Inconsistent Return to Sport Despite Improved Outcomes After Re-revision Anterior Cruciate Ligament Reconstruction: An Updated Systematic Review

Purpose The primary objective was to systematically review the literature evaluating patient reported outcomes and return to sport following re-revision anterior cruciate ligament reconstruction (ACLR) procedures. The secondary objectives were two-fold: identify the risk factors that lead to revision ACLR failure and assess the secondary knee structure injuries after the initial revision ACLR. It was hypothesized that re-revision ACLR would result in improved post-operative outcomes, but that there would be a low return to the pre-injury level of sports activities due to concomitant knee injuries such as meniscal and chondral lesions. Methods A systematic review of the literature was performed using Medline/PubMed and Cochrane. Inclusion criteria were outcomes of re-revision ACL reconstruction, minimum of two years follow-up, human studies, and English language. Excluded studies were basic science articles, epidemiological studies, editorials, surgical techniques, surveys, cadaveric, and animal studies. Results Fifteen studies met the inclusion criteria and were considered for review. There were 6 Level III, and 9 Level IV studies that included 399 patients undergoing re-revision ACL reconstruction. Concomitant meniscal lesions at the time of re-revision ranged from 35% to 90%. The prevalence of concomitant cartilaginous lesions at the time of re-revision ranged from 13.6% to 90%. Compared to preoperative scores, patient reported outcomes overall improved after re-revision ACL reconstruction with mean preoperative Lysholm scores ranging from 38.4 to 73.15 and improved to postoperative scores ranging from 68 to 87.8. However, return to sport at pre-injury levels was inconsistent with rates ranging from 12.5-80%. Conclusions Re-revision ACL reconstruction was found to restore knee stability and improve functional outcomes. Despite this improvement, there was a low return to sport at pre-injury level. Functional outcomes were also inferior when compared to primary ACL reconstruction. Concomitant knee pathologies were also found to rise in prevalence compared to revision and primary ACLR cases.