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

Alexander R Vap; Andreas Persson; Anne Marie Fenstad; Gilbert Moatshe; Robert F LaPrade; Lars Engebretsen

doi:10.1016/j.arthro.2019.01.027

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

Arthroscopy. 2019 Jun;35(6):1695-1701. doi: 10.1016/j.arthro.2019.01.027. Epub 2019 Apr 30.

Authors

Alexander R Vap¹, Andreas Persson², Anne Marie Fenstad³, Gilbert Moatshe⁴, Robert F LaPrade⁵, Lars Engebretsen⁶

Affiliations

¹ Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia, U.S.A.
² Department of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway; Norwegian Knee Ligament Registry, Haukeland University Hospital, Bergen, Norway.
³ Norwegian Knee Ligament Registry, Haukeland University Hospital, Bergen, Norway.
⁴ Department of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway; Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; Norwegian School of Sports Sciences, Oslo Sports Trauma Research, Oslo, Norway.
⁵ Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; Steadman Clinic, Vail, Colorado, U.S.A.. Electronic address: laprademdphd@gmail.com.
⁶ Department of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway; Norwegian School of Sports Sciences, Oslo Sports Trauma Research, Oslo, Norway.

PMID: 31053456
DOI: 10.1016/j.arthro.2019.01.027

Abstract

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.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Anterior Cruciate Ligament / surgery*
Anterior Cruciate Ligament Injuries / epidemiology
Anterior Cruciate Ligament Injuries / surgery*
Anterior Cruciate Ligament Reconstruction / methods
Anterior Cruciate Ligament Reconstruction / statistics & numerical data*
Child
Female
Humans
Incidence
Knee Joint / surgery*
Male
Middle Aged
Norway / epidemiology
Registries*
Reoperation
Retrospective Studies
Young Adult