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J Knee Surg 2022; 35(01): 072-077
DOI: 10.1055/s-0040-1712969
Original Article

Revision Anterior Cruciate Ligament Reconstruction after Surgical Management of Multiligament Knee Injury

John R. Worley 
1   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
,
Olubusola Brimmo 
1   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
,
Clayton W. Nuelle 
2   Department of Orthopaedics, TSAOG Orthopaedics, San Antonio, Texas
3   Department of Orthopaedics, Burkhart Research Institute for Orthopaedics, San Antonio, Texas
,
Bradford P. Zitsch
4   School of Medicine, University of Missouri, Columbia, Missouri
,
Emily V. Leary 
1   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
5   Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
,
James L. Cook 
1   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
5   Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
,
James P. Stannard 
1   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
5   Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
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Abstract

The purpose of this study is to determine factors associated with the need for revision anterior cruciate ligament reconstruction (ACLR) after multiligament knee injury (MLKI) and to report outcomes for patients undergoing revision ACLR after MLKI. This involves a retrospective review of 231 MLKIs in 225 patients treated over a 12-year period, with institutional review board approval. Patients with two or more injured knee ligaments requiring surgical reconstruction, including the ACL, were included for analyses. Overall, 231 knees with MLKIs underwent ACLR, with 10% (n = 24) requiring revision ACLR. There were no significant differences in age, sex, tobacco use, diabetes, or body mass index between cohorts requiring or not requiring revision ACLR. However, patients requiring revision ACLR had significantly longer follow-up duration (55.1 vs. 37.4 months, p = 0.004), more ligament reconstructions/repairs (mean 3.0 vs. 1.7, p < 0.001), more nonligament surgeries (mean 2.2 vs. 0.7, p = 0.002), more total surgeries (mean 5.3 vs. 2.4, p < 0.001), and more graft reconstructions (mean 4.7 vs. 2.7, p < 0.001). Patients in both groups had similar return to work (p = 0.12) and activity (p = 0.91) levels at final follow-up. Patients who had revision ACLR took significantly longer to return to work at their highest level (18 vs. 12 months, p = 0.036), but similar time to return to their highest level of activity (p = 0.33). Range of motion (134 vs. 127 degrees, p = 0.14), pain severity (2.2 vs. 1.7, p = 0.24), and Lysholm's scores (86.3 vs. 90.0, p = 0.24) at final follow-up were similar between groups. Patients requiring revision ACLR in the setting of a MLKI had more overall concurrent surgeries and other ligament reconstructions, but had similar final outcome scores to those who did not require revision surgery. Revision ligament surgery can be associated with increased pain, stiffness, and decrease patient outcomes. Revision surgery is often necessary after multiligament knee reconstructions, but patients requiring ACLR in the setting of a MLKI have good overall outcomes, with patients requiring revision ACLR at a rate of 10%.

Keywords

multiligament knee injury - anterior cruciate ligament - anterior cruciate ligament reconstruction - anterior cruciate ligament revision - knee dislocation

Note

This research poster was presented at the Mid-America Orthopaedic Association's Annual Conference, April 10 to 14, 2019, Miramar Beach, FL.


Ethical Approval

This study was approved and executed under 2001636 from the University of Missouri Institutional Review Board.




Publication History

Received: 07 April 2020

Accepted: 16 May 2020

Article published online:
16 June 2020

© 2020. Thieme. All rights reserved.

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