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Revision anterior cruciate ligament reconstruction: clinical outcome and evidence for return to sport

Abstract

Purpose

An increasing number of patients undergo revision anterior cruciate ligament (ACL) reconstruction, with the intention of returning to sport being a major indication. The aim of this study is to assess the available evidence for clinical improvement and return to sport, to understand the real potential of this procedure in regaining functional activity, and to facilitate improved counselling of patients regarding the expected outcome after revision ACL reconstruction.

Methods

The search was conducted on the PubMed database. Articles reporting clinical results for revision ACL reconstruction were included. A meta-analysis was performed on return to sport, and results were compared to the literature on primary ACL reconstruction. Other specific clinical outcomes (Lysholm, Tegner, IKDC Objective scores) were also included in the meta-analysis.

Results

Of the 503 identified records, a total of 59 studies involving 5365 patients were included in the qualitative data synthesis. Only 31 articles reported the rate of return to sport. Whereas 73 % of good objective results and satisfactory subjective results were documented, 57 % of patients did not return to the same level of sport activity, significantly inferior to that of a primary procedure.

Conclusion

The real potential of revision ACL reconstruction should not be overestimated due to the low number of patients able to return to their previous activity level, significantly inferior with respect to that reported for primary ACL reconstruction. This finding will help physicians in the clinical practice providing realistic expectations to the patients. Future studies should focus on participation-based outcome measures such as return to sport and in strategies to improve the results in terms of return to previous activities after revision ACL reconstruction.

Level of evidence

Systematic review and meta-analysis including Level IV studies, Level IV.

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Correspondence to Luca Andriolo.

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G. Filardo is consultant and receives institutional support from: Finceramica Faenza Spa (Italy), Fidia Farmaceutici Spa (Italy), CartiHeal (2009) Ltd (Israel). He is consultant for: EON Medica SRL (Italy). He receives Institutional Support from: IGEA Clinical Biophysics (Italy), BIOMET (USA) and Kensey Nash (USA). E. Kon is consultant for CartiHeal (2009) Ltd (Israel) and has stocks of CartiHeal (2009) Ltd (Israel). She is consultant and receives institutional support from Finceramica Faenza Spa (Italy). She receives institutional support from Fidia Farmaceutici Spa (Italy), IGEA Clinical Biophysics (Italy), BIOMET (USA), and Kensey Nash (USA). M. Marcacci receives royalties and research institutional support from Fin-Ceramica Faenza SpA (Italy). He receives institutional support from: Fidia Farmaceutici Spa (Italy), CartiHeal (2009) Ltd (Israel), IGEA Clinical Biophysics (Italy), BIOMET (USA), and Kensey Nash (USA). Stefano Zaffagnini received financial support from I + srl, Italy, and he has royalties from Springer, Germany. He receives institutional support from: Fidia Farmaceutici Spa (Italy), CartiHeal (2009) Ltd (Israel), IGEA Clinical Biophysics (Italy), BIOMET (USA), and Kensey Nash (USA). L. Andriolo, M. Ricci, F. Della Villa, and S. Della Villa declare that they have no conflict of interest.

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Andriolo, L., Filardo, G., Kon, E. et al. Revision anterior cruciate ligament reconstruction: clinical outcome and evidence for return to sport. Knee Surg Sports Traumatol Arthrosc 23, 2825–2845 (2015). https://doi.org/10.1007/s00167-015-3702-9

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Keywords

  • Revision ACL
  • Meta-analysis
  • Clinical outcome
  • Return to sport