Contralateral ACL Tear Research Articles

Risk Factors and Predictors Of Subsequent ACL Injury After ACL Reconstruction: Prospective Analysis Of 2801 Primary ACL Reconstructions

Objectives:Retear of an ACL after an ACL reconstruction (ACLR) is devastating for all involved. Understanding risk factors and predictors of subsequent ACL tear after an ACLR is vital for patient education of subsequent risk of injury and if a predictor is modifiable, to make adjustments to minimize the risk of repeat ACL tear. The objectives of this study were 1) to identify the risk factors and predictors for ispilateral and contralateral ACL tears after primary ACLR and 2) to compare retear risk between the 2002/03 and 2007/08 cohorts. This is the largest and most comprehensive prospective analysis of this kind in the literature.Methods:Data from the 2002-2008 MOON database was used to identify risk factors for ACL retear. Subjects who had a primary ACLR with no history of contralateral knee surgery and had 2 year follow-up data were included. Subjects who had multiligament surgery were excluded. Graft type (auto-BTB, auto-hamstring, allograft), age, Marx score at time of index surgery, sport played post ACLR, sex, smoking status, lateral meniscus tear at the time of ACLR, medial meniscus tear at the time of ACLR, BMI, and MOON site were evaluated to determine their contribution to both ipsilateral retear and contralateral ACL tear. The analysis was repeated using the 2002/3 and 2007/8 cohort and included age, graft, sex, and Marx. An ANOVA with post-hoc analysis was performed to detect significant differences in age and Marx score by graft type over time.Results:A total of 2801 subjects met all inclusion/exclusion criteria. There were 165/2801 (5.89%) ipsilateral and 177/2801 (6.32%) contralateral ACL tears identified in the cohort at the two year follow-up. The odds of ipsilateral retear are 1.68 times greater for hamstring autograft (p=0.04) and 4.67 times greater for an allograft (p<0.001) compared to auto-BTB. The odds of ipsilateral retear decrease by 8% for every yearly increase in age (p < 0.001) and increases by 6% for every increased point on the Marx score (p = 0.017). The odds of contralateral ACL tear increase by 7% for every increased point on the Marx score (p = 0.004) and decreases by 5% for every one point increase in BMI (p = 0.03). In 2002/3, there were 61/815 (7.5%) retears compared to 37/1056 (3.5%) in 2007/8. The odds of retear by for the 2002/03 and 2007/08 cohorts are summarized in table 1. The mean age (figure 1) of subjects receiving BTB and hamstring remained constant over time whereas the mean age of subjects receiving allograft rose by seven years (p < 0.001). Hamstring use was a predictor of retear compared to BTB in the 02/03 group (7.9% vs. 4.2%), but not in the 07/08 group (4.1% vs. 3.4%).Conclusion:Age, activity, and graft type were predictors of increased risk of ipsilateral graft failure after ACLR. Higher activity and lower BMI were found to be risk factors in contralateral ACL tears. Allograft use in young active patients was shown to be a risk factor for graft retear in the 02/03 group, subsequent to this, graft choice changed to using allografts in older and less active patients with an associated decrease in graft retear risk in the 07/08 group. The contralateral ACL injury risk did not change from the early group to the later group. The risk of ACL graft retear was lower for all graft types in the 07/08 group compared to the 02/03 group. The relative decrease risk in hamstring autografts compared to BTB in 07/08 compared to 02/03 may be due to improved surgical techniques, rehabilitation, and/or slower return to play guidelines, and bears further investigation.

High Satisfaction Yet Decreased Activity 4 Years After Transphyseal ACL Reconstruction

ACL injuries in preteens and teens are common occurrences. Reconstruction is believed to be optimum treatment for those wishing to return to running, cutting, and jumping sports. Rates of reoperation, satisfaction, and long-term return to and maintenance of preinjury activity after ACL reconstruction in young athletes are important information for physicians, patients, and parents. The purposes of this study were to address the following questions in this skeletally immature patient population undergoing ACL reconstruction: (1) What is the reinjury rate and the need for subsequent surgeries? (2) How do patient satisfaction and function as assessed by patient and physician correlate with return to sport? (3) What factors contribute to failure to return to preinjury activity levels? This is a retrospective review of 29 patients who underwent transphyseal ACL reconstruction using soft tissue grafts passed through open physes and followed to skeletal maturity, and at least 2 years from their index surgery, who were invited and returned for a study interview and examination. Pre- and postinjury activity levels were assessed via the Tegner activity score, satisfaction was determined using a 10-point Likert scale, function was assessed via the Lysholm score and IKDC grade, and an open-ended questionnaire was used for explanations of changes in activity levels. Reoperations were classified as major or minor, determined from a review of the medical records conducted after interview and examination. At a minimum followup of 2 years (mean, 4 years; range, 2-8 years), four revision reconstructions and seven minor operations were performed for a reoperation rate of 11 of 29 (38%). Eight of 29 patients (28%) sustained contralateral ACL ruptures. The mean satisfaction score was 9 (range, 4-10) and mean Lysholm score was 91 (range, 61-100). Only 12 of 29 (41%) patients returned to and maintained their preinjury level of sport. High satisfaction correlated with return to prior level of sports, although there was no relationship between function and activity level. Reoperation on the index knee or contralateral ACL tear did not correlate with a change in activity level; rather, most patients who were less active indicated a change in interest with advancing age. Despite high satisfaction and function, less than 50% of patients maintained their preinjury level of play 4 years after ACL reconstruction. Satisfaction correlated significantly with knee function; highly satisfied patients were more likely to return to and maintain their prior level of participation in sports. Contributing factors to decreased activity include changes in lifestyle with increasing age. Reoperation did not correlate with lower activity scores or failure to return to sports. Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

The Rate of Subsequent Surgery and Predictors After Anterior Cruciate Ligament Reconstruction

Background: Subsequent surgeries have a profound effect on patient satisfaction and outcome after primary anterior cruciate ligament reconstruction (ACLR). There have been no prospective studies to date describing the rate and predictors (surgical and patient variables) of all subsequent knee surgeries at short-term and midterm follow-up along with analyses of surgical and patient variables that are associated with subsequent surgeries. Purpose: To report the rate and predictors of all subsequent surgeries at short-term and midterm follow-up along with associated patient variables. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 980 patients (540 male) were prospectively enrolled in a Multicenter Orthopaedic Outcomes Network (MOON) cohort from January 2002 to December 2003. The 2- and 6-year follow-up information for subsequent procedures was obtained. Operative reports were obtained, and all procedures were categorized. Results: One hundred eighty-five patients underwent a subsequent surgery on the ipsilateral leg (18.9%) and 100 on the contralateral knee (10.2%) at 6-year follow-up. On the ipsilateral knee, there was a 7.7% rate of ACL revisions, a 13.3% rate of cartilage procedures, a 5.4% rate of arthrofibrosis procedures, and a 2.4% rate of procedures related to hardware. For the contralateral knee, there was a 6.4% rate of primary ACL ruptures. Younger age at the index surgery and the use of allografts were predictors (risk factors) for subsequent surgery. Revision ACLR, female sex, body mass index, and surgical exposure were not significant predictors. Conclusion: At 6-year follow-up, 18.9% of patients who had undergone ACLR underwent subsequent surgeries on the ipsilateral knee. The rates between an ipsilateral ACLR graft versus a contralateral normal ACL tear were similar (7.7% vs 6.4%, respectively). Younger age and the use of allografts were risk factors for subsequent surgery.