Re-revision anterior cruciate ligament reconstruction showed more laxity than revision anterior cruciate ligament reconstruction at a minimum 2-year follow-up.

Purpose: This study aimed to compare patient demographics, associated lesions (concurrent meniscal and chondral injuries), and clinical outcomes between revision and re-revision anterior cruciate ligament reconstructions.

Methods: Patients who underwent revision or re-revision anterior cruciate ligament reconstruction between 2008 and 2016 with a minimum 2-year follow-up were retrospectively evaluated. Detailed patient demographic data, radiographic preoperative tunnel diameters, posterior tibia slope, and concurrent meniscal and chondral lesion were reviewed. Clinical scores and laxity tests' results were compared between the groups at the last follow-up.

Results: Eighty-two patients (mean age, 33.8 ± 9.9 years; revision group, n = 62; re-revision group, n = 20) were included. The re-revision group showed a higher grade for preoperative arthritis (P < 0.001); more severe preoperative bone defects of the femoral (13.8 ± 2.6 vs 11.7 ± 2.7 mm, P = 0.004) and tibial tunnels (14.6 ± 2.4 vs 13.0 ± 2.3 mm, P = 0.010); and a higher prevalence of subtotal medial meniscectomy (P = 0.008) and chondral defects of the medial (P = 0.006) and lateral femoral condyles (P < 0.001), patella (P = 0.040), and trochlea (P = 0.036). At the final follow-up, the clinical scores did not differ significantly between the groups. However, the re-revision group showed more instability in the anterior drawer (P = 0.001), Lachman (P < 0.001), and pivot-shift (P < 0.001) tests, while a side-to-side difference was observed on the Telos stress radiographs (7.1 ± 4.7 vs 4.9 ± 3.7 mm, P = 0.038).

Conclusion: These findings showed that the patients who underwent re-revision had poor prognostic factors as compared with those who underwent revision anterior cruciate ligament reconstruction. Although the clinical scores did not differ significantly between the groups, the re-revision group showed more laxity at the 2-year follow-up.

Level Of Evidence: Cohort study; IV.