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Comparison of Improvement in Patient-Reported Knee Function After Revision and Multiple-Revision ACL Reconstruction Compared With Primary ACL Reconstruction.

Authors :
Kaarre J
Herman ZJ
Grassi A
Hamrin Senorski E
Musahl V
Samuelsson K
Source :
Orthopaedic journal of sports medicine [Orthop J Sports Med] 2023 Dec 22; Vol. 11 (12), pp. 23259671231217725. Date of Electronic Publication: 2023 Dec 22 (Print Publication: 2023).
Publication Year :
2023

Abstract

Background: Graft failure after anterior cruciate ligament reconstruction (ACLR) is a debilitating complication often requiring revision surgery. It is widely agreed upon that functional knee outcomes after revision ACLR (r-ACLR) are inferior compared with those after primary reconstruction. However, data are scarce on outcomes after multiple-revision ACLR (mr-ACLR).<br />Purpose: To compare patient-reported knee function in terms of Knee injury and Osteoarthritis Outcome Score (KOOS) preoperatively and 1-year postoperatively after primary ACLR, r-ACLR, and mr-ACLR and evaluate the pre- to postoperative improvement in KOOS scores for each procedure.<br />Study Design: Cohort study; Level of evidence, 3.<br />Methods: Patients from the Swedish National Knee Ligament Registry who underwent their index ACLR between 2005 and 2020 with a minimum age of 15 years at the time of surgery were included in this study. All patients had pre- and postoperative KOOS data. The 1-year postoperative KOOS and the pre- to postoperative changes in KOOS were assessed between patients who underwent primary ACLR and those who underwent subsequent r-ACLR and mr-ACLR.<br />Results: Of 20,542 included patients, 19,769 (96.2%) underwent primary ACLR, 760 (3.7%) underwent r-ACLR, and 13 (0.06%) underwent mr-ACLR. Patients who underwent r-ACLR had significantly smaller pre- to postoperative changes on all KOOS subscales compared with patients undergoing primary ACLR ( P < .0001 for all). Furthermore, patients in the mr-ACLR group had significantly smaller changes in the KOOS-Pain subscale compared with patients in the r-ACLR group (-9 ± 23.3 vs 2.5 ± 18; P = .024).<br />Conclusion: The study results indicated that while improvement is seen after primary ACLR, r-ACLR, and mr-ACLR, the greatest improvement in functional outcomes is observed after primary ACLR. Patients who underwent at least 1 r-ACLR, specifically mr-ACLR, had lower postoperative outcome scores, indicating that primary ACLR may provide the best chance for recovery after ACL injury.<br />Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: V.M. has received education payments from Smith & Nephew, Arthrex, and DePuy Synthes; consulting fees from Smith & Nephew; and nonconsulting fees from Smith & Nephew and Synthes. K. S. is a member of the Board of Directors, Getinge AB (publ.). AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.<br /> (© The Author(s) 2023.)

Details

Language :
English
ISSN :
2325-9671
Volume :
11
Issue :
12
Database :
MEDLINE
Journal :
Orthopaedic journal of sports medicine
Publication Type :
Academic Journal
Accession number :
38145220
Full Text :
https://doi.org/10.1177/23259671231217725