Outcomes After 1-Stage Versus 2-Stage Revision Anterior Cruciate Ligament Reconstruction

In 1982, the Lysholm score was first published as a physician-administered score in the American Journal of Sports Medicine. The Tegner activity scale was published in 1985. The Lysholm and Tegner scores are valid as patient-administered scores and responsive at early time points after treatment of anterior cruciate ligament tears. Cohort study (Diagnosis); Level of evidence, 1. All patients were treated for an anterior cruciate ligament tear. For responsiveness, the Lysholm score (n = 1075) and Tegner activity level (n = 505) were measured preoperatively and 6, 9, 12, and 24 months postoperatively. For test-retest (n = 50), scores were measured at 2 years postoperatively and again within 4 weeks by questionnaire. For criterion validity (n = 170), patients completed the Short Form-12 and the International Knee Documentation Committee score in addition to Lysholm and Tegner instruments. For all other analyses, preoperative Lysholm score (n = 1783) or Tegner activity levels (n = 687) were collected. There was acceptable test-retest reliability for both the Lysholm (intraclass correlation coefficient = 0.9) and Tegner (intraclass correlation coefficient = 0.8) scores. The minimum detectable change for Lysholm was 8.9 and for Tegner was 1. The Lysholm demonstrated acceptable internal consistency. The Lysholm correlated with the International Knee Documentation Committee (r = .8) and the Short Form-12 (r = .4), and Tegner correlated with the Short Form-12 (r = .2). Both scores had acceptable floor and ceiling effects and all hypotheses were significant. The Lysholm and Tegner were responsive to change at each of the time points. After 25 years of changes in treatment of anterior cruciate ligament injuries, the Lysholm knee score and the Tegner activity scale demonstrated acceptable psychometric parameters as patient-administered scores and showed acceptable responsiveness to be used in early return to function after anterior cruciate ligament treatment.

Anterior cruciate ligament (ACL) reconstruction is one of the most frequently performed orthopaedic procedures. Failures are a reality of surgery; to limit failures, we must first understand and quantify them. The purposes of this study were to determine the rate and factors associated with graft failure after anatomic ACL reconstruction performed with allograft. Case series; Level of evidence, 4. All consecutive subjects who underwent anatomic single- or double-bundle ACL reconstruction with allograft between January 2007 and December 2009 were included and followed clinically. Graft failure was defined as patient-reported instability, pathological laxity during the physical examination, or evidence of a failed graft on magnetic resonance imaging or during arthroscopy. Potential predictors of graft failure that were explored included subject age, sex, height, weight, body mass index, meniscus injury, and time of return to preinjury sports. There were 206 subjects included in this study: 168 double-bundle and 38 single-bundle reconstructions. Overall, 27 (13%) subjects experienced graft failure. Twenty-three (13%) double-bundle subjects failed. The characteristics associated with double-bundle graft failure were younger age (19 vs 25 years, P < .001) and earlier return to sports (at 222 vs 267 days, P = .007). Four (11%) of the single-bundle subjects failed. The characteristics associated with single-bundle graft failure were younger age (19 vs 24 years, P = .049) and increased body mass (83 vs 65 kg, P = .031). The overall graft failure rate after anatomic ACL reconstruction with allograft was 13%. Younger age, earlier return to sports, and a higher body weight were associated with graft failure.

The factors that lead to patients failing multiple anterior cruciate ligament (ACL) reconstructions are not well understood. Multiple-revision ACL reconstruction will have different characteristics than first-time revision in terms of previous and current graft selection, mode of failure, chondral/meniscal injuries, and surgical charactieristics. Case-control study; Level of evidence, 3. A prospective multicenter ACL revision database was utilized for the time period from March 2006 to June 2011. Patients were divided into those who underwent a single-revision ACL reconstruction and those who underwent multiple-revision ACL reconstructions. The primary outcome variable was Marx activity level. Primary data analyses between the groups included a comparison of graft type, perceived mechanism of failure, associated injury (meniscus, ligament, and cartilage), reconstruction type, and tunnel position. Data were compared by analysis of variance with a post hoc Tukey test. A total of 1200 patients (58% men; median age, 26 years) were enrolled, with 1049 (87%) patients having a primary revision and 151 (13%) patients having a second or subsequent revision. Marx activity levels were significantly higher (9.77) in the primary-revision group than in those patients with multiple revisions (6.74). The most common cause of reruptures was a traumatic, noncontact ACL graft injury in 55% of primary-revision patients; 25% of patients had a nontraumatic, gradual-onset recurrent injury, and 11% had a traumatic, contact injury. In the multiple-revision group, a nontraumatic, gradual-onset injury was the most common cause of recurrence (47%), followed by traumatic noncontact (35%) and nontraumatic sudden onset (11%) (P < .01 between groups). Chondral injuries in the medial compartment were significantly more common in the multiple-revision group than in the single-revision group, as were chondral injuries in the patellofemoral compartment. Patients with multiple-revision ACL reconstructions had lower activity levels, were more likely to have chondral injuries in the medial and patellofemoral compartments, and had a high rate of a nontraumatic, recurrent injury of their graft.