BACKGROUND Anterior cruciate ligament (ACL) revision surgery has been associated with inferior outcome compared with primary ACL reconstruction. However, this has rarely been investigated in a consecutive cohort limited to patients that have undergone both primary and revision ACL reconstruction. This study aimed to assess differences in outcome and concomitant injuries between primary and revision ACL reconstruction in such a cohort, and to identify predictors of the patient-reported outcome after ACL revision. METHODS Patients who had undergone both primary and revision ACL reconstruction were identified in the Swedish National Knee Ligament Registry. Patients aged 13-49 years with hamstring tendon primary ACL reconstruction and data on the Knee Injury and Osteoarthritis Outcome Score (KOOS) on at least one occasion (preoperative or one year postoperatively) at both surgeries were eligible. Concomitant injuries and the KOOS were compared between each patient's primary and revision ACL reconstruction. Linear regression analyses were performed to determine predictors of the one-year KOOS after ACL revision. RESULTS A total of 1014 patients were included. Cartilage injuries increased at ACL revision (p < 0.001), as 23.0% had a cartilage injury at ACL revision that was not present at primary ACL reconstruction. The 1-year KOOS was lower after ACL revision compared with primary ACL reconstruction, with the largest difference in the KOOS sports and recreation (5.2 points, SD 32.2, p = 0.002). A posterolateral corner (PLC) injury at ACL revision was a negative predictor of KOOS, with the largest effect on the sports and recreation subscale (β = - 29.20 [95% CI - 50.71; - 6.69], p = 0.011). The use of allograft for ACL revision was an independent predictor of a poorer KOOS QoL (β = - 12.69 [95% CI - 21.84; - 3.55], p = 0.0066) and KOOS4 (β = - 11.40 [95% CI - 19.24; - 3.57], p = 0.0044). CONCLUSION Patients undergoing ACL revision reported a 1-year outcome that was slightly inferior to the 1-year outcome after their primary ACL reconstruction. An ACL revision was associated with an increase in cartilage injuries. A PLC injury at ACL revision and the use of allograft for ACL revision predicted a clinically relevant poorer KOOS one year after ACL revision.

中文翻译：

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一项既进行初次ACL修订又进行ACL修订的患者的伴随损伤和患者报告的结局比较-一项国家注册研究。

背景技术与原发性ACL重建相比，前交叉韧带（ACL）翻新手术的效果较差。然而，这很少在连续队列中进行过研究，仅限于接受了原发性和修订性ACL重建的患者。这项研究的目的是评估此类队列中原发性和修订性ACL重建之间的结局和伴随伤害的差异，并确定ACL修订后患者报告的结局的预测因素。方法在瑞典国家膝关节韧带注册中心对经历了原发性和翻修性ACL重建的患者进行了鉴定。在两次手术中至少有一次（术前或术后一年）接受绳肌腱原发性ACL重建并在至少一次（术前或术后一年）膝关节损伤和骨关节炎结果评分（KOOS）数据的13-49岁患者。比较了每例患者的原发性和翻修性ACL重建的伴随损伤和KOOS。进行线性回归分析以确定ACL修订后一年KOOS的预测因子。结果共纳入1014例患者。在ACL修订版中，软骨损伤增加（p <0.001），因为23.0％的ACL修订版中存在软骨损伤，而在最初的ACL重建中则不存在。ACL修订后的1年期KOOS与主要ACL重建相比较低，在KOOS体育和休闲方面差异最大（5.2分，SD 32.2，p = 0.002）。ACL修订时的后外侧角（PLC）损伤是KOOS的阴性预测指标，对运动和休闲分量表的影响最大（β=-29.20 [95％CI-50.71;-6.69]，p = 0.011）。同种异体移植用于ACL修订是KOOS QoL（β=-12.69 [95％CI-21.84;-3.55]，p = 0.0066）和KOOS4（β=-11.40 [95％CI-19.24; -3.57]，p = 0.0044）。结论接受ACL修订的患者报告的1年结局略逊于其初次ACL重建后的1年结局。ACL修订与软骨损伤增加有关。ACL修订版中的PLC损伤以及同种异体移植物用于ACL修订版，预示ACL修订版在临床上较差的KOOS具有临床意义。