The epidemiology of revision anterior cruciate ligament reconstruction in Ontario, Canada.

BACKGROUND

Knowledge of the rate of and risk factors for re-revision, reoperation, and readmission after revision anterior cruciate ligament reconstruction (ACLR) is limited.

PURPOSE

To determine the rate of and risk factors for re-revision, reoperation, and readmission after revision ACLR.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

All patients who underwent first revision ACLR in Ontario, Canada, from January 2004 to December 2010 were identified and followed until December 2012. Exclusions included age <16 years, previous osteotomy, or multiligament knee reconstruction. The main outcome was re-revision ACLR. Secondary outcomes included reoperation (irrigation and debridement [I&D], meniscectomy, manipulation under anesthesia, contralateral ACLR, and total knee arthroplasty) and readmission. Survival to re-revision was determined using the Kaplan-Meier approach. A Cox proportional hazards model or logistic regression were used to determine the influence of patient, surgical, and provider factors on outcomes. A post hoc analysis was performed to determine the influence of the aforementioned factors on postoperative infection risk.

RESULTS

Overall, 827 patients were included (median age, 30 years; 58.8% males). Single-stage revisions comprised 92.9% of cases, and a meniscal procedure (repair or debridement) was performed in 45.3% of cases. The re-revision rate at a mean follow-up of 4.8 ± 2.2 years was 4.4%, and the 5-year survival rate was 95.4%. The rates of I&D, meniscectomy, contralateral ACLR, and readmission were 0.8%, 3.1%, 3.4%, and 4.1%, respectively. Manipulation under anesthesia and total knee arthroplasty were rare. Young age significantly increased contralateral ACLR risk (risk decreased by 5.1% with each year of age >16 years; P = .02) but not re-revision ACLR risk. Low surgeon's annual volume of revision ACLR (<4 revisions/year: odds ratio, 1.2; P = .02) and male sex (odds ratio, 13.3; P = .01) significantly increased overall infection risk; male sex also influenced I&D risk.

CONCLUSION

Re-revision, reoperation, and readmission rates after revision ACLR were low, and the risk for I&D, infection, and contralateral ACLR were influenced by male sex, low surgeon volume, and young age, respectively.

CLINICAL RELEVANCE

This is the first study to determine morbidity rates and risk factors after revision ACLR, providing reference data from the general population.