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Return to Sport Following Revision Anterior Cruciate Ligament Reconstruction in Athletes: A Systematic Review

      Purpose

      To report the rate of return to sport following revision anterior cruciate ligament (ACL) reconstruction in athletes.

      Methods

      A systematic review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted for athletes undergoing revision ACL reconstruction at a minimum 1-year follow-up. The primary outcome measure was return to sport following revision ACL reconstruction. Secondary outcomes were International Knee Documentation Committee score, Knee Injury and Osteoarthritis Outcome Score, Tegner and Lysholm scores, KT-1000 arthrometer measurements, and rates of ACL rerupture. A subjective analysis was performed, and data were summarized using forest plots, ranges, and tables.

      Results

      Thirteen studies met the inclusion criteria. The rate of return to sport at any level ranged from 56% to 100%. The rate of return to sport at preinjury level ranged from 13% to 69%. The average time to return to sport ranged from 6.7 to 12 months. The average patient-reported outcome scores ranged from 43% to 86% (International Knee Documentation Committee score), 45% to 95% (Knee Injury and Osteoarthritis Outcome Score), 4.3 to 9 (Tegner), and 84% to 91% (Lysholm). KT-1000 arthrometer measurements ranged from 1.2 to 3.1 mm. Rates of ACL rerupture ranged from 0% to 20%.

      Conclusions

      This systematic review demonstrated a relatively high rate of return to sport at any level in patients who underwent revision ACL reconstruction, but a relatively low rate of return to sport at preinjury level of play. Patient-reported outcomes were favorable, showing improvement at follow-up from preoperative scores. Rates of ACL rerupture were high relative to those reported for primary ACL reconstruction. This study suggests that athletes may have difficulty resuming their previous level of sport following revision ACL reconstruction but have a good chance of returning to a lower level of play.

      Level of Evidence

      Level IV, systematic review of Level II-IV studies.
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      Linked Article

      • Editorial Commentary: Return to Play Following Revision Anterior Cruciate Ligament Reconstruction
        ArthroscopyVol. 35Issue 7
        • Preview
          In many cases, athletes return to play after anterior cruciate ligament (ACL) reconstruction. In such cases, after a second ACL tear, these athletes may again expert full return to play after ACL revision. Unfortunately, results after revision ACL reconstruction are inferior to results after primary surgery. Sport specific data is difficult to determine, as are predictors of positive outcomes which include concomitant pathology or psychological factors. Chances of return to the same level may be 60% or less.
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