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Does revision ACL reconstruction measure up to primary surgery? A meta-analysis comparing patient-reported and clinician-reported outcomes, and radiographic results
  1. Alberto Grassi1,
  2. Clare L Ardern2,3,4,
  3. Giulio Maria Marcheggiani Muccioli1,
  4. Maria Pia Neri1,
  5. Maurilio Marcacci1,
  6. Stefano Zaffagnini1
  1. 1II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Bologna, Italy
  2. 2Aspetar Orthopaedic & Sports Medicine Hospital, Doha, Qatar
  3. 3Division of Physiotherapy, Linköping University, Linköping, Sweden
  4. 4School of Allied Health, La Trobe University, Melbourne, Australia
  1. Correspondence to Dr Alberto Grassi, II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Vi aPupilli 1, Bologna 40136, Italy; alberto.grassi3{at}studio.unibo.it

Abstract

Purpose To 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.

Design Systematic review and meta-analysis

Data sources The 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 studies Articles 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.

Results 8 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.

Conclusions Revision 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.

  • Knee
  • ACL
  • Review
  • Arthroscopy

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