TY - JOUR
T1 - Surgical Predictors of Clinical Outcome 6 Years After Revision ACL Reconstruction
AU - The MARS Group
AU - Wright, Rick W.
AU - Huston, Laura J.
AU - Haas, Amanda K.
AU - Pennings, Jacquelyn S.
AU - Allen, Christina R.
AU - Cooper, Daniel E.
AU - DeBerardino, Thomas M.
AU - Dunn, Warren R.
AU - Lantz, Brett (Brick) A.
AU - Spindler, Kurt P.
AU - Stuart, Michael J.
AU - Amendola, Annunziato
AU - Annunziata, Christopher C.
AU - Arciero, Robert A.
AU - Bach, Bernard R.
AU - Baker, Champ L.
AU - Bartolozzi, Arthur R.
AU - Baumgarten, Keith M.
AU - Berg, Jeffrey H.
AU - Bernas, Geoffrey A.
AU - Brockmeier, Stephen F.
AU - Brophy, Robert H.
AU - Bush-Joseph, Charles A.
AU - Butler, J. Brad
AU - Carey, James L.
AU - Carpenter, James E.
AU - Cole, Brian J.
AU - Cooper, Jonathan M.
AU - Cox, Charles L.
AU - Creighton, R. Alexander
AU - David, Tal S.
AU - Flanigan, David C.
AU - Frederick, Robert W.
AU - Ganley, Theodore J.
AU - Gatt, Charles J.
AU - Gecha, Steven R.
AU - Giffin, James Robert
AU - Hame, Sharon L.
AU - Hannafin, Jo A.
AU - Harner, Christopher D.
AU - Harris, Norman Lindsay
AU - Hechtman, Keith S.
AU - Hershman, Elliott B.
AU - Hoellrich, Rudolf G.
AU - Johnson, David C.
AU - Johnson, Timothy S.
AU - Jones, Morgan H.
AU - Kaeding, Christopher C.
AU - Kamath, Ganesh V.
AU - Klootwyk, Thomas E.
AU - Levy, Bruce A.
AU - Ma, C. Benjamin
AU - Maiers, G. Peter
AU - Marx, Robert G.
AU - Matava, Matthew J.
AU - Mathien, Gregory M.
AU - McAllister, David R.
AU - McCarty, Eric C.
AU - McCormack, Robert G.
AU - Miller, Bruce S.
AU - Nissen, Carl W.
AU - O’Neill, Daniel F.
AU - Owens, Brett D.
AU - Parker, Richard D.
AU - Purnell, Mark L.
AU - Ramappa, Arun J.
AU - Rauh, Michael A.
AU - Rettig, Arthur C.
AU - Sekiya, Jon K.
AU - Shea, Kevin G.
AU - Sherman, Orrin H.
AU - Slauterbeck, James R.
AU - Smith, Matthew V.
AU - Spang, Jeffrey T.
AU - Svoboda, Steven J.
AU - Taft, Timothy N.
AU - Tenuta, Joachim J.
AU - Tingstad, Edwin M.
AU - Vidal, Armando F.
AU - Viskontas, Darius G.
AU - White, Richard A.
AU - Williams, James S.
AU - Wolcott, Michelle L.
AU - Wolf, Brian R.
AU - York, James J.
N1 - Publisher Copyright:
© 2024 The Author(s).
PY - 2024/11
Y1 - 2024/11
N2 - Background: Revision anterior cruciate ligament (ACL) reconstruction has been documented to have inferior outcomes compared with primary ACL reconstruction. The reasons why remain unknown. Purpose: To determine whether surgical factors performed at the time of revision ACL reconstruction can influence a patient’s outcome at 6-year follow-up. Study Design: Cohort study; Level of evidence, 2. Methods: Patients who underwent revision ACL reconstruction were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline patient characteristics, surgical technique and pathology, and a series of validated patient-reported outcome instruments: Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) subjective form, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Marx activity rating score. Patients were followed up for 6 years and asked to complete the identical set of outcome instruments. Regression analysis was used to control for baseline patient characteristics and surgical variables to assess the surgical risk factors for clinical outcomes 6 years after surgery. Results: A total of 1234 patients were enrolled (716 men, 58%; median age, 26 years), and 6-year follow-up was obtained on 79% of patients (980/1234). Using an interference screw for femoral fixation compared with a cross-pin resulted in significantly better outcomes in 6-year IKDC scores (odds ratio [OR], 2.2; 95% CI, 1.2-3.9; P =.008) and KOOS sports/recreation and quality of life subscale scores (OR range, 2.2-2.7; 95% CI, 1.2-4.8; P <.01). Use of an interference screw compared with a cross-pin resulted in a 2.6 times less likely chance of having a subsequent surgery within 6 years. Use of an interference screw for tibial fixation compared with any combination of tibial fixation techniques resulted in significantly improved scores for IKDC (OR, 1.96; 95% CI, 1.3-2.9; P =.001); KOOS pain, activities of daily living, and sports/recreation subscales (OR range, 1.5-1.6; 95% CI, 1.0-2.4; P <.05); and WOMAC pain and activities of daily living subscales (OR range, 1.5-1.8; 95% CI, 1.0-2.7; P <.05). Use of a transtibial surgical approach compared with an anteromedial portal approach resulted in significantly improved KOOS pain and quality of life subscale scores at 6 years (OR, 1.5; 95% CI, 1.02-2.2; P≤.04). Conclusion: There are surgical variables at the time of ACL revision that can modify clinical outcomes at 6 years. Opting for a transtibial surgical approach and choosing an interference screw for femoral and tibial fixation improved patients’ odds of having a significantly better 6-year clinical outcome in this cohort.
AB - Background: Revision anterior cruciate ligament (ACL) reconstruction has been documented to have inferior outcomes compared with primary ACL reconstruction. The reasons why remain unknown. Purpose: To determine whether surgical factors performed at the time of revision ACL reconstruction can influence a patient’s outcome at 6-year follow-up. Study Design: Cohort study; Level of evidence, 2. Methods: Patients who underwent revision ACL reconstruction were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline patient characteristics, surgical technique and pathology, and a series of validated patient-reported outcome instruments: Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) subjective form, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Marx activity rating score. Patients were followed up for 6 years and asked to complete the identical set of outcome instruments. Regression analysis was used to control for baseline patient characteristics and surgical variables to assess the surgical risk factors for clinical outcomes 6 years after surgery. Results: A total of 1234 patients were enrolled (716 men, 58%; median age, 26 years), and 6-year follow-up was obtained on 79% of patients (980/1234). Using an interference screw for femoral fixation compared with a cross-pin resulted in significantly better outcomes in 6-year IKDC scores (odds ratio [OR], 2.2; 95% CI, 1.2-3.9; P =.008) and KOOS sports/recreation and quality of life subscale scores (OR range, 2.2-2.7; 95% CI, 1.2-4.8; P <.01). Use of an interference screw compared with a cross-pin resulted in a 2.6 times less likely chance of having a subsequent surgery within 6 years. Use of an interference screw for tibial fixation compared with any combination of tibial fixation techniques resulted in significantly improved scores for IKDC (OR, 1.96; 95% CI, 1.3-2.9; P =.001); KOOS pain, activities of daily living, and sports/recreation subscales (OR range, 1.5-1.6; 95% CI, 1.0-2.4; P <.05); and WOMAC pain and activities of daily living subscales (OR range, 1.5-1.8; 95% CI, 1.0-2.7; P <.05). Use of a transtibial surgical approach compared with an anteromedial portal approach resulted in significantly improved KOOS pain and quality of life subscale scores at 6 years (OR, 1.5; 95% CI, 1.02-2.2; P≤.04). Conclusion: There are surgical variables at the time of ACL revision that can modify clinical outcomes at 6 years. Opting for a transtibial surgical approach and choosing an interference screw for femoral and tibial fixation improved patients’ odds of having a significantly better 6-year clinical outcome in this cohort.
KW - anterior cruciate ligament reconstruction
KW - outcomes
KW - revision
KW - surgical predictors
UR - http://www.scopus.com/inward/record.url?scp=85208602575&partnerID=8YFLogxK
U2 - 10.1177/03635465241288227
DO - 10.1177/03635465241288227
M3 - Article
C2 - 39503722
AN - SCOPUS:85208602575
SN - 0363-5465
VL - 52
SP - 3286
EP - 3294
JO - American Journal of Sports Medicine
JF - American Journal of Sports Medicine
IS - 13
ER -