BACKGROUND Revision anterior cruciate ligament (ACL) reconstruction has been documented to have inferior outcomes compared with primary ACL reconstruction. The reasons why remain unknown. PURPOSE To determine whether surgical factors performed at the time of revision ACL reconstruction can influence a patient's outcome at 6-year follow-up. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Patients who underwent revision ACL reconstruction were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline patient characteristics, surgical technique and pathology, and a series of validated patient-reported outcome instruments: Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) subjective form, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Marx activity rating score. Patients were followed up for 6 years and asked to complete the identical set of outcome instruments. Regression analysis was used to control for baseline patient characteristics and surgical variables to assess the surgical risk factors for clinical outcomes 6 years after surgery. RESULTS A total of 1234 patients were enrolled (716 men, 58%; median age, 26 years), and 6-year follow-up was obtained on 79% of patients (980/1234). Using an interference screw for femoral fixation compared with a cross-pin resulted in significantly better outcomes in 6-year IKDC scores (odds ratio [OR], 2.2; 95% CI, 1.2-3.9; P = .008) and KOOS sports/recreation and quality of life subscale scores (OR range, 2.2-2.7; 95% CI, 1.2-4.8; P < .01). Use of an interference screw compared with a cross-pin resulted in a 2.6 times less likely chance of having a subsequent surgery within 6 years. Use of an interference screw for tibial fixation compared with any combination of tibial fixation techniques resulted in significantly improved scores for IKDC (OR, 1.96; 95% CI, 1.3-2.9; P = .001); KOOS pain, activities of daily living, and sports/recreation subscales (OR range, 1.5-1.6; 95% CI, 1.0-2.4; P < .05); and WOMAC pain and activities of daily living subscales (OR range, 1.5-1.8; 95% CI, 1.0-2.7; P < .05). Use of a transtibial surgical approach compared with an anteromedial portal approach resulted in significantly improved KOOS pain and quality of life subscale scores at 6 years (OR, 1.5; 95% CI, 1.02-2.2; P≤ .04). CONCLUSION There are surgical variables at the time of ACL revision that can modify clinical outcomes at 6 years. Opting for a transtibial surgical approach and choosing an interference screw for femoral and tibial fixation improved patients' odds of having a significantly better 6-year clinical outcome in this cohort.

中文翻译：

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翻修 ACL 重建后 6 年临床结果的手术预测因子。


背景 与原发性 ACL 重建相比，翻修前交叉韧带 （ACL） 重建的结局较差。原因尚不清楚。目的 确定在翻修 ACL 重建时进行的手术因素是否会影响患者在 6 年随访中的预后。研究设计 队列研究;证据水平，2.方法 确定 2006 年至 2011 年间接受翻修 ACL 重建的患者并前瞻性入组。收集的数据包括基线患者特征、手术技术和病理学，以及一系列经过验证的患者报告结果工具：膝关节损伤和骨关节炎结果评分 （KOOS）、国际膝关节文献委员会 （IKDC） 主观表格、西安大略大学和麦克马斯特大学骨关节炎指数 （WOMAC） 和 Marx 活动评分。对患者进行了 6 年的随访，并要求完成相同的结果工具集。采用回归分析控制基线患者特征和手术变量，以评估术后 6 年临床结局的手术危险因素。结果 共纳入 1234 例患者 （716 例男性，58%;中位年龄 26 岁），79% 的患者 （980/1234） 进行了 6 年随访。与交叉销相比，使用干涉螺钉进行股骨固定导致 6 年 IKDC 评分的结局显著改善 （比值比 [OR]，2.2;95% CI，1.2-3.9;P = .008） 和 KOOS 运动/娱乐和生活质量分量表评分 （OR 范围，2.2-2.7;95% CI，1.2-4.8;P < .01）.与十字针相比，使用干涉螺钉导致 6 年内进行后续手术的可能性降低了 2.6 倍。 与胫骨固定技术的任何组合相比，使用干涉螺钉进行胫骨固定导致 IKDC 评分显着提高 （OR，1.96;95% CI，1.3-2.9;P = .001）;KOOS 疼痛、日常生活活动和运动/娱乐分量表（OR 范围，1.5-1.6;95% CI，1.0-2.4;P < .05）;和 WOMAC 疼痛和日常生活分量表的活动 （OR 范围，1.5-1.8;95% CI，1.0-2.7;P < .05）.与前内侧门路入路相比，使用胫骨手术入路导致 6 年时 KOOS 疼痛和生活质量分量表评分显著改善 （OR，1.5;95% CI，1.02-2.2;P≤ .04）。结论 ACL 翻修时存在可改变 6 年临床结局的手术变量。选择经胫骨手术方法并选择用于股骨和胫骨固定的干涉螺钉提高了患者在该队列中获得显着更好的 6 年临床结果的几率。