Improved Activity, Return to Sport, and Graft Survivorship With Suture‐Augmented Versus Isolated Revision Anterior Cruciate Ligament Reconstruction Using All‐Soft‐Tissue Grafts

Purpose To compare clinical outcomes of suture‐augmented revision anterior cruciate ligament reconstruction (arACLR) and isolated revision anterior cruciate ligament reconstruction (irACLR) using all‐soft‐tissue grafts. Methods Consecutive patients with clinically diagnosed anterior cruciate ligament reconstruction graft failure at a single institution between January 2020 and January 2023 were retrospectively analyzed. Patients who underwent revision anterior cruciate ligament reconstruction using all‐soft‐tissue grafts with a minimum 2‐year follow‐up were included and divided into the irACLR and arACLR groups based on whether suture augmentation was used. Multivariate regression models with inverse probability of treatment weighting were used to compare the treatment modalities with the primary outcome (patient‐reported outcome measures) and the secondary outcomes (graft failure, contralateral injury, arthrofibrosis, hardware irritation, return to sport, and satisfaction). Exploratory analyses were performed on passive anterior tibial subluxation (PATS) measured on pre‐ and postoperative magnetic resonance imaging. Results A total of 47 patients in the arACLR group and 57 patients in the irACLR group were included. The baseline characteristics were well balanced between the groups after inverse probability of treatment weighting, with no difference in surgical characteristics. In the inverse probability of treatment weighting model, arACLR was associated with a higher postoperative Tegner score compared with irACLR ( β , 0.64 [95% confidence interval, 0.06‐1.22], P = .031), with no significant difference in Lysholm or International Knee Documentation Committee subjective scores (all P > .05). A higher percentage of patients in the arACLR group met the minimal clinically important difference for the Tegner score as compared with the irACLR group (39/47 vs 34/57, P = .018). arACLR showed a decreased graft failure rate (odds ratio, 0.20 [95% confidence interval, 0.05‐0.65], P = .006) and increased return to sport rate (odds ratio, 3.85 [95% confidence interval, 2.09‐7.29], P < .001) compared with irACLR, with no significant difference in the rate of contralateral injury, arthrofibrosis, hardware irritation, and satisfaction (all P > .05). Exploratory analyses showed significantly lower postoperative lateral PATS (4.2 ± 3.0 vs 8.3 ± 2.9 mm, P < .001), medial PATS (2.4 ± 2.2 vs 4.7 ± 2.4 mm, P < .001), and rotational PATS (1.8 ± 2.3 vs 3.6 ± 2.4 mm, P = .002) in the arACLR compared with the irACLR group. Conclusions arACLR was associated with improved postoperative Tegner score, reduced graft failure rate, and increased return to sport rate compared with irACLR with similar complication and patient satisfaction rate at a minimum of 2‐year follow‐up. Level of Evidence Level III, retrospective cohort study.