title: Does revision ACL reconstruction measure up to primary surgery? A meta-analysis comparing patient-reported and clinician-reported outcomes, and radiographic results.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Systematic review and meta-analysis
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Grassi
authors.affiliation: Aspetar Orthopaedic & Sports Medicine Hospital, Doha, Qatar Division of Physiotherapy, Linköping University, Linköping, Sweden School of Allied Health, La Trobe University, Melbourne, Australia.
authors.forename: Clare L
authors.identifier: http://orcid.org/0000-0001-8102-3631
authors.initials: CL
authors.lastname: Ardern
authors.affiliation: II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Giulio Maria
authors.initials: GM
authors.lastname: Marcheggiani Muccioli
authors.affiliation: II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Neri
authors.affiliation: II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Maurilio
authors.initials: M
authors.lastname: Marcacci
authors.affiliation: II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Zaffagnini
mesh_terms: D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis / Q000209:etiology; D007719:Knee Joint; D008297:Male; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000209:etiology; D063868:Patient Outcome Assessment; D017060:Patient Satisfaction; D012086:Reoperation; D015599:Trauma Severity Indices
keywords: ACL; Arthroscopy; Knee; Review