Summary

Revision PCL reconstruction is associated with a lower quality of life and a higher rate of clinical failure compared to primary PCL reconstruction.

Abstract

Purpose

Graft failure after posterior cruciate ligament reconstruction (PCLR) has been shown to adversely affect physical activity and quality of life. However, so far there is limited evidence on clinical outcomes after revision PCLR. The purpose of this study was to compare patient-reported outcomes and concomitant injuries between patients undergoing primary and revision PCLR after a minimum 1-year follow-up.

Methods

This was a prospective observational cohort study based on three major Scandinavian knee ligament registries (Sweden, Norway, Denmark). Patients undergoing primary and revision PCLR between 2005 and 2019 were included. Demographic characteristics, concomitant injuries, concurrent surgical procedures, and clinical outcomes based on the Knee injury and Osteoarthritis Outcome Score (KOOS) were collected. KOOS subscales were evaluated preoperatively and after a mean follow-up of 21.8 ± 5.4 months and 21.4 ± 5.8 months for patients undergoing primary PCLR and revision PCLR, respectively. A 3:1 caliper matching (country, concomitant injuries, injury side, injury mechanism, age) was performed to match primary PCLR patients to revision PCLR patients. Clinical failure was assessed at final follow-up and was defined as KOOS QoL < 44 points based on previous research.

Results

In total, 792 patients undergoing primary PCLR and 45 patients undergoing revision PCLR were included. At the time of surgery, there was no difference in concomitant meniscus (40% vs. 36%, p = 0.63), cartilage (12% vs. 4%, p = 0.15), anterior cruciate ligament (53% vs. 40%, p = 0.13), and neurovascular (1.3% vs. 6.7%, p = 0.057) injuries. After 3:1 caliper matching, 135 patients with primary PCLR (58% male) with a mean age of 30.0 ± 11.0 years and 45 patients with revision PCLR (58% male) with a mean age of 29.0 ± 10.5 years were included in the final analysis. There were no between-group differences in any preoperative KOOS subscales (all p > 0.05). Postoperatively, KOOS knee-related quality of life (QoL) subscale was significantly lower in patients undergoing revision PCLR compared to patients undergoing primary PCLR (35.9 ± 23.0 points vs. 51.7 ± 23.6 points, p = 0.005). No differences were found between groups for other KOOS subscales (all p > 0.05). At final follow-up, 55% (n = 43) and 70% (n = 16) of patients met the criterion for clinical failure (KOOS QoL < 44 points) after primary and revision PCLR, respectively.

Conclusion

This study underscores the severe effects of PCLR graft failure, as revision PCLR was associated with a lower quality of life and a higher rate of clinical failure compared to primary PCLR.