title: Outcomes of repeat revision anterior cruciate ligament reconstruction.
abstract: BACKGROUND
  As anterior cruciate ligament (ACL) reconstruction is performed increasingly in the United States, the rate of revision ACL reconstruction continues to rise. A paucity of literature exists with respect to repeat ACL revision surgery.
  
  
  OBJECTIVE
  To evaluate the functional outcomes of patients who had undergone at least 2 revision ACL reconstructions.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  The records of all patients who had undergone repeat revision ACL reconstructions between 1998 and 2009 were retrospectively reviewed. Data collected included patient demographics, operative findings, pre- and postoperative physical examination findings, radiographs, and Tegner, Lysholm, and International Knee Documentation Committee (IKDC) subjective scores.
  
  
  RESULTS
  Fifteen patients had undergone repeat revision ACL reconstruction during the study period. Mean age was 27 years (range, 18-57 years). Mean follow-up was 5 years (range, 2-10 years). At the time of repeat revision surgery, new tunnels were drilled in 9 of 15 (60%) cases. Of those, 8 of 9 (89%) were drilled because femoral tunnels were deemed "too anterior." During repeat revision, 11 of 15 (73%) patients were noted to have a meniscal tear, and 9 of 15 (67%) had International Cartilage Repair Society (ICRS) grade 3 or 4 chondral lesions. Mean Lysholm score was 60 preoperatively and increased to 82 postoperatively (P < .001). Mean preoperative IKDC score was 59, which increased to 80 postoperatively (P < .001). Mean preoperative Tegner score was 6.0. Mean postoperative Tegner score was 4.5, with only 4 of 15 (27%) patients having returned to their prior activity level (P < .001). Two patients (13%) sustained a traumatic rerupture. Presence of grade 3 or 4 chondral lesions and body mass index greater than 28 at the time of repeat revision were associated with a "fair" or "poor" outcome by Lysholm score (P = .007 and P = .03, respectively) and IDKC subjective scoring (P = .04 and P = .007, respectively).
  
  
  CONCLUSIONS
  Repeat revision ACL reconstruction may improve the functional outcomes of patients who have failed revision ACL reconstruction. Most patients do not return to prior activity level following repeat revision. Presence of grade 3 or 4 chondral lesions and body mass index greater than 28 were associated with worse outcomes.
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Griffith
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Allen
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Levy
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stuart
authors.forename: Diane L
authors.initials: DL
authors.lastname: Dahm
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000009:adverse effects; D015992:Body Mass Index; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000209:etiology*; D007718:Knee Injuries / Q000150:complications / Q000601:surgery; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008592:Menisci, Tibial / Q000601:surgery; D008875:Middle Aged; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D012421:Rupture / Q000150:complications / Q000601:surgery; D012720:Severity of Illness Index; D000070600:Tibial Meniscus Injuries; D016896:Treatment Outcome; D055815:Young Adult
keywords: ACL; cartilage; knee; revision