Outcomes after revision anterior cruciate ligament reconstruction - A prospective observational study

Objectives: Revision anterior cruciate ligament reconstruction (ACLR) presents its own set of surgical challenges, the outcomes of which are subpar and debatable. We conducted a prospective observational study on patients with failed primary ACLR to identify the causes of failure and determine the functional outcomes after revision ACLR. Materials and Methods: 30 patients aged between 15 and 50 years were included in the study. In 40% of cases, revision ACLR was done using the same/bypassing the original femoral and tibial tunnels. Concurrent procedures such as lateral extra-articular tenodesis, high tibial osteotomy, and posterolateral corner reconstruction were performed in 40%, 13.3%, and 6.7% cases, respectively. The patients were followed up for 12 months, and the Tegner Activity Scale, Lysholm score, and International Knee Documentation Committee subjective scores were used to evaluate the functional outcome. Results: It was found that most primary ACLRs failed due to tunnel malposition and failure to recognize additional ligament injuries. After revision ACLR, the total IKDC score improved from a mean and standard deviation of 23.53 ± 4.46 when the patient reported to us to 88.43 ± 2.92 postoperatively after 12 months of follow-up ( P < 0.001). In the same time, the total Tegner score improved from 1.06 ± 0.90 to 6.76 ± 0.77 ( P < 0.001) while the total Lysholm score improved from 35.90 ± 9.67 to 87.93 ± 6.45 ( P = 0.001). Conclusion: It is vital to identify the cause of failure in a primary ACLR before embarking upon a revision ACLR. Excellent to good functional outcomes are possible in revision surgeries by creating the same/by bypassing the original tunnels or by adding concurrent procedures pragmatically.