title: The long-term clinical and radiological outcomes in patients who suffer recurrent injuries to the anterior cruciate ligament after reconstruction.
abstract: OBJECTIVE
  The aim of this study was to investigate the long-term clinical and radiological outcome of patients who suffer recurrent injuries to the anterior cruciate ligament (ACL) after reconstruction and require revision surgery.
  
  
  METHODS
  From a consecutive series of 200 patients who underwent primary reconstruction following rupture of the ACL, we identified 36 who sustained a further rupture, 29 of whom underwent revision surgery. Patients were reviewed prospectively at one, two, seven, 15 and about 20 years after their original surgery. Primary outcome measures were the number of further ruptures, the posterior tibial slope (PTS), and functional and radiological outcomes. These were compared with a gender and age matched cohort of patients who underwent primary ACL reconstruction only.
  
  
  RESULTS
  At a mean follow-up of 18.3 years (14.3 to 20.2), 29 patients had undergone revision surgery and within this revision group 11 had sustained more than three ruptures of the ACL (3 to 6). The mean age at the time of revision reconstruction was 26.4 years (14 to 54). The mean PTS was significantly higher in those patients who suffered a further injury to the ACL (11°) compared with the control group (9°) (p < 0.001). The mean PTS in those patients who sustained more than three ruptures was 12°.
  
  
  CONCLUSIONS
  Patients who suffer recurrent injuries to the ACL after reconstruction have poorer functional and radiological outcomes than those who suffer a single injury. The causes of further injury are likely to be multifactorial but an increased PTS appears to have a significant association with recurrent ACL injuries. Cite this article: Bone Joint J 2017;99-B:337-43.
authors.affiliation: Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, EH16 4SU, UK.
authors.forename: I
authors.initials: I
authors.lastname: Ahmed
authors.affiliation: North Sydney Orthopaedic and Sports Medicine Centre, 2/3 Gillies St, Wollstonecraft, NSW, 2065, Australia.
authors.forename: L
authors.initials: L
authors.lastname: Salmon
authors.affiliation: North Sydney Orthopaedic and Sports Medicine Centre, 2/3 Gillies St, Wollstonecraft, NSW, 2065, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Roe
authors.affiliation: North Sydney Orthopaedic and Sports Medicine Centre, 2/3 Gillies St, Wollstonecraft, NSW, 2065, Australia.
authors.forename: L
authors.initials: L
authors.lastname: Pinczewski
mesh_terms: D000293:Adolescent; D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000534:rehabilitation / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods* / Q000534:rehabilitation; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D020127:Recovery of Function; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D012307:Risk Factors; D013977:Tibia / Q000000981:diagnostic imaging / Q000473:pathology; D016896:Treatment Outcome; D055815:Young Adult
keywords: Anterior cruciate ligament injury; Functional outcomes; Posterior tibial slope; Revision anterior cruciate ligament reconstruction