Return to Sports and Subsequent ACL Injury Rates after Revision ACL reconstruction with Patellar Tendon Autograft

OBJECTIVES: We sought to determine the rate at which competitive and recreational athletes of different age groups returned to the same sport at the same level after revision ACL reconstruction with a patella tendon autograft, as well as define the subsequent ACL injury rate to either knee. METHODS: We prospectively studied patients after revision ACL reconstruction with patellar tendon autograft. Patients who were involved in jumping/pivoting sports when they injured the ACL reconstructed knee and had the desire to return to the same sport at the same competitive level were included in the study. All patients underwent a perioperative rehabilitation program that emphasized limiting postoperative hemarthrosis, obtaining full range of motion, and achieving quadriceps muscle control before participating in an aggressive strengthening and functional progression program. Patients were grouped by age and competitive sport levels of high school (age <17.5 years, mean 16.6 ± 0.9 years; N=84), college (ages 18 to 21.9 years, mean 19.6 ± 1.2 years; N=58) or recreational (22 to 35 years, mean age 27.6 ± 4.1 years; N=117). A subjective activity survey was used to determine what specific sport and sport level patients participated in before and after surgery. The International Knee Documentation Committee (IKDC) and modified Noyes knee surveys were also obtained. RESULTS: Of 84 high school athletes, 62 (74%) returned to play the same sport in high school. Of 58 college athletes, 43 (74%) returned to play the same sport at the college level. Of 117 recreational athletes, 73 (62%) returned to the same sport at a recreational level. The number of patients who had a subsequent ACL graft tear rate after revision surgery was 2 of 84 (2.3%) in the high school group, 3 of 58 (5.1%) in the college group, and 4 of 117 (3.4%) in the recreational group. The number of patients who had a subsequent ACL tear in the contralateral knee was 1 of 84 (1.1%) in the high school group, 1 of 58 (1.7%) in the college group, and 2 of 117 (1.7%) in the recreational group. Long-term subjective follow-up was obtained for 210 patients at 7.2 ± 5.3 years after surgery. The mean IKDC subjective total score was 86.1 ± 11.7 points at 2 years after surgery and 76.7 ± 18.3 at long-term follow-up. The mean modified Noyes total score was 89.7 ± 11.1 points at 2 years after surgery and 83.7 ± 16.2 points at long-term follow-up. CONCLUSION: Revision ACL reconstruction with a patellar tendon autograft combined with perioperative rehabilitation allows patients to return to the same sport at the same level at a high rate, which is higher than what is reported for revision surgery with hamstring grafts or allografts. Subsequent ACL injury rates to either knee is low and appears lower than after primary surgery, which may indicate that although patients report they return to the same level of sport, they may be doing so at a lower intensity.