Anterior Cruciate Ligament Revision Reconstruction

Anterior cruciate ligament (ACL) reconstruction is a common procedure in the United States. Data from ap- proximately 10 years ago estimated 100,000 ACL recon- structions per year were performed in this country. Since then, it can be assumed that this number has continued to grow. Data from the American Board of Orthopaedic Surgery demonstrate ACL reconstruction continues to be listed as one of the top 10 most commonly performed procedures by board certification applicants. Although primary ACL reconstructions generally are a highly suc- cessful procedure, ACL grafts rupture at a rate of at least 3%, and this rate can be as high as 10% to 20% according to some studies.14,21 Thus, several thousand revision ACL reconstructions are performed each year. This number will continue to rise as patients’ expectations to maintain a healthy active lifestyle later in life continue to increase.

Unfortunately, it has been demonstrated in several studies that revision ACL reconstructions do not approach the success of primary ACL reconstructions. A variety of reasons may contribute to this decreased success. These may include impaired tunnel location and increased chondral and meniscal damage, as well as associated laxities and instabilities not addressed at the primary reconstruction. Given the relative rarity of ACL revision reconstructions, the ability to perform rigorous studies with adequate sample size is difficult; hence, high-level evidence in this area has yet to accumulate. While some studies have been performed prospectively, the majority of studies are retrospective case series. In addition, relatively few studies have used modern validated patient- based instruments as outcome measures, relying instead on physical measures of stability as the benchmark for a good outcome.

This study represents the subset of revision ACL reconstructions enrolled in the first year (2002) of the Multicenter Orthopaedic Outcome Network (MOON) cohort study for which 2 years of follow-up are avail- able. The primary outcomes of the study were reoperation within 2 years following ACL revision reconstruction and health-related quality of life as measured by the Short Form-36 Health Survey (SF-36).

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