Aims The aim of this study was to investigate the long-term clinical and radiological outcome of patients who suffer recurrent injuries to the anterior cruciate ligament (ACL) after reconstruction and require revision surgery.
Patients and Methods From a consecutive series of 200 patients who underwent primary reconstruction following rupture of the ACL, we identified 36 who sustained a further rupture, 29 of whom underwent revision surgery. Patients were reviewed prospectively at one, two, seven, 15 and about 20 years after their original surgery. Primary outcome measures were the number of further ruptures, the posterior tibial slope (PTS), and functional and radiological outcomes. These were compared with a gender and age matched cohort of patients who underwent primary ACL reconstruction only.
Results At a mean follow-up of 18.3 years (14.3 to 20.2), 29 patients had undergone revision surgery and within this revision group 11 had sustained more than three ruptures of the ACL (3 to 6). The mean age at the time of revision reconstruction was 26.4 years (14 to 54). The mean PTS was significantly higher in those patients who suffered a further injury to the ACL (11°) compared with the control group (9°) (p < 0.001). The mean PTS in those patients who sustained more than three ruptures was 12°.
Conclusion Patients who suffer recurrent injuries to the ACL after reconstruction have poorer functional and radiological outcomes than those who suffer a single injury. The causes of further injury are likely to be multifactorial but an increased PTS appears to have a significant association with recurrent ACL injuries.
Cite this article: Bone Joint J 2017;99-B:337–43.
- Anterior cruciate ligament injury
- Revision anterior cruciate ligament reconstruction
- Posterior tibial slope
- Functional outcomes
I. Ahmed: Data analysis, Radiographic analysis, Writing the paper.
L. Salmon: Data collection and analysis, Patient reviews and outcome measures, Reviewing the paper.
J. Roe: Reviewing the paper.
L. Pinczewski: Performed operations, Reviewing the paper.
This study was funded by a research grant from the Australian Orthopaedic Association.
The author or one or more of the authors have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article. In addition, benefits have been or will be directed to a research fund, foundation, educational institution, or other non- profit organisation with which one or more of the authors are associated.
This article was primary edited by J. Scott.
Supplementary material. A table showing the complete clinical, operative and radiological details of the revision group (n = 29) can be found alongside the online version of this article at www.bjj.boneandjoint.org.uk
- Received January 10, 2016.
- Accepted November 15, 2016.
- ©2017 The British Editorial Society of Bone & Joint Surgery