Medium to Long Term Follow Up After ACL Revision

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K N E E

Medium to long-term follow-up after ACL revision

Martin Lind

Bent Lund

Peter Faun

Sinan Said Lene Lindberg Miller

Svend Erik Christiansen

Received: 12 March 2011/ Accepted: 14 July 2011 / Published online: 29 July 2011

Springer-Verlag 2011

Abstract

Purpose The aim of the present study is to present epi-demiology and clinical outcome after revision anterior

cruciate ligament (ACL) reconstruction with an interme-

diate follow-up time of up to 9 years.

Methods A retrospective study of patients treated with

ACL revision from 2001 to 2007 at a university referral

clinic was conducted. Study follow-up was performed in

2010; this follow-up included objective IKDC scores,

KOOS, Tegner and SANE subjective scores, KT-1000

knee laxity measurements and registration of reoperations

and complications.

Results One hundred and twenty-eight patients were

available for follow-up. Median follow-up time was 6

(29) years. Mean age was 32 years, 50% were men.

Eleven percent required staged procedures, 30% were

reconstructed with allograft tendons and 23% had collateral

ligament reconstruction in combination with the ACL

revision. SANE knee global score (0100) was 74 at fol-

low-up, KOOS sub-scores were preoperatively 66, 69, 77,

42 and 39 for pain, symptoms, activity of daily living,

sports and quality of life, respectively. At follow-up, scores

were 70, 76, 81, 50 and 50, respectively. Sport and quality

of life scores increased significantly. KT-1000 was 6.2 mm

preoperatively and 2.5 at follow-up (P\ 0.05). Six percent

were re-revised and 2 patients had total knee replacements.

Conclusion Despite objective findings of acceptable

sagittal knee stability at follow-up, subjective outcome

scores indicate significant knee impairment with low scores

in sport and quality of life. A re-revision rate of 6% after6 years is acceptable. It is imperative that patients eligible

for ACL revision receive proper counseling in terms of

outcome expectancies.

Level of evidence Retrospective case series, Level IV.

Keywords Revision ACL Retrospective case study

KOOS ACL failure

Introduction

Reconstruction of the anterior cruciate ligament in order

to restore knee stability in young active patients is

increasingly performed. Incidence of surgery in the age

group most prone to ACL injuries (1540 years) is

85/100,000 [6]. Overall incidence in Western nations is

approximately 40/100,000, resulting in more than 250,000

ACL reconstructions performed yearly in Europe and the

United States alone. As established definitions of failure

have not yet been determined, outcome of ACL recon-

struction is at present not extensively described. Failed

ACL reconstruction can ultimately necessitate ACL

revision reconstruction. However, indications for ACL

revision are not clearly defined, and certainly not all

patients with poor outcome after ACL reconstruction will

require an ACL revision nor will they benefit from such a

procedure.

While the exact incidence of ACL reconstruction failure

leading to ACL revision is unknown, data from national

registries has demonstrated both that 10% of all ACL

reconstruction procedures are revision procedures and that

ACL revision is performed in less than 5% of all knee

ligament reconstructions within the first 2 postoperative

M. Lind (&) B. Lund P. Faun S. Said

L. L. Miller S. E. Christiansen

Division of Sports Trauma, Orthopedic Department,

Aarhus University Hospital, Tage Hansensgade 2,

8000 Aarhus C, Denmark

e-mail: [email protected]

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Knee Surg Sports Traumatol Arthrosc (2012) 20:166172

DOI 10.1007/s00167-011-1629-3
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years [15]. Therefore, opportunities to perform high-evi-

dence level studies are severely limited. Current knowledge

concerning outcome after ACL revision is based on level 3

and 4 studies, typically with fewer than 50 patients [5,11].

Because these studies use varying objective and subjective

outcome measures and present different operative tech-

nique principles, inter-study comparison is difficult.

In Scandinavia, national registries have now beenestablished. These registries can generate demographic and

outcome data for ACL revision for entire nations and

thereby provide more reliable data describing the true

outcome after both ACL reconstruction and ACL revision,

but because these registries have been established only

very recently, published data describing ACL revision

outcome is correspondingly sparse [7, 15]. In the United

States, multicenter cohort studies, the multicenter ortho-

pedic outcome network (MOON), have established cohorts

of ACL reconstruction and ACL revision-operated patients

with high levels of follow-up and established outcome

parameters that will enable the generation of valid data forthe outcome of these procedures [23, 24]. Results from

these studies have established that clinical outcome after

ACL revision is poorer than after primary ACL recon-

struction and that repeated graft failure is a potential

problem.

ACL revisions are typically performed on young and

active individuals who will possibly face impaired knee

function resulting from a failed procedure and it is there-

fore vitally important to improve current knowledge con-

cerning outcome after ACL revision. Since, at the present

time, there is a lack of knowledge surrounding failure of

ACL revision, predictors of repeat graft failure and poor

clinical outcome need to be established.

The aim of the present study is to investigate the epi-

demiology and clinical outcome of ACL revision after an

intermediate follow-up period of 29 years in a large

patient cohort treated at a university referral clinic.

Materials and methods

In the period from 2001 to 2007, a total of 168 patients

were treated with ACL revision surgery at Aarhus Uni-

versity Hospital, Division of Sports Trauma, which is a

university referral clinic. Inclusion criteria were: first-

time ACL revision surgery with and without concomitant

collateral ligament reconstructions. Exclusion criteria

were: repeat ACL revision or concomitant PCL knee

ligament reconstruction. Due to lack of follow-up

opportunity, deceased patients and patients who had

migrated out of the country were also excluded from the

study.

Evaluation

All included patients were admitted for study follow-up in

the first 6 months of 2010. At follow-up, patients were

clinically evaluated by an independent physiotherapist;

evaluation included objective and instrumented knee laxity

measurement.

Patients were evaluated by means of follow-up objectiveIKDC scores [8]. Pivot shift was graded as either absent,

minor, moderate or gross. Anterior sagittal instability at

25 of knee flexion was objectively assessed by means of

instrumented KT-1000 measurements, with the index side

to normal side difference at maximum anterior load as the

primary parameter.

Patient-related outcome measures were performed by

means of preoperative and follow-up KOOS subjective

scores [19]. KOOS quality of life subscale below 44 points

has been suggested as an indicator for failure after ACL

reconstruction surgery [3]. Using the single assessment

numeric evaluation (SANE) method, patients were alsoasked to rate their overall knee function on the operated

side on a scale from 1 to 100, with 100 being normal [22].

Ability to perform sports and working ability were assessed

by means of Tegner functional score (010) [20]. Pain at

rest and after 15 min of walking was evaluated using a

010 Likert scale. Follow-up patient satisfaction with the

outcome was graded: very satisfied with the outcome,

satisfied with the outcome, slightly unsatisfied with the

outcome and unsatisfied. Patients were also asked whether

or not they would have the procedure performed again.

All complications and reoperations during the follow-up

period were registered.

Generally, in cases with acceptable tunnel positioning

and limited tunnel widening, an autograft tendon either

semitendinosus/gracilis (ST/G) or patella-bone-tendon-

bone (BTB) was used so that if the primary procedure was

performed with ST/G and BTB, graft was used for the

revision procedure and vice versa. If tunnel widening was

extensive ([12 mm), a staged procedure with allogenic

bone transplantation in both femoral and tibial tunnels was

performed. Tunnel widening was assessed in accordance

with the method described by LInsalata et al. [13].

Poor femoral tunnel position at primary surgery was

defined as vertical if the hole angle was less than 25to the

vertical axis, and anterior if the center of the tunnel was

anterior to the posterior one-third of the Blumensaat line

(our own definition). Allograft tendons were used in cases

where the patients occupation contraindicated the use of

BTB graft, or if the patient had a strong aversion toward

autograft harvest and the surgeon considered the use of

allograft to be beneficial. The latter could be applicable in

cases of moderate tunnel widening and tunnel malposition

Knee Surg Sports Traumatol Arthrosc (2012) 20:166172 167

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where an allograft with bone blocks could compensate for

these insufficiencies and enable a single stage procedure.

Collateral ligament insufficiency was treated with rele-

vant ligament reconstruction according to previously pub-

lished methods [9,14].

Rehabilitation

Patients were allowed unloaded free range of motion

immediate postoperatively. Full-weight bearing was

allowed after 2 weeks. Controlled sports activities after

34 months and contact sports after 12 months were

allowed. However, patients were advised to discontinue

contact sports if the cause for revision was new trauma

during contact sports.

Statistical analysis

KOOS score, pain score, SANE score and KT-1000 data

are expressed as mean values with standard deviation inbrackets. Tegner scores are expressed as median values

with range values in brackets. Comparison of preoperative

and follow-up KT-1000 and KOOS data was performed

with Students t test. A P value of\0.05 was considered

significant.

Results

One hundred and twenty-eight patients (76%) were avail-

able for follow-up. Ninety-eight patients were seen at a

project follow-up visit and, for all subjective scores, 30

patients were followed up by means of telephone interview

and mail contact. Average follow-up was 5.9 years (range

29 years). Fifty percent were women. Median age was

31 years with a range from 16 to 58.

Primary ACL reconstruction

At primary ACL reconstruction, graft choice for the cohort

was patella tendon in 50% of patients and semitendinosus/

gracilis in 41%. Of the 9% of other graft types, 6% were

various synthetic graft materials. Thirty-three percent had

meniscus injury; of these, 27% were isolated medial, 4%

isolated lateral and 2% combined medial and lateral.

Revision ACL reconstruction

Median time from primary ACL reconstruction to ACL

revision was 58 months (range 0311). The surgeon-eval-

uated primary cause of ACL graft failure is shown in

Table1. The three most common causes were: new trauma

(30%), unknown cause (24%) and femoral tunnel placement

(20%). Staged procedures with initial tunnel bone grafting

with allograft bone was performed in 11% of patients. Graft

choice at ACL revision was PTB graft in 28%, semitendi-

nosus/gracilis graft in 41% and allograft in 31% of patients.

A collateral ligament reconstruction was performed at the

time of ACL revision in 23% of cases. In 3% of cases, MCL

was performed and in 20% of cases a combination of LCLand posterolateral corner reconstruction was performed.

Meniscus injury was seen in 45% of patients with 30%

medial and 15% lateral lesions. Cartilage lesions (ICRS

grade 3 or 4) were seen in 59% of patients. In 17% of cases,

the cartilage lesions were isolated to one compartment and

in 32%, multiple compartments were affected. In all cases,

cartilage lesions were treated solely with debridement, with

no cartilage repair procedures performed.

Objective knee stability outcome

Sagittal knee laxity measured by means of the KT-1000knee stability test improved significantly from 6.5 mm

preoperatively to 2.5 mm at follow-up. No improvement in

sagittal knee laxity was seen in only 3% of patients and a

follow-up side-to-side difference of[5 mm (IKDC group

C and D for anterior laxity) was seen in 6% of patients.

Pivot shift was absent in 41%, minor in 48% and moderate

in 18% of patients.

Overall, objective IKDC score at follow-up was 5%

group A, 59% group B, 29% group C and 5% group D.

Subjective outcome

Patient-related outcome measures are presented in Table2

and Fig.1. KOOS scores demonstrated significant improve-

ment for the sub-score of sports and recreation and quality

of life, which improved 8 and 11 points, respectively.

When dividing the patient material into two groups of

patients who had either isolated ACL revision or in com-

bination with collateral ligament reconstruction, the fol-

lowing was found: In terms of preoperative status, patients

with collateral insufficiency had a lower KOOS sports/

Table 1 Surgeon-evaluated causes for revision ACL surgery

Cause for revision ACL surgery %

New trauma 30

Unknown cause 24

Femoral tunnel placement 20

Collateral ligament laxity 7

Combined femoral and tibial tunnel placement 6

Tibia tunnel placement 6

Tunnel widening 3

Other cause 5

168 Knee Surg Sports Traumatol Arthrosc (2012) 20:166172

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recreation sub-score than patients with isolated sagittal

laxity. At follow-up, a tendency toward higher KOOS

scores but no significant differences in the various sub-

scores was found for patients with isolated ACL revision.

Overall, 2/3 of the patients (63%) stated that they were

satisfied or very satisfied with the outcome of the ACL

revision and 74% stated that they would have the procedure

again now that they knew the outcome. Pain score mean

values are seen in Table 2. The mean values are relatively

low, between 2 and 3. Fifty percent of patients were at restand 43% completely pain free after 15 min of walking.

Complications and failures

The primary event indicating failure is re-revision of the

ACL. Seven patients (6%) required re-ACL revision. The

interval between ACL revision and re-ACL revision was

between 2.3 and 8.4 years. Including re-ACL revision, a

total of 30% of patients had one or more reoperations.

Other causes for reoperation were: meniscus injury

(13 patients/10%), arthrofibrosis (2 patients/1.6%), deep

infection (2 patients/1.6%), and superficial infection

(1 patient/0.8%); 2 patients had total knee arthroplasty due

to severe chronic pain. Another cause for reoperation was

hardware removal in 12% of patients. A severely low score

(below 44 points) in the KOOS quality of life subscale was

found in 31% of patients.

Discussion

The most important finding of the present study was that

outcome after ACL revision is less favorable than after

primary ACL, based on less improvement in patient-related

outcome scores, and higher reoperation rates. These key

findings emphasize the need for proper counseling of

patients before consenting to undergo an ACL revision

procedure.

Table 2 Patient-related

outcome results

Tegner score, SANE score and

pain scores is presented as

median and range in brackets

All cases

N= 128

Isolated ACL revision

N= 99

ACL revision ? collateral

N= 29

Follow-up Follow-up Follow-up

SANE score 75 (40100) 75 (40100) 80 (4590)

Tegner score 4 (18) 4 (110) 4 (18)

Pain score (rest) 2 (18) 2 (18) 2 (16)

Pain score

(15 min walk)

2 (110) 2 (110) 2 (110)

Patient satisfaction

Very satisfied (%) 33 35 33

Satisfied (%) 31 30 38

Fair (%) 26 28 19

Unsatisfied (%) 10 7 10

Would have

procedure

again (%)

74 74 73

Fig. 1 KOOS profiles of preoperative and follow-up conditions.aAll

patients.b Patients with isolated ACL revision. c Patients with ACLrevision in combination with collateral ligament reconstruction. The

different sub-scores are PAIN, SYMPtoms, activities of daily living,

SPORTs and recreation and quality Of life. Asterisk indicatedP\0.05 for comparison within sub-score


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Due to the scarcity of literature encompassing larger

clinical studies, a comparison of outcome data from the

present study to other studies is difficult. Most studies on

ACL revision are focused on a specific surgical technique

or graft choice [1, 2, 4, 5, 12, 18]. Few studies examine

results after the normal spectrum of ACL revision seen at a

specialized center. A recent review presented outcome data

from published retrospective studies where the patientnumbers ranged from 21 to 107 with failure rates from 6 to

24% after 56 years follow-up [11]. The majority of the

studies used specific techniques and graft choices and as

such did not investigate the typical array of surgical tech-

niques needed for ACL revision. The value of the present

study lies in its substantial patient cohort of 128 and the

typical spectrum of ACL reconstruction failure cases seen

at a specialized center combined with a midterm follow-up

median 6 years.

In contrast to the retrospective data mentioned above,

a cohort of prospectively followed patients with ACL

reconstruction and ACL revision procedures has beenestablished in a multicenter orthopedic outcome network in

the USA. Preliminary results from this network present a

cohort of 47 ACL revision patients followed for 2 years.

They demonstrate that reoperations were seen in 15% of

patients and of these, 5% were re-ACL revision. Subjective

outcome investigated by means of SF36 demonstrated

improvement only in the physical activity score and not in

mental health and vitality [23]. Another study derived from

a national registry for knee ligament reconstruction also

demonstrated less favorable results after 1 year follow-up

in 222 patients based on KOOS scores after ACL revision

compared to primary ACL reconstruction [15]. A case

series from a major university clinic in the USA with 25

ACL revision patients operated with allografts presented

data on patient satisfaction: In this study, 76% of patients

declared that they would have the ACL revision procedure

performed again compared to 74% in the present study

[10].

We performed a subgroup analysis by dividing the

patients into groups of either isolated ACL revision or in

combination with collateral ligament reconstructions. The

only difference between the two groups was a lower pre-

operative KOOS sports and recreation sub-score, which is

understandable against the background of a combined lig-

ament insufficiency. The various follow-up outcome scores

between the two groups did not differ.

The KOOS score has recently gained increasing popu-

larity for the evaluation of patient-related outcome after

ACL reconstruction [3, 6, 15]. However, of the five sub-

scales in the KOOS score, the subscale for activity of daily

living is particularly unresponsive in terms of ACL

reconstruction treatment. This has necessitated modifica-

tions of the score in order to adapt a measure specifically

for ACL reconstruction patients. A recent study investi-

gating conservative treatment after ACL injury devised a

measure called KOOS4 that is calculated as the average

score of KOOS pain, symptoms, sports and quality of life

subscales [3]. Another problem with patient-related out-

come measures in ACL patients is a poor correlation to

functional parameters such leg strength, hop test and

objective knee laxity [17].An inter-study comparison of subjective outcome

measures is always challenging. By using the overall

improvement in responsive KOOS sub-scores (KOOS4),

the following impact of primary ACL reconstruction and

ACL revision has been demonstrated: In the Danish ACL

registry, the KOOS4 improved 25 points for primary

ACL reconstruction and 13 points for ACL revision [15];

in the recent ACL level 1 study by Frobell et al. [3],

KOOS4 improved 39 points for the ACL reconstruction

group. These data must be compared to a KOOS4improvement of only 8 points in the present study. These

data indicate that the impact on subjective outcome ofACL revision is only about half that of primary ACL

reconstruction.

A recent French multicenter study investigating

descriptive data of ACL revision in 293 patients demon-

strated that the main causes for ACL graft failure were

femoral tunnel position (36%), new trauma (30%), and

unknown cause (15%). The present study found the same

three main revision causes [21]. The same study showed a

cumulative meniscus lesion incidence of 70% after

2.5 years follow-up after ACL revision. They demonstrated

that meniscectomy negatively influenced both functional

outcome and knee stability. This accumulated incidence of

meniscus and cartilage injuries in ACL revision patients is

a likely cause of poorer clinical outcome after ACL revi-

sion as compared to primary ACL reconstruction. The use

of allografts for primary ACL reconstruction has been

demonstrated as a risk factor for revision. In a study by

Mehta et al. [16], the use of allograft resulted in a tenfold

increase in revision rates within the first 4 postoperative

years.

The risk of re-revision in the present study was found to

be 6% after a median 6 years follow-up. This is a higher

risk compared to the revision risk after primary ACL

reconstruction. The 5-year incidence following primary

ACL reconstruction has recently been shown to be in the

range of 34% in national register studies (unpublished

data). Preliminary data from the MOON cohort at 2 years

follow-up demonstrated a reoperation risk of 15%, of

which 2.5% were re-revisions [23]. However, the latter

prospective cohort was limited to 39 patients making the

statistical background for re-revision rate potentially weak.

In the present study, no patients had ACL revision before

the 2 years follow-up.


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The present study is primarily limited by its design as a

retrospective study. Another weakness is the follow-up

completeness, which is limited by the fact that patients

typically were referred to our clinic from the entire country

and therefore living so far away that traveling to a follow-

up visit was unacceptable. We did, however, gather follow-

up data on some of these patients by means of telephone

interview and mail correspondence in order to obtainpatient-related outcome scores. The patients included in

this study were surgically treated by four different sur-

geons, which could potentially add bias due to different

surgical strategies choices on the part of the individual

surgeon. However, the results are more likely to represent

the general outcome after ACL revision performed by

multiple surgeons. Similarly, patients with a wide age

range were included, which can also introduce bias but at

the same time, this wide age range also represents the

typical clinical scenario for ACL revision cases. Our sub-

group analysis results in smaller study groups thus limiting

the power of analysis. The results from the subgroupanalysis should therefore be evaluated cautiously. For a

single institution study, our case series, with follow-up data

from 128 patients, is large, which increases the validity and

interest of the presented data. Even though the present

study is a single-center study, ACL revision was performed

by means of a variety of techniques and multiple graft

choices, all chosen by several surgeons. We therefore

consider that our material represents the ACL revision

patient population to an acceptable degree.

As improvements in subjective clinical outcome fol-

lowing revision ACL reconstruction are limited despite

achievement of acceptable knee stability, patients should

be carefully counseled before undergoing revision ACL

surgery.

Conclusion

Results from this study on ACL revision demonstrate

limited improvement in patient-related outcome scores

compared to studies on primary ACL reconstruction. The

total reoperation rate of 30%, 6% of which was re-ACL

revision, is relatively high. It is imperative that patients

eligible for ACL revision receive proper counseling in

terms of outcome expectancies.

References

1. Ferretti A, Conteduca F, Monaco E, De Carli A, DArrigo C

(2006) Revision anterior cruciate ligament reconstruction with

doubled semitendinosus and gracilis tendons and lateral extra-

articular reconstruction. J Bone Joint Surg Am 88:23732379

2. Fox JA, Pierce M, Bojchuk J, Hayden J, Bush-Joseph CA, Bach

BR Jr (2004) Revision anterior cruciate ligament reconstruction

with nonirradiated fresh-frozen patellar tendon allograft.

Arthroscopy 20:787794

3. Frobell RB, Roos EM, Roos HP, Ranstam J, Lohmander LS

(2010) A randomized trial of treatment for acute anterior cruciate

ligament tears. N Engl J Med 363:331342

4. Fules PJ, Madhav RT, Goddard RK, Mowbray MA (2003)

Revision anterior cruciate ligament reconstruction using auto-

grafts with a polyester fixation device. Knee 10:335340

5. George MS, Dunn WR, Spindler KP (2006) Current concepts

review: revision anterior cruciate ligament reconstruction. Am J

Sports Med 34:20262037

6. Granan LP, Bahr R, Steindal K, Furnes O, Engebretsen L (2008)

Development of a national cruciate ligament surgery registry: the

Norwegian National Knee Ligament Registry. Am J Sports Med

36:308315

7. Granan LP, Forssblad M, Lind M, Engebretsen L (2009) The

Scandinavian ACL registries 20042007: baseline epidemiology.

Acta Orthop 80:563567

8. Hefti F, Muller W, Jakob RP, Staubli HU (1993) Evaluation of

knee ligament injuries with the IKDC form. Knee Surg Sports

Traumatol Arthrosc 1:226234

9. Jakobsen BW, Lund B, Christiansen SE, Lind MC (2010) Ana-

tomic reconstruction of the posterolateral corner of the knee: a

case series with isolated reconstructions in 27 patients. Arthros-

copy 26:918925

10. Johnson DL, Swenson TM, Irrgang JJ, Fu FH, Harner CD (1996)

Revision anterior cruciate ligament surgery: experience from

Pittsburgh. Clin Orthop Relat Res 325:100109

11. Kamath GV, Redfern JC, Greis PE, Burks RT (2011) Revision

anterior cruciate ligament reconstruction. Am J Sports Med

39:199217

12. Kartus J, Stener S, Lindahl S, Eriksson BI, Karlsson J (1998) Ipsi-

or contralateral patellar tendon graft in anterior cruciate ligament

revision surgery. A comparison of two methods. Am J Sports

Med 26:499504

13. LInsalata JC, Klatt B, Fu FH, Harner CD (1997) Tunnel

expansion following anterior cruciate ligament reconstruction: a

comparison of hamstring and patellar tendon autografts. Knee

Surg Sports Traumatol Arthrosc 5:234238

14. Lind M, Jakobsen BW, Lund B, Hansen MS, Abdallah O,

Christiansen SE (2009) Anatomical reconstruction of the medial

collateral ligament and posteromedial corner of the knee in

patients with chronic medial collateral ligament instability. Am J

Sports Med 37:11161122

15. Lind M, Menhert F, Pedersen AB (2009) The first results from the

Danish ACL reconstruction registry: epidemiologic and 2 year

follow-up results from 5,818 knee ligament reconstructions. Knee

Surg Sports Traumatol Arthrosc 17:117124

16. Mehta VM, Mandala C, Foster D, Petsche TS (2010) Comparison

of revision rates in bone-patella tendon-bone autograft and allo-

graft anterior cruciate ligament reconstruction. Orthopedics 33:12

17. Moller E, Weidenhielm L, Werner S (2009) Outcome and knee-related quality of life after anterior cruciate ligament recon-

struction: a long-term follow-up. Knee Surg Sports Traumatol

Arthrosc 17:786794

18. Noyes FR, Barber-Westin SD (2001) Revision anterior cruciate

surgery with use of bone-patellar tendon-bone autogenous grafts.

J Bone Joint Surg Am 83-A:11311143

19. Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD

(1998) Knee injury and osteoarthritis outcome score (KOOS)

development of a self-administered outcome measure. J Orthop

Sports Phys Ther 28:8896

20. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of

knee ligament injuries. Clin Orthop Relat Res 198:4349


1 3


7/8

21. Trojani C, Sbihi A, Djian P, Potel JF, Hulet C, Jouve F, Bussiere

C, Ehkirch FP, Burdin G, Dubrana F, Beaufils P, Franceschi JP,

Chassaing V, Colombet P, Neyret P (2011) Causes for failure of

ACL reconstruction and influence of meniscectomies after revi-

sion. Knee Surg Sports Traumatol Arthrosc 19:196201

22. Williams GN, Gangel TJ, Arciero RA, Uhorchak JM, Taylor DC

(1999) Comparison of the Single Assessment Numeric Evalua-

tion method and two shoulder rating scales. Outcomes measures

after shoulder surgery. Am J Sports Med 27:214221

23. Wright RW, Dunn WR, Amendola A, Andrish JT, Flanigan DC,

Jones M, Kaeding CC, Marx RG, Matava MJ, McCarty EC,

Parker RD, Vidal A, Wolcott M, Wolf BR, Spindler KP (2007)

Anterior cruciate ligament revision reconstruction: two-year

results from the MOON cohort. J Knee Surg 20:308311

24. Wright RW, Huston LJ, Spindler KP, Dunn WR, Haas AK, Allen

CR, Cooper DE, DeBerardino TM, Lantz BB, Mann BJ, Stuart

MJ (2010) Descriptive epidemiology of the Multicenter ACL

Revision Study (MARS) cohort. Am J Sports Med 38:19791986


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Medium to Long Term Follow Up After ACL Revision