Return to Sports Activity in the Revision of Anterior Cruciate Ligament Reconstruction: A 2-6 Year Follow-up Study

Introduction: and Objective: The risk of an anterior cruciate ligament (ACL) injury in young patients and those with sports activity is increasing. Regarding the need of athletes with ACL re-rupture to return to sports, ACL revision surgery has received great importance. This study was conducted to evaluate the outcome of ACL reconstruction revision surgery in athletes.

Method: In general, 62 patients with primary surgery and 62 patients with revision ACL surgery were investigated in this study. The study subjects were matched in terms of age, gender, involved leg, injury mechanism, sports group, time of surgery, and the degree of cartilage injury and ankle meniscus rupture. The studied variables included age, gender, body mass index (BMI), sports group, infection, meniscus injuries, chondral lesion, time to return to sports, quality of return to sports, range of motion, Lachman's test, and knee injury and osteoarthritis outcome score (KOOS), International Knee Documentation Committee score, Lysholm, and Marx scores. They were obtained through the information in the patients' medical records and the questionnaire filled out by the participants and the examiner's physician through the follow-ups. Then, the collected data were imported into the SPSS software and underwent analysis.

Results: The mean follow-up of patients was 49 months (in the range of 2-6 years). None of the patients had a chronic infection. The mean time to return to sports was 29.2 ± 3.2 and 35.3 ± 4.3 weeks in the primary surgery and revision surgery groups, respectively. In addition, 34 (54.8%) and 25 (40.3%) patients of the primary surgery and the revision surgery groups returned to the same level before injury, respectively. On the latest follow-up, the results of the Lachman test showed no significant difference between the two groups (P = 0.222) whereas Lysholm, IKDC, MARX, and KOOS scores on the latest follow-up in primary surgery were significantly higher than those of revision surgery (P < 0.001).

Conclusion: The rate of return to sports in revision surgery was 14.5% lower than that of primary surgery, and the average time of return to sports was six weeks. The rate of return to sports, similar to before the injury, was significantly lower in the revision group, females, the age group of over 25 years, and contact sports activity, and patients with a chondral lesion. All knee performance scores were also poorer in the revision surgery.