Results of revision anterior cruciate ligament surgery

Background: Revision anterior cruciate ligament surgery remains challenging. Purpose: To analyze the authors' experience with revision anterior cruciate ligament surgery and determine the association between stability and functional results. Study Design: Case series; Level of evidence, 4. Methods: Between 1991 and 2002, 95 of 102 patients who underwent revision anterior cruciate ligament reconstruction at the authors' institution met the criteria for inclusion in the study. Of those, the 63 (66%) who returned for complete clinical and radiologic evaluation (mean follow-up, 72.7 months) formed the study group. Subjective evaluation focused on return to sports, arthritic symptoms, and subjective International Knee Documentation Committee criteria. Clinical evaluation included examination, KT-1000 arthrometer and functional testing, and radiographic analysis of alignment and arthritis. Results: Based on International Knee Documentation Committee subjective scores and return to sports, results were rated as excellent/good in 45 patients (71%), fair in 6 (10%), and poor in 12 (19%). A grade IA or IIA Lachman and a KT-1000 arthrometer side-to-side difference of <3 mm (32/63 patients) was associated with a good/excellent result (P < .05). The mechanical axis was midline in 78% (49/63 patients). Radiographic arthritis (16 patients, 25%) was associated with duration of instability after primary failure (P < .03). Return to sports occurred in 59% (37/63 patients). Sixteen patients (25%) required a second revision surgery. Conclusion: Revision anterior cruciate ligament surgery allowed approximately 60% of patients to go back to sports, most of them at lower levels than their prerevision function. Instrumented laxity of <3 mm was associated with a better result. Radiographic arthritis was associated with duration of instability symptoms after primary failure. Patients who undergo revision anterior cruciate ligament surgery should be counseled as to the expected outcome and cautioned that this procedure probably represents a salvage situation and may not allow them to return to their desired levels of function.