Does revision ACL reconstruction measure up to primary surgery? A meta-analysis comparing patient-reported and clinician-reported outcomes, and radiographic results

• Published in: British journal of sports medicine 2016-06, Vol.50 (12), p.716-724
• Main Authors: Grassi, Alberto, Ardern, Clare L, Marcheggiani Muccioli, Giulio Maria, Neri, Maria Pia, Marcacci, Maurilio, Zaffagnini, Stefano
• Format: Article
• Language: English
• Subjects: Adult; Anterior Cruciate Ligament Injuries - diagnostic imaging; Anterior Cruciate Ligament Injuries - surgery; Anterior Cruciate Ligament Reconstruction - methods; Anterior Cruciate Ligament Reconstruction - standards; Female; Humans; Joint Instability - diagnosis; Joint Instability - etiology; Knee Joint; Male; Osteoarthritis, Knee - diagnosis; Osteoarthritis, Knee - etiology; Patient Outcome Assessment; Patient Satisfaction; Reoperation; Trauma Severity Indices
• ISSN: 0306-3674; 1473-0480; 1473-0480
• DOI: 10.1136/bjsports-2015-094948

PurposeTo compare patient-reported and clinician-reported outcomes, and radiographic results between patients who had had revision ACL reconstruction and those who had had primary ACL reconstruction.DesignSystematic review and meta-analysisData sourcesThe MEDLINE, CINAHL, EMBASE and SPORTDiscus electronic databases were searched on 6 August 2015, using 3 main concepts: (1) revision ACL reconstruction, (2) primary ACL reconstruction and (3) treatment outcomes.Eligibility criteria for selecting studiesArticles that compared patient-reported or clinician-reported outcomes or radiographic results between patients who had had revision ACL reconstruction and those who had had primary surgery with a minimum of 2 years follow-up were included. The outcomes evaluated were the Lysholm Knee Scoring Scale, objective International Knee Documentation Committee (IKDC) classification, Tegner Activity Scale, side-to-side difference in anterior tibial translation measured with KT-1000/2000 arthrometer, pivot shift test, tibiofemoral osteoarthritis grading on plain radiographs and subsequent knee surgeries.Results8 studies (300 revision ACL reconstructions and 413 primary ACL reconstructions) were included in the meta-analysis. Patients who had had revision surgery reported inferior Lysholm Knee Scoring Scale scores (mean difference: 7.8 points), had inferior clinician-reported knee function as assessed with the objective IKDC classification (IKDC category A: 27% vs 57%; IKDC category C or D: 22% vs 8%) and pivot shift test (grade II or III: 7% vs 2%), and more radiographic evidence of tibiofemoral osteoarthritis (50% vs 25%) compared with patients who had had primary surgery.ConclusionsRevision ACL reconstruction restored similar anterior-posterior knee laxity compared with primary ACL reconstruction. Patients who had had revision surgery reported inferior Lysholm Knee Scoring Scale scores, had inferior clinician-reported knee function and more radiographic signs of tibiofemoral osteoarthritis compared with patients with primary ACL reconstruction.