J Knee Surg 2011; 24(4): 289-294
DOI: 10.1055/s-0031-1292650

© Thieme Medical Publishers

Revision ACL Reconstruction Outcomes: MOON Cohort

Rick Wright1 , Kurt Spindler2 , Laura Huston2 , Annunziato Amendola3 , Jack Andrish4 , Rob Brophy1 , James Carey2 , Charlie Cox2 , David Flanigan5 , Morgan Jones4 , Christopher Kaeding5 , Robert Marx6 , Matthew Matava1 , Eric McCarty7 , Richard Parker4 , Armando Vidal7 , Michelle Wolcott7 , Brian Wolf3 , Warren Dunn2
  • 1Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
  • 2Department of Orthopaedic Surgery, Vanderbilt Orthopaedic Institute, Nashville, Tennessee
  • 3Department of Orthopaedic Surgery, University of Iowa, Iowa City, Iowa
  • 4Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
  • 5Department of Orthopaedic Surgery, Ohio State University, Medical Center, Columbus, Ohio
  • 6Division of Sports Medicine, Hospital for Special Surgery, New York, New York
  • 7Department of Orthopaedic Surgery, University of Colorado School of Medicine, Denver, Colorado
Further Information

Publication History

Publication Date:
27 October 2011 (online)


Many clinicians believe that the results of revision anterior cruciate ligament (ACL) reconstruction compare unfavorably with primary ACL reconstruction. However, few prospective studies have evaluated revision ACL reconstruction using validated patient-based metrics. This study was performed to evaluate and compare the results of revision ACL reconstruction and primary ACL reconstruction. The Multicenter Orthopaedic Outcomes Network consortium is an NIH-funded, hypothesis-driven, multicenter prospective cohort study of patients undergoing ACL reconstruction. All patients preoperatively complete a series of validated patient-oriented questionnaires. At scheduled 2-year follow-up all patients are given the same series of questionnaires to complete. The study evaluated the results of 2-year follow-up of revision ACL reconstruction performed in 2001. Parameters evaluated included Marx activity level, Knee Injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) scores. For this study 446 subjects met inclusion criteria; 2-year follow-up was obtained on 393 (88%). The study group consisted of 55% males with median age of 22 years. There were 33 revision ACL reconstruction cases, for which follow-up was available for 29 (88%). Median baseline Marx (interquartile range) was 12 (8 to 16) and 12 (6 to 16) for the primary ACL reconstruction and revision ACL reconstruction groups, respectively (p = 0.81). At 2 years, median Marx was 9 (4 to 13) and 5 (0 to 10) for the primary ACL reconstruction and revision ACL reconstruction groups, respectively (p = 0.03). Median 2-year IKDC was 75.9 (revision) versus 83.9 (primary) (p = 0.003). Median KOOS subscale Knee Related Quality of Life (KRQOL) at 2 years was 62.5 (revision) versus 75 (primary) (p < 0.001), subscale Sports and Recreation was 75 (revision) and 85 (primary) (p = 0.005), subscale Pain was 83.3 (revision) and 91.7 (primary) (p = 0.002). Marx activity score declined at 2-year follow-up in revision ACL reconstruction compared with primary ACL reconstruction. IKDC and KRQOL were significantly decreased in revision ACL reconstruction compared with primary ACL reconstruction at 2-year follow-up. Revision ACL reconstruction resulted in a significantly worse outcome as measured by these patient-based measures at 2 years.


  • 1 Johnson D L, Warner J J. Diagnosis for anterior cruciate ligament surgery.  Clin Sports Med. 1993;  12 (4) 671-684
  • 2 Roos H, Ornell M, Gärdsell P, Lohmander L S, Lindstrand A. Soccer after anterior cruciate ligament injury—an incompatible combination? A national survey of incidence and risk factors and a 7-year follow-up of 310 players.  Acta Orthop Scand. 1995;  66 (2) 107-112
  • 3 Saperstein A L, Fetto J F. The anterior cruciate ligament-deficient knee: a diagnostic and therapeutic algorithm.  Orthop Rev. 1992;  21 (11) 1297-1305
  • 4 Gottlob C A, Baker Jr C L. Anterior cruciate ligament reconstruction: socioeconomic issues and cost effectiveness.  Am J Orthop. 2000;  29 (6) 472-476
  • 5 Gottlob C A, Baker Jr C L, Pellissier J M, Colvin L. Cost effectiveness of anterior cruciate ligament reconstruction in young adults.  Clin Orthop Relat Res. 1999;  (367) 272-282
  • 6 Dunn W R, Lyman S, Lincoln A E, Amoroso P J, Wickiewicz T, Marx R G. The effect of anterior cruciate ligament reconstruction on the risk of knee reinjury.  Am J Sports Med. 2004;  32 (8) 1906-1914
  • 7 Bach Jr B R. ACL reconstruction: revisited, revised, reviewed.  J Knee Surg. 2004;  17 (3) 125-126
  • 8 George M S, Dunn W R, Spindler K P. Current concepts review: revision anterior cruciate ligament reconstruction.  Am J Sports Med. 2006;  34 (12) 2026-2037
  • 9 Battaglia II M J, Cordasco F A, Hannafin J A et al.. Results of revision anterior cruciate ligament surgery.  Am J Sports Med. 2007;  35 (12) 2057-2066
  • 10 Wright R W, Dunn W R, Amendola A MOON Cohort et al. Anterior cruciate ligament revision reconstruction: two-year results from the MOON cohort.  J Knee Surg. 2007;  20 (4) 308-311
  • 11 Dunn W R, Wolf B R, Amendola A et al.. Multirater agreement of arthroscopic meniscal lesions.  Am J Sports Med. 2004;  32 (8) 1937-1940
  • 12 Marx R G, Connor J, Lyman S Multicenter Orthopaedic Outcomes Network et al. Multirater agreement of arthroscopic grading of knee articular cartilage.  Am J Sports Med. 2005;  33 (11) 1654-1657
  • 13 Spindler K P, Warren T A, Callison Jr J C, Secic M, Fleisch S B, Wright R W. Clinical outcome at a minimum of five years after reconstruction of the anterior cruciate ligament.  J Bone Joint Surg Am. 2005;  87 (8) 1673-1679
  • 14 Wright R W, Dunn W R, Amendola A et al.. Risk of tearing the intact anterior cruciate ligament in the contralateral knee and rupturing the anterior cruciate ligament graft during the first 2 years after anterior cruciate ligament reconstruction: a prospective MOON cohort study.  Am J Sports Med. 2007;  35 (7) 1131-1134
  • 15 Marx R G, Stump T J, Jones E C, Wickiewicz T L, Warren R F. Development and evaluation of an activity rating scale for disorders of the knee.  Am J Sports Med. 2001;  29 (2) 213-218
  • 16 Irrgang J J, Anderson A F, Boland A L et al.. Development and validation of the international knee documentation committee subjective knee form.  Am J Sports Med. 2001;  29 (5) 600-613
  • 17 Irrgang J J, Anderson A F. Development and validation of health-related quality of life measures for the knee.  Clin Orthop Relat Res. 2002;  (402) 95-109
  • 18 Irrgang J J, Anderson A F, Boland A L International Knee Documentation Committee et al. Responsiveness of the International Knee Documentation Committee Subjective Knee Form.  Am J Sports Med. 2006;  34 (10) 1567-1573
  • 19 Anderson A F, Irrgang J J, Kocher M S, Mann B J, Harrast J J. International Knee Documentation Committee . The International Knee Documentation Committee Subjective Knee Evaluation Form: normative data.  Am J Sports Med. 2006;  34 (1) 128-135
  • 20 Roos E M, Roos H P, Lohmander L S, Ekdahl C, Beynnon B D. Knee Injury and Osteoarthritis Outcome Score (KOOS)—development of a self-administered outcome measure.  J Orthop Sports Phys Ther. 1998;  28 (2) 88-96
  • 21 Roos E M, Lohmander L S. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis.  Health Qual Life Outcomes. 2003;  1 64
  • 22 Roos E M, Roos H P, Ekdahl C, Lohmander L S. Knee injury and Osteoarthritis Outcome Score (KOOS)—validation of a Swedish version.  Scand J Med Sci Sports. 1998;  8 (6) 439-448
  • 23 Roos E M, Roos H P, Ryd L, Lohmander L S. Substantial disability 3 months after arthroscopic partial meniscectomy: A prospective study of patient-relevant outcomes.  Arthroscopy. 2000;  16 (6) 619-626
  • 24 Englund M, Roos E M, Lohmander L S. Impact of type of meniscal tear on radiographic and symptomatic knee osteoarthritis: a sixteen-year followup of meniscectomy with matched controls.  Arthritis Rheum. 2003;  48 (8) 2178-2187
  • 25 Roos E M, Ostenberg A, Roos H, Ekdahl C, Lohmander L S. Long-term outcome of meniscectomy: symptoms, function, and performance tests in patients with or without radiographic osteoarthritis compared to matched controls.  Osteoarthritis Cartilage. 2001;  9 (4) 316-324
  • 26 W-Dahl A, Toksvig-Larsen S, Roos E M. A 2-year prospective study of patient-relevant outcomes in patients operated on for knee osteoarthritis with tibial osteotomy.  BMC Musculoskelet Disord. 2005;  6 18
  • 27 Fox J A, Pierce M, Bojchuk J, Hayden J, Bush-Joseph C A, Bach Jr B R. Revision anterior cruciate ligament reconstruction with nonirradiated fresh-frozen patellar tendon allograft.  Arthroscopy. 2004;  20 (8) 787-794

Rick WrightM.D. 

Department of Orthopaedic Surgery, Washington University School of Medicine, 1 Barnes-Jewish Hospital Plaza

Suite 11300, St. Louis, MO 63131

Email: wright@wudosis.wustl.edu