Knee not good as new after second repair surgery

NEW YORK (Reuters Health) - Athletes who must undergo a second surgery to repair the main ligament stabilizing the knee can often return to their sport, but they shouldn't expect that the joint will perform as well as it did before the injury, a team of sports surgeons advises.

"Patients who undergo revision anterior cruciate ligament surgery should be counseled as to the expected outcome and cautioned that this procedure probably represents a salvage situation and may not allow them to return to their desired levels of function," they caution.

In the current issue of the American Journal of Sports Medicine, Dr. Michael J. Battaglia II of the United States Naval Academy in Annapolis, Maryland and colleagues report on 63 patients who required a second surgery to reconstruct their anterior cruciate ligament (ACL).

All were treated at the Hospital for Special Surgery in New York City and needed the operation due to continued instability of the joint, in most cases due to repeat injury rather than technical problems with the surgery.

The surgery restored knee stability in 79 percent of the patients, Battaglia and colleagues report. Two-thirds returned to sports, while 56 percent were able to engage in sporting activities with no restrictions. Joint instability, arthritic symptoms, and fear of re-injury topped the list of reasons why the remaining third of patients did not go back to playing sports.

The longer people had gone after their initial knee injury before having their first ACL reconstruction, the more likely they were to have symptoms of arthritis, the investigators also note.

One-quarter of the patients had a second failure of the ACL surgery and required one or two more operations. Just 7 of the 16 patients who required a second or third surgery had normal or near-normal knee function afterwards.

"Obtaining good subjective or objective results becomes increasingly difficult with subsequent revisions," the researchers note. "However, it appears that it is still possible to obtain satisfactory results and potentially decrease the long-term effects of repeated episodes of instability by performing revision reconstruction in a timely fashion."

SOURCE: American Journal of Sports Medicine, December 2007.