Re-revision Anterior Cruciate Ligament Reconstruction: An Evaluation From the Norwegian Knee Ligament Registry

      Purpose

      To identify the rate of re-revision anterior cruciate ligament reconstruction (ACLR) to estimate the influence of patient-related factors on the risk of re-revision ACLR. The secondary aim of the study was to report the intra-articular findings and patient-related factors at the time of revision ACLR and to compare these with the findings in a matched controlled group of primary ACLR.

      Methods

      Patients with primary ACLR without a subsequent need of revision and patients with a revision ACLR identified in the Norwegian Knee Ligament Registry from June 2004 through September 2016 were included. Using age at operation, sex, activity at injury, and year of ACLR as covariates, a propensity score matched control group of primary ACLR patients for the revision ACLR patients was identified. For the revision ACLR patients, re-revision ACLR rates at 1, 2, 5, and 8 years were estimated with Kaplan-Meier analysis; the hazard ratio for a re-revision ACLR was estimated using a multivariable Cox regression model.

      Results

      The cumulative estimated proportion of patients undergoing a re-revision ACLR at 1, 2, 5, and 8 years after the original revision ACLR was 0.4%, 3.0%, 6.5%, and 9.0% respectively. There was no significant difference between the control and revision ACLR groups regarding cartilage injury ( P = .72) or associated ligament injury ( P = .17). Revision ACLR patients did have fewer meniscal injuries ( P < .001). There were no intraoperative findings or surgical techniques identified as a predictor for a higher risk of re-revision ACLR.

      Conclusions

      Based on a review of a large ligament reconstruction registry,one can expect 9% of patients to undergo a re-revision ALCR at 8 years of follow up. Revision ACLR did not have an increase in cartilage injuries or associated ligament injuries and had significantly fewer meniscal injuries compared with a primary ACLR control group.

      Level of Evidence

      Level III, retrospective comparative study.
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      References

        • Lynch T.S.
        • Parker R.D.
        • Patel R.M.
        • et al.
        The impact of the Multicenter Orthopaedic Outcomes Network (MOON) research on anterior cruciate ligament reconstruction and orthopaedic practice.
        J Am Acad Orthopaed Surg. 2015; 23: 154-163
        • Mall N.A.
        • Chalmers P.N.
        • Moric M.
        • et al.
        Incidence and trends of anterior cruciate ligament reconstruction in the United States.
        Am J Sports Med. 2014; 42: 2363-2370
        • Granan L.P.
        • Bahr R.
        • Steindal K.
        • Furnes O.
        • Engebretsen L.
        Development of a national cruciate ligament surgery registry: The Norwegian National Knee Ligament Registry.
        Am J Sports Med. 2008; 36: 308-315
        • Granan L.P.
        • Forssblad M.
        • Lind M.
        • Engebretsen L.
        The Scandinavian ACL registries 2004-2007: Baseline epidemiology.
        Acta Orthopaed. 2009; 80: 563-567
        • Lind M.
        • Menhert F.
        • Pedersen A.B.
        The first results from the Danish ACL reconstruction registry: Epidemiologic and 2 year follow-up results from 5,818 knee ligament reconstructions.
        Knee Surg Sports Traumatol Arthrosc. 2009; 17: 117-124
        • Yamamoto Y.
        • Hsu W.H.
        • Woo S.L.
        • Van Scyoc A.H.
        • Takakura Y.
        • Debski R.E.
        Knee stability and graft function after anterior cruciate ligament reconstruction: A comparison of a lateral and an anatomical femoral tunnel placement.
        Am J Sports Med. 2004; 32: 1825-1832
        • Kato Y.
        • Maeyama A.
        • Lertwanich P.
        • et al.
        Biomechanical comparison of different graft positions for single-bundle anterior cruciate ligament reconstruction.
        Knee Surg Sports Traumatol Arthrosc. 2013; 21: 816-823
        • Kamien P.M.
        • Hydrick J.M.
        • Replogle W.H.
        • Go L.T.
        • Barrett G.R.
        Age, graft size, and Tegner activity level as predictors of failure in anterior cruciate ligament reconstruction with hamstring autograft.
        Am J Sports Med. 2013; 41: 1808-1812
        • Grassi A.
        • Kim C.
        • Marcheggiani Muccioli G.M.
        • Zaffagnini S.
        • Amendola A.
        What is the mid-term failure rate of revision ACL reconstruction? A systematic review.
        Clin Orthop Related Res. 2017; 475: 2484-2499
        • Hettrich C.M.
        • Dunn W.R.
        • Reinke E.K.
        • Group M.
        • Spindler K.P.
        The rate of subsequent surgery and predictors after anterior cruciate ligament reconstruction: Two- and 6-year follow-up results from a multicenter cohort.
        Am J Sports Med. 2013; 41: 1534-1540
        • Leroux T.
        • Wasserstein D.
        • Dwyer T.
        • et al.
        The epidemiology of revision anterior cruciate ligament reconstruction in Ontario, Canada.
        Am J Sports Med. 2014; 42: 2666-2672
        • Lind M.
        • Lund B.
        • Fauno P.
        • Said S.
        • Miller L.L.
        • Christiansen S.E.
        Medium to long-term follow-up after ACL revision.
        Knee Surg Sports Traumatol Arthrosc. 2012; 20: 166-172
        • Wyatt R.W.
        • Inacio M.C.
        • Liddle K.D.
        • Maletis G.B.
        Prevalence and incidence of cartilage injuries and meniscus tears in patients who underwent both primary and revision anterior cruciate ligament reconstructions.
        Am J Sports Med. 2014; 42: 1841-1846
        • Grossman M.G.
        • ElAttrache N.S.
        • Shields C.L.
        • Glousman R.E.
        Revision anterior cruciate ligament reconstruction: Three- to nine-year follow-up.
        Arthroscopy. 2005; 21: 418-423
        • Diamantopoulos A.P.
        • Lorbach O.
        • Paessler H.H.
        Anterior cruciate ligament revision reconstruction: Results in 107 patients.
        Am J Sports Med. 2008; 36: 851-860
        • Eberhardt C.
        • Kurth A.H.
        • Hailer N.
        • Jager A.
        Revision ACL reconstruction using autogenous patellar tendon graft.
        Knee Surg Sports Traumatol Arthrosc. 2000; 8: 290-295
        • Hamrin Senorski E.
        • Alentorn-Geli E.
        • Musahl V.
        • et al.
        Increased odds of patient-reported success at 2 years after anterior cruciate ligament reconstruction in patients without cartilage lesions: a cohort study from the Swedish National Knee Ligament Register.
        Knee Surg Sports Traumatol Arthrosc. 2018; 26: 1086-1095
        • Battaglia 2nd, M.J.
        • Cordasco F.A.
        • Hannafin J.A.
        • et al.
        Results of revision anterior cruciate ligament surgery.
        Am J Sports Med. 2007; 35: 2057-2066
        • Grassi A.
        • Ardern C.L.
        • Marcheggiani Muccioli G.M.
        • Neri M.P.
        • Marcacci M.
        • Zaffagnini S.
        Does revision ACL reconstruction measure up to primary surgery? A meta-analysis comparing patient-reported and clinician-reported outcomes, and radiographic results.
        Br J Sports Med. 2016; 50: 716-724
        • Feucht M.J.
        • Cotic M.
        • Saier T.
        • et al.
        Patient expectations of primary and revision anterior cruciate ligament reconstruction.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 201-207
        • Denti M.
        • Lo Vetere D.
        • Bait C.
        • Schonhuber H.
        • Melegati G.
        • Volpi P.
        Revision anterior cruciate ligament reconstruction: Causes of failure, surgical technique, and clinical results.
        Am J Sports Med. 2008; 36: 1896-1902
        • Chen J.L.
        • Allen C.R.
        • Stephens T.E.
        • et al.
        Differences in mechanisms of failure, intraoperative findings, and surgical characteristics between single- and multiple-revision ACL reconstructions: A MARS cohort study.
        Am J Sports Med. 2013; 41: 1571-1578
        • Group M.
        • Wright R.W.
        • Huston L.J.
        • et al.
        Descriptive epidemiology of the Multicenter ACL Revision Study (MARS) cohort.
        Am J Sports Med. 2010; 38: 1979-1986
        • R Core Team. R
        A language and environment for statistical computing.
        R Foundation for Statistical Computing, Vienna, Austria2015
        • Stampf S.
        • Graf E.
        • Schmoor C.
        • Schumacher M.
        Estimators and confidence intervals for the marginal odds ratio using logistic regression and propensity score stratification.
        Stat Med. 2010; 29: 760-769
        • Ranstam J.
        • Karrholm J.
        • Pulkkinen P.
        • et al.
        Statistical analysis of arthroplasty data. II. Guidelines.
        Acta Orthopaed. 2011; 82: 258-267
        • Persson A.
        • Fjeldsgaard K.
        • Gjertsen J.E.
        • et al.
        Increased risk of revision with hamstring tendon grafts compared with patellar tendon grafts after anterior cruciate ligament reconstruction: A study of 12,643 patients from the Norwegian Cruciate Ligament Registry, 2004-2012.
        Am J Sports Med. 2014; 42: 285-291
        • Schlumberger M.
        • Schuster P.
        • Schulz M.
        • et al.
        Traumatic graft rupture after primary and revision anterior cruciate ligament reconstruction: Retrospective analysis of incidence and risk factors in 2915 cases.
        Knee Surg Sports Traumatol Arthrosc. 2017; 25: 1535-1541
        • MARS Group
        Effect of graft choice on the outcome of revision anterior cruciate ligament reconstruction in the Multicenter ACL Revision Study (MARS) Cohort.
        Am J Sports Med. 2014; 42: 2301-2310
        • Lind M.
        • Menhert F.
        • Pedersen A.B.
        Incidence and outcome after revision anterior cruciate ligament reconstruction: Results from the Danish registry for knee ligament reconstructions.
        Am J Sports Med. 2012; 40: 1551-1557
        • Dejour D.
        • Saffarini M.
        • Demey G.
        • Baverel L.
        Tibial slope correction combined with second revision ACL produces good knee stability and prevents graft rupture.
        Knee Surg Sports Traumatol Arthrosc. 2015; 23: 2846-2852
        • Wegrzyn J.
        • Chouteau J.
        • Philippot R.
        • Fessy M.H.
        • Moyen B.
        Repeat revision of anterior cruciate ligament reconstruction: A retrospective review of management and outcome of 10 patients with an average 3-year follow-up.
        Am J Sports Med. 2009; 37: 776-785
        • Liechti D.J.
        • Chahla J.
        • Dean C.S.
        • et al.
        Outcomes and risk factors of rerevision anterior cruciate ligament reconstruction: A systematic review.
        Arthroscopy. 2016; 32: 2151-2159
        • Arianjam A.
        • Inacio M.C.S.
        • Funahashi T.T.
        • Maletis G.B.
        Analysis of 2019 patients undergoing revision anterior cruciate ligament reconstruction from a community-based registry.
        Am J Sports Med. 2017; 45: 1574-1580
        • Borchers J.R.
        • Kaeding C.C.
        • Pedroza A.D.
        • et al.
        Intra-articular findings in primary and revision anterior cruciate ligament reconstruction surgery: A comparison of the MOON and MARS study groups.
        Am J Sports Med. 2011; 39: 1889-1893
        • Grassi A.
        • Nitri M.
        • Moulton S.G.
        • et al.
        Does the type of graft affect the outcome of revision anterior cruciate ligament reconstruction? A meta-analysis of 32 studies.
        Bone Joint J. 2017; 99-B: 714-723
        • Shakked R.
        • Weinberg M.
        • Capo J.
        • Jazrawi L.
        • Strauss E.
        Autograft choice in young female patients: Patella tendon versus hamstring.
        J Knee Surg. 2017; 30: 258-263
        • Xie X.
        • Liu X.
        • Chen Z.
        • Yu Y.
        • Peng S.
        • Li Q.
        A meta-analysis of bone-patellar tendon-bone autograft versus four-strand hamstring tendon autograft for anterior cruciate ligament reconstruction.
        Knee. 2015; 22: 100-110
        • Kaplan Y.
        Identifying individuals with an anterior cruciate ligament-deficient knee as copers and noncopers: A narrative literature review.
        J Orthop Sports Phys Ther. 2011; 41: 758-766
        • Eitzen I.
        • Eitzen T.J.
        • Holm I.
        • Snyder-Mackler L.
        • Risberg M.A.
        Anterior cruciate ligament-deficient potential copers and noncopers reveal different isokinetic quadriceps strength profiles in the early stage after injury.
        Am J Sports Med. 2010; 38: 586-593
        • Fitzgerald G.K.
        • Axe M.J.
        • Snyder-Mackler L.
        A decision-making scheme for returning patients to high-level activity with nonoperative treatment after anterior cruciate ligament rupture.
        Knee Surg Sports Traumatol Arthrosc. 2000; 8: 76-82