Summary

Comparative analysis of return to sports and functional outcomes in patients undergoing primary, revision, and re-revision ACL surgeries.

Abstract

Introduction

The purpose of our study was to analyze return to sports and functional outcomes in a series of patients who underwent ACL reconstruction (ACLr), ACL revision (RACL), and second revision ACL (R-RACL) with a minimum follow-up of 6 years.

Materials And Methods

Between 2010 and 2017, 148 patients were evaluated with a minimum follow-up of 6 years. Patients were divided into three groups. Group A consisted of patients who underwent ACLr, Group B included patients who underwent RACL, and Group C comprised patients who underwent R-RACL. We recorded the type of sport, intensity, frequency, expectations, time to return to sports, and failure rate. Preoperative and last follow-up data included subjective scores using Lysholm, IKDC, and Tegner forms. Objective stability was assessed with the KT-1000 knee arthrometer (Medmetric Corp).

Results

Group A (ACLr) consisted of 80 patients with a median age at surgery of 20 years (IQR: 25–45 years). The average time to return to sports was 11 months (SD 1.4). Of these, 10 (12%) patients returned to a higher level, 34 (41%) returned to the same level as before the injury, 31 (37%) returned to a lower level, and 6 (7%) could not return to sports. Additionally, 50% classified sports as very important. The Tegner score remained stable at 7.10 (SD 0.81) at the last follow-up. Group B (RACL), which included 41 patients, had a median age at revision surgery of 29 years (IQR: 24–36). The average time from revision to follow-up was 70 months (IQR: 58-81). The average time to return to sports was 12.5 months (SD 2.7). Sixteen patients (39%) returned to the same level as before the injury, while 25 (61%) returned to a lower level. The Tegner score decreased from 6.7 (SD 1.3) to 5.6 (SD 1.6). In Group C (R-RACL), with 12 patients, the median age at R-RACL was 32 years (IQR: 30–34 years) and the average follow-up was 27 months (IQR: 24–39). Despite improvements in IKDC and Lysholm scores, only 44% could return to sports. The Tegner score decreased from 7.08 (SD 0.62) to 4.58 (SD 1.29), and only 2 patients (15%) returned to the same level as before the injury, while 8 (61%) returned to a lower level.

Conclusion

As the number of ACL revision surgeries increases, there is a decline in Tegner scores and the ability to return to the same level of sports. Additionally, the time to resume sports and the age at the time of revision surgery increase proportionally with the number of revision surgeries. Only patients who underwent primary ACL reconstruction achieved a higher level of return. This highlights the importance of setting realistic expectations for patients, especially after undergoing revision surgeries.

Keywords: Return to Sports (RTS) - ACL Revision (RACL) - Arthroscopy.
Level of Evidence: IV.