Surgical predictors of clinical outcome six years after revision ACL reconstruction


Nashville, Tenn. (4:14 p.m. EDT – July 9, 2021) – Orthopedic surgeons know that knee surgeries that require revisions have poorer results than primary surgeries, but until now the reason was unknown. Today, a team of orthopedic doctors report that opting for a transtibial surgical approach and choosing an inference screw for femoral and tibial fixation will improve the patient’s chances of having a significantly better clinical outcome at six years of age.

The research was presented today at the 2021 Combined Annual Meeting of the American Orthopedic Society of Sports Medicine-Arthroscopy Association of North America by Rick Wright MD, Vanderbilt University Medical Center, Nashville, TN.

A team of orthopedic physicians and researchers from the University of Washington, St. Louis, MO., And Vanderbilt University Medical Center in Nashville, Tenn., Designed a study to determine whether surgical factors performed at the time revision of anterior cruciate ligament reconstruction have the capacity to influence a patient’s outcome at six years of follow-up.

One of the most common knee injuries is an anterior cruciate ligament injury, which usually includes a complete rupture or tear of the ligament. The surgery involves reconstruction of the ACL, where the damaged ACL is replaced either with an autograft (tissue, such as part of the patellar tendon or hamstring tendons, taken from the person’s own body) or an allograft (a specially treated tendon or ligament extracted from a cadaver human being) under arthroscopic control.

Researchers recruited 1,234 patients who underwent ACL reconstruction revision (58% male and 42% female) between 2006 and 2011. Data collected included baseline demographics, surgical technique, and pathology, as well. as a series of validated patient-reported outcome instruments (IKDC, KOOS, and Marx activity assessment score). Patients were followed for 6 years and asked to complete the same set of outcome instruments.

At six years, follow-up was obtained in 77% (949/1234) of the patients. The researchers found three important factors of poor outcome in these patients, including that the surgical variables determining outcome in revision patients were related to femoral and tibial fixation.

The use of an interference screw for femoral fixation compared to a cross wire gave significantly better results in IKDC scores at six years (OR = 2.2; 95% CI = 1.2, 3.8; p = 0.008), the KOOS sports / rec and KOOS QOL subscales (OR range = 2.2-2.7; 95% CI = 1.2, 3.8; p

The use of an interference screw for tibial fixation over any combination of tibial fixation techniques also resulted in a significant improvement in IKDC (OR = 2.0; 95% CI = 1.3, 2.9; p = 0.001), pain KOOS, ADL, sports / rec (OR range = 1.5-1.6; 95% CI = 1.0; 2.4; p

The use of a transtibial surgical approach compared to an anteromedial portal approach resulted in a significant improvement in the KOOS pain and quality of life subscales at six years (OR = 1.5; 95% CI = 1, 02, 2.2; p

Regarding the position of the tunnel at the time of revision surgery, surgeons who noted that the position of the tibial tunnel opening was in the “optimal position” fared significantly worse in the IKDC scores. at six years (OR = 0.6; 95% CI = 0.4; 0.8; p = 0.003), Marx activity levels (OR = 0.20; 95% CI = 0.07, 0.6; p = 0.005), KOOS Symptom, Pain, Sports / Recreation and Quality of Life subscales (OR range = 0.56-0.68; 95% CI = 0, 38, 0.47; p

The research team also noted other factors that affected the results, including: lower baseline scores, lower baseline activity level, being a smoker at the time of the review, higher BMI, female sex, shorter time since the patient’s last ACL reconstruction, and having an anterior ACL reconstruction on the contralateral side significantly increased the odds of reporting poorer clinical outcomes at 6 years.

“There are surgical variables that the physician can control at the time of an ACL revision that have the ability to alter the clinical outcome,” said Dr. Rick Wright, “based on the results at age 6, opting for a transtibial surgical approach and by choosing an inference screw for femoral and tibial fixation, will improve the patient’s chances of having a significantly better clinical outcome at 6 years. “


The American Orthopedic Society for Sports Medicine (AOSSM) is the world’s premier sports medicine organization representing the interests of orthopedic surgeons and other professionals who provide comprehensive health services for the care of athletes and active people of all ages and of all levels. We cultivate evidence-based knowledge, deliver comprehensive educational programs, and promote emerging research that advances the science and practice of sports medicine. AOSSM is also a founding partner of the STOP Sports Injuries campaign to prevent overuse and traumatic injuries in children.

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