Background:

The optimum management strategy after failure of revision anterior cruciate ligament reconstruction (RACLR) is not clearly defined. The literature evaluating differences in outcomes between surgical and nonsurgical management is sparse.

Purpose/Hypothesis:

The purpose was to evaluate the outcomes of surgical versus nonsurgical management of failed first RACLR. It was hypothesized that the long-term clinical outcomes of second RACLR would be superior with respect to knee stability, return to sport, and patient-reported outcome measures when compared with nonsurgical treatment.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Patients who experienced failure of first RACLR were evaluated. All participants followed the same rehabilitation protocol regardless of whether they underwent nonsurgical treatment or a second RACLR. Follow-up comprised regular clinical review and a standardized telephone interview at the end of the study period. Patient-reported outcome measures were recorded at the final follow-up.

Results:

A total of 41 patients with a mean follow-up of 104 ± 52.7 months (range, 40-140 months) were evaluated. Of these, 31 underwent a second RACLR, and 10 patients chose nonsurgical treatment. There was a high rate of return to sport in both groups, but patients undergoing second RACLR had significantly better Tegner (6.35 vs 4.8; P = .012), Lysholm (88.5 vs 78.3; P = .0353), Knee injury and Osteoarthritis Outcome Score (KOOS) Quality of Life (72.6 vs 56.3; P = .0490), and KOOS Sport and Recreation scores (81.4 vs 62.5; P = .0033). Significantly more patients undergoing second RACLR achieved the Patient Acceptable Symptom State for KOOS Sport and Recreation than those who underwent nonsurgical management (74.2% vs 30%; P = .015). The most important predictor of failure to achieve a good/excellent Lysholm score in multivariate analysis was nonsurgical management (P = .0095).

Conclusion:

Both second RACLR and nonsurgical management of failed first RACLR were associated with high rates of return to sport. However, second RACLR was associated with significantly better functional outcome scores with respect to Tegner, Lysholm, KOOS Quality of Life, and KOOS Sport and Recreation scores compared to nonsurgical management. In addition, nonsurgical treatment was the only significant predictor of failure to achieve a good/excellent Lysholm score at the final follow-up, and this was likely a function of inferior knee stability in that group.

中文翻译：

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失败的第一次修订 ACL 重建的管理：来自 SANTI 集团的非手术治疗与第二次修订 ACL 重建的临床结果

背景：

翻修前交叉韧带重建 (RACLR) 失败后的最佳管理策略尚不明确。评估手术和非手术治疗结果差异的文献很少。

目的/假设：

目的是评估第一次 RACLR 失败的手术与非手术治疗的结果。据推测，与非手术治疗相比，第二次 RACLR 的长期临床结果在膝关节稳定性、恢复运动和患者报告的结果测量方面会更好。

学习规划：

队列研究；证据水平，3。

方法：

评估了第一次 RACLR 失败的患者。所有参与者都遵循相同的康复方案，无论他们是否接受了非手术治疗或第二次 RACLR。随访包括定期临床审查和研究结束时的标准化电话访谈。在最终随访时记录患者报告的结果测量值。

结果：

共评估了 41 名患者，平均随访时间为 104 ± 52.7 个月（范围，40-140 个月）。其中，31 人接受了第二次 RACLR，10 人选择了非手术治疗。两组的运动恢复率都很高，但接受第二次 RACLR 的患者的 Tegner（6.35 对 4.8；P = .012）、Lysholm（88.5 对 78.3；P = .0353）、膝关节损伤和骨关节炎结果明显更好得分 (KOOS) 生活质量（72.6 对 56.3；P = .0490），以及 KOOS 运动和娱乐得分（81.4 对 62.5；P = .0033）。与接受非手术治疗的患者相比，接受第二次 RACLR 的患者达到患者可接受的 KOOS 运动和娱乐症状状态（74.2% vs 30%；P= .015)。在多变量分析中未能达到良好/优秀 Lysholm 评分的最重要预测因素是非手术治疗 ( P = .0095)。

结论：

第二次 RACLR 和第一次 RACLR 失败的非手术治疗都与运动恢复率高相关。然而，与非手术治疗相比，第二次 RACLR 与 Tegner、Lysholm、KOOS 生活质量和 KOOS 运动和娱乐评分的功能结果评分显着相关。此外，非手术治疗是在最终随访中未能达到良好/优秀 Lysholm 评分的唯一重要预测因素，这可能是该组膝关节稳定性较差的功能。