Clinical Outcomes in Revision Anterior Cruciate Ligament Reconstruction: A Meta-Analysis

Rohith Mohan, Kate E. Webster, Nick R. Johnson, Michael J. Stuart, Timothy Hewett, Aaron Krych

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Purpose: The purpose of this meta-analysis was to determine overall objective graft failure rate, failure rate by graft type (allograft vs autograft reconstruction), instrumented laxity, and patient outcome scores following revision anterior cruciate ligament (ACL) reconstruction. Outcomes of interest were collected for all studies meeting the study inclusion criteria, but lower-level studies (level III/IV) were not pooled for quantitative synthesis due to high levels of heterogeneity in these study populations. Methods: A comprehensive search strategy was performed to identify studies reporting outcomes of revision ACL reconstruction. The primary outcome reported was graft failure. A meta-analysis comparing rate of failure by graft type was conducted using a random effects model. Studies also reported patient clinical outcome scores, including International Knee Documentation Committee (IKDC), Lysholm, and knee injury and osteoarthritis outcome scores (KOOS) and graft laxity. Results: Eight studies with 3,021 patients (56% male, 44% female) with an average age of 30 ± 4 years and mean follow-up time of 57 months were included. The overall objective failure rate was 6% (95% confidence interval [CI], 1.8%-12.3%). Mean instrumented laxity as side-to-side difference was 2.5 mm (95% CI, 1.9-3.1 mm). Mean IKDC subjective score was 76.99 (95% CI, 76.64-77.34), mean KOOS symptoms score was 76.73 (95% CI, 75.85-77.61), and mean Lysholm score was 86.18 (95% CI, 79.08-93.28). The proportion of patients with IKDC grade A or B was 85% (95% CI, 77%-91%). When the available data for failure rate were analyzed by graft type, autograft reconstruction had a failure rate of 4.1% (95% CI, 2.0%-6.9%), similar to allograft reconstruction at 3.6% (95% CI, 1.4%-6.7%). Conclusions: In this meta-analysis, revision ACL reconstruction had failure rates similar to autograft or allograft reconstruction. Overall outcome scores for revision reconstruction have improved but appear modest when compared with primary ACL reconstruction surgery. Level of Evidence: Meta-analysis of Level II studies, Level II.

Original languageEnglish (US)
JournalArthroscopy - Journal of Arthroscopic and Related Surgery
DOIs
StateAccepted/In press - 2017

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Anterior Cruciate Ligament Reconstruction
Meta-Analysis
Confidence Intervals
Transplants
Autografts
Documentation
Allografts
Knee Injuries
Knee
Knee Osteoarthritis
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

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Clinical Outcomes in Revision Anterior Cruciate Ligament Reconstruction : A Meta-Analysis. / Mohan, Rohith; Webster, Kate E.; Johnson, Nick R.; Stuart, Michael J.; Hewett, Timothy; Krych, Aaron.

In: Arthroscopy - Journal of Arthroscopic and Related Surgery, 2017.

Research output: Contribution to journalArticle

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title = "Clinical Outcomes in Revision Anterior Cruciate Ligament Reconstruction: A Meta-Analysis",
abstract = "Purpose: The purpose of this meta-analysis was to determine overall objective graft failure rate, failure rate by graft type (allograft vs autograft reconstruction), instrumented laxity, and patient outcome scores following revision anterior cruciate ligament (ACL) reconstruction. Outcomes of interest were collected for all studies meeting the study inclusion criteria, but lower-level studies (level III/IV) were not pooled for quantitative synthesis due to high levels of heterogeneity in these study populations. Methods: A comprehensive search strategy was performed to identify studies reporting outcomes of revision ACL reconstruction. The primary outcome reported was graft failure. A meta-analysis comparing rate of failure by graft type was conducted using a random effects model. Studies also reported patient clinical outcome scores, including International Knee Documentation Committee (IKDC), Lysholm, and knee injury and osteoarthritis outcome scores (KOOS) and graft laxity. Results: Eight studies with 3,021 patients (56{\%} male, 44{\%} female) with an average age of 30 ± 4 years and mean follow-up time of 57 months were included. The overall objective failure rate was 6{\%} (95{\%} confidence interval [CI], 1.8{\%}-12.3{\%}). Mean instrumented laxity as side-to-side difference was 2.5 mm (95{\%} CI, 1.9-3.1 mm). Mean IKDC subjective score was 76.99 (95{\%} CI, 76.64-77.34), mean KOOS symptoms score was 76.73 (95{\%} CI, 75.85-77.61), and mean Lysholm score was 86.18 (95{\%} CI, 79.08-93.28). The proportion of patients with IKDC grade A or B was 85{\%} (95{\%} CI, 77{\%}-91{\%}). When the available data for failure rate were analyzed by graft type, autograft reconstruction had a failure rate of 4.1{\%} (95{\%} CI, 2.0{\%}-6.9{\%}), similar to allograft reconstruction at 3.6{\%} (95{\%} CI, 1.4{\%}-6.7{\%}). Conclusions: In this meta-analysis, revision ACL reconstruction had failure rates similar to autograft or allograft reconstruction. Overall outcome scores for revision reconstruction have improved but appear modest when compared with primary ACL reconstruction surgery. Level of Evidence: Meta-analysis of Level II studies, Level II.",
author = "Rohith Mohan and Webster, {Kate E.} and Johnson, {Nick R.} and Stuart, {Michael J.} and Timothy Hewett and Aaron Krych",
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T1 - Clinical Outcomes in Revision Anterior Cruciate Ligament Reconstruction

T2 - A Meta-Analysis

AU - Mohan, Rohith

AU - Webster, Kate E.

AU - Johnson, Nick R.

AU - Stuart, Michael J.

AU - Hewett, Timothy

AU - Krych, Aaron

PY - 2017

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N2 - Purpose: The purpose of this meta-analysis was to determine overall objective graft failure rate, failure rate by graft type (allograft vs autograft reconstruction), instrumented laxity, and patient outcome scores following revision anterior cruciate ligament (ACL) reconstruction. Outcomes of interest were collected for all studies meeting the study inclusion criteria, but lower-level studies (level III/IV) were not pooled for quantitative synthesis due to high levels of heterogeneity in these study populations. Methods: A comprehensive search strategy was performed to identify studies reporting outcomes of revision ACL reconstruction. The primary outcome reported was graft failure. A meta-analysis comparing rate of failure by graft type was conducted using a random effects model. Studies also reported patient clinical outcome scores, including International Knee Documentation Committee (IKDC), Lysholm, and knee injury and osteoarthritis outcome scores (KOOS) and graft laxity. Results: Eight studies with 3,021 patients (56% male, 44% female) with an average age of 30 ± 4 years and mean follow-up time of 57 months were included. The overall objective failure rate was 6% (95% confidence interval [CI], 1.8%-12.3%). Mean instrumented laxity as side-to-side difference was 2.5 mm (95% CI, 1.9-3.1 mm). Mean IKDC subjective score was 76.99 (95% CI, 76.64-77.34), mean KOOS symptoms score was 76.73 (95% CI, 75.85-77.61), and mean Lysholm score was 86.18 (95% CI, 79.08-93.28). The proportion of patients with IKDC grade A or B was 85% (95% CI, 77%-91%). When the available data for failure rate were analyzed by graft type, autograft reconstruction had a failure rate of 4.1% (95% CI, 2.0%-6.9%), similar to allograft reconstruction at 3.6% (95% CI, 1.4%-6.7%). Conclusions: In this meta-analysis, revision ACL reconstruction had failure rates similar to autograft or allograft reconstruction. Overall outcome scores for revision reconstruction have improved but appear modest when compared with primary ACL reconstruction surgery. Level of Evidence: Meta-analysis of Level II studies, Level II.

AB - Purpose: The purpose of this meta-analysis was to determine overall objective graft failure rate, failure rate by graft type (allograft vs autograft reconstruction), instrumented laxity, and patient outcome scores following revision anterior cruciate ligament (ACL) reconstruction. Outcomes of interest were collected for all studies meeting the study inclusion criteria, but lower-level studies (level III/IV) were not pooled for quantitative synthesis due to high levels of heterogeneity in these study populations. Methods: A comprehensive search strategy was performed to identify studies reporting outcomes of revision ACL reconstruction. The primary outcome reported was graft failure. A meta-analysis comparing rate of failure by graft type was conducted using a random effects model. Studies also reported patient clinical outcome scores, including International Knee Documentation Committee (IKDC), Lysholm, and knee injury and osteoarthritis outcome scores (KOOS) and graft laxity. Results: Eight studies with 3,021 patients (56% male, 44% female) with an average age of 30 ± 4 years and mean follow-up time of 57 months were included. The overall objective failure rate was 6% (95% confidence interval [CI], 1.8%-12.3%). Mean instrumented laxity as side-to-side difference was 2.5 mm (95% CI, 1.9-3.1 mm). Mean IKDC subjective score was 76.99 (95% CI, 76.64-77.34), mean KOOS symptoms score was 76.73 (95% CI, 75.85-77.61), and mean Lysholm score was 86.18 (95% CI, 79.08-93.28). The proportion of patients with IKDC grade A or B was 85% (95% CI, 77%-91%). When the available data for failure rate were analyzed by graft type, autograft reconstruction had a failure rate of 4.1% (95% CI, 2.0%-6.9%), similar to allograft reconstruction at 3.6% (95% CI, 1.4%-6.7%). Conclusions: In this meta-analysis, revision ACL reconstruction had failure rates similar to autograft or allograft reconstruction. Overall outcome scores for revision reconstruction have improved but appear modest when compared with primary ACL reconstruction surgery. Level of Evidence: Meta-analysis of Level II studies, Level II.

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