Single Revision Versus Multiple Revision Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis
N.F. Nascimento Filho, R.A.S. Conde, D.P. Leal, A.G.M. Da Silva, V.M. Ribeiro, A.C. De AlbuquerqueObjectives:
To compare long-term functional outcomes between first-time revision and multiple-revision (re-revision) ACL reconstruction.
Methods:
We systematically searched PubMed, Embase, Cochrane Library, and Web of Science for cohort studies comparing functional outcomes between patients undergoing revision and re-revision ACL reconstruction, with a minimum follow-up of two years. Primary outcomes included Lysholm, IKDC, and KOOS scores. A random-effects model was applied to account for between-study heterogeneity, assessed using the I² statistic.
Results:
Five cohort studies comprising 1,545 patients (1,408 single revision and 137 re-revision) were included. The Lysholm score showed a non-significant trend favoring first-time revisions (MD = 6.19; 95% CI: -0.54 to 12.93; p = 0.072; I² = 83.9%). However, the leave-one-out sensitivity analysis revealed that omitting one specific study (Helito et al.) resulted in a statistically significant difference favoring the single revision group (MD = 8.38; 95% CI: 0.15 to 16.61). IKDC scores showed no statistical difference between groups (MD = 5.06; 95% CI: -1.72 to 11.85; p = 0.143; I² = 78.1%). Conversely, KOOS subscales consistently favored the single revision group, with statistically significant differences in Pain (MD = 12.11; p = 0.02), Symptoms (MD = 12.35; p = 0.02), Sport/Recreation (MD = 23.90; p = 0.009), Quality of Life (MD = 23.10; p = 0.004), and Activities of Daily Living (MD = 6.95; p = 0.01).
Conclusion:
First-time ACL revision yields better functional outcomes than re-revision, particularly in IKDC and KOOS pain, symptoms, and quality-of-life domains. High heterogeneity warrants cautious interpretation, and further long-term studies are needed.