2025 ISAKOS Biennial Congress Paper
Revision Acl Reconstruction, But Not Bilateral Acl Reconstruction, Is Associated With Clinically Relevant Inferior Subjective Knee Function Compared With Primary Acl Reconstruction: A Comparative Analysis Of 6,831 Patients
Riccardo Cristiani, MD, PhD, Stockholm SWEDEN
Eric Hamrin Senorski, PT, PhD, Assoc. Prof., Västra Frölunda SWEDEN
Camilo P. Helito, MD, PhD, Prof, São Paulo, SP BRAZIL
Kristian Samuelsson, Prof, MD, PhD, MSc, Mölndal, Västra Götalands län SWEDEN
Anders Stalman, MD, PhD, Associate Professor, Saltsjobaden, Sweden SWEDEN
Stockholm Sports Trauma Research Center, FIFA Medical Centre of Excellence, Karolinska Institutet, Stockholm, Stockholm, SWEDEN
FDA Status Not Applicable
Summary
Inferior subjective results with revision ACLR but not with bilateral ACLR in comparison with primary ACLR
Abstract
Purpose
To compare the subjective knee function of revision and bilateral anterior cruciate ligament (ACL) reconstruction (ACLR) with that of primary ACLR in a large cohort.
Methods
Patients without concomitant ligament injuries who underwent primary, revision, or bilateral ACLR at (xxx-blinded for review-xxx) between 2005 and 2018 were identified. The Knee injury and Osteoarthritis Outcome Score (KOOS) was collected preoperatively and at 1, 2, and 5 years postoperatively from the (xxx-blinded for review-xxx). Patients who underwent revision and bilateral ACLR were compared with those who underwent primary ACLR (control group) using Student’s t-test.
Results
A total of 6,831 patients (6,102 with primary ACLRs, 343 with revision ACLRs, and 386 with bilateral ACLRs) were included. Preoperatively, there were significant but non-clinically relevant differences in favour of the revision ACLR group for KOOS Symptoms, Pain, Activity of Daily Living (ADL), and Sport/Rec subscale scores compared with the primary ACLR group. Postoperatively, except for the 1-year Symptoms and ADL subscales, the revision ACLR group reported significantly lower scores on all KOOS subscales than the primary ACLR group, with clinically relevant differences (>8–10 points) for the 1-, 2-, and 5-year Sport/Rec and Quality of Life (QOL) subscales. The bilateral ACLR group reported significantly, but not clinically relevant, inferior scores on the 1-year Symptoms and QOL subscales and the 5-year Sport/Rec and QOL subscales compared with the primary ACLR group.
Conclusions
Revision ACLR, but not bilateral ACLR, was associated with clinically relevant inferior subjective knee function compared with primary ACLR. It is important to counsel patients regarding their future subjective knee function after repeated ACLR. Compared to primary ACLR, inferior subjective results should be expected after revision ACLR, but not after bilateral ACLR.