholm		IKDC
			Prior revision ACLR	At 5-yr F-up revision ACLR	Prior revision ACLR	At 5-yr F-up revision ACLR	Prior revision ACLR	At 5-yr F-up revision ACLR
1	Male	30	7	4	47	65	62	71
2	Male	42	7	7	61	84	49	89
3	Male	29	7	4	39	86	59	90
4	Male	35	7	4	80	95	37	97
5	Female	28	7	6	38	86	49	86

ACLR: Anterior cruciate ligament reconstruction; F-up: Follow-up; IKDC: International Knee Documentation Committee.