Purpose
To evaluate patient-reported outcomes (PROs) and graft failure rates in revision allograft
anterior cruciate ligament reconstruction (ACLR) in patients aged 40 and older and
compare them with primary ACLRs.
Methods
Patients aged 40 and older who underwent arthroscopic soft-tissue allograft ACLR between
2005 and 2016 with a minimum 2-year follow-up were retrospectively reviewed. Patients
were grouped based on revision versus primary ACLR. The rate of achieving an International
Knee Documentation Committee (IKDC) patient acceptable symptom state (PASS) score
was recorded. Patient satisfaction, PROs, and graft failure were compared between
groups using the χ2 test, Fisher exact test, and Mann–Whitney U test.
Results
We identified 32 patients who underwent revision ACLR and 201 patients who underwent
primary ACLR aged 40 and older who met inclusion criteria with a mean follow-up of
6.2 and 6.9 years, respectively (P = .042). There was a lower rate of concomitant meniscal repair in the primary ACLR
group (6% vs 21.9%, P = .007) There were no other differences in chondral injuries, mechanism of injury,
or meniscal injuries between groups. The median IKDC score was greater in the primary
ACLR group as compared with the revision ACLR group (83.9 vs 70.6, P < .001). Patients who underwent revision ACLR were less likely to achieve the IKDC
PASS threshold (82.5% vs 56.3%, P = .001) and were less likely to report satisfaction as compared with patients who
underwent primary ACLR (90.5% vs 78.1%, P =.038). No difference in graft failure rates was identified between groups (8% vs
15.6%, P = .180).
Conclusions
Revision allograft ACLR in patients aged 40 and older was associated with lower PROs
compared with primary ACLR. Patients who underwent revision ACLR failed to meet the
IKDC PASS threshold more often and were dissatisfied with procedure results more than
twice as often as patients that underwent primary ACLR.
Level of Evidence
III, retrospective cohort study.
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Article info
Publication history
Published online: July 12, 2022
Accepted:
June 26,
2022
Received:
December 3,
2021
Footnotes
See commentary on page 88
The authors report the following potential conflicts of interest or sources of funding: J.C.R. is a paid presenter for Flexion Therapeutics; a paid consultant for Smith & Nephew, Medical Device Business Services, Stryker, and DePuy; and is on the data and safety and monitoring board for Ferring Pharmaceuticals, Anika Therapeutics, and Ankasa Regenerative Therapeutics. M.J.S. has received hospitality payments from Smith & Nephew and education support from Arthrex. ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2022 by the Arthroscopy Association of North America
