Recognizing the better autograft and the factors influencing outcomes of revision anterior cruciate ligament reconstruction

Objectives: The outcome of revision anterior cruciate ligament reconstruction (ACLR) is inferior to that of the primary reconstruction and is influenced by multiple factors. The purpose of this study was to identify the better autograft suited for revision ACLR and to assess the factors influencing the outcome of revision. Methods: A total of 102 patients who underwent revision ACLR were enrolled in this study. The patients were grouped based on the type of autograft used for revision. The mechanism of injury and the cause of the primary ACLR failure, meniscal, and chondral status were noted. All patients’ Tegner Lysholm functional scores were assessed at 2 years of follow-up. Results: Almost 37.3% of the patients underwent revision ACLR with bone-patellar tendon bone, 41.3% with semitendinosus-gracilis, and 21.3% with quadriceps tendon autografts. The mean Tegner-Lysholm score was 85.4 ± 15.8, with the majority achieving good to excellent scores. Chondral defect of Grade 3/4 was associated with an inferior poorer functional outcome (P = 0.03). At a 2-year follow-up, the non-contact mechanism of primary ACLR failure was associated with worse scores compared to the contact mechanism of failure (P = 0.03). On comparison of Lysholm functional score between different autografts using the Kruskal-Wallis test, the p-value was insignificant (P = 0.9). Conclusion: Non-contact mechanism of primary ACLR failure and Grade 3/4 chondral defects was associated with a poorer functional outcome at 2 years post-revision ACLR. The overall functional outcome of revision ACLR was good to excellent in our Middle East Asian population, with no one autograft found to be superior to the other.