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J Knee Surg 2016; 29(04): 329-336
DOI: 10.1055/s-0035-1554925
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Risk Factors for Revision Anterior Cruciate Ligament Reconstruction

Brent A. Ponce
1   Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
,
E. Lyle Cain Jr.
2   American Sports Medicine Institute, Birmingham, Alabama
,
Ryan Pflugner
1   Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
,
Glenn S. Fleisig
2   American Sports Medicine Institute, Birmingham, Alabama
,
Bradley L. Young
1   Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
,
Hikel A. Boohaker
1   Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
,
Thomas A. Swain
3   Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
,
James R. Andrews
2   American Sports Medicine Institute, Birmingham, Alabama
,
Jeffrey R. Dugas
2   American Sports Medicine Institute, Birmingham, Alabama
› Author Affiliations
Further Information

Publication History

21 July 2014

21 March 2015

Publication Date:
01 August 2015 (online)

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Abstract

Purpose The purpose of this study was to identify risk factors for revision surgery following primary anterior cruciate ligament (ACL) reconstruction.

Methods A retrospective analysis of 2,965 patients who underwent a primary ACL reconstruction were separated into two groups: those who returned to our center for revision of their reconstruction (n = 67) and those who did not return to our center for revision of their reconstruction (n = 2,898). Patient characteristics assessed at the time of primary reconstruction include age, gender, graft type, graft source, meniscal and/or chondral injury, sport, side of effected extremity, level of competition, and surgeon. Multivariable analyses were performed to identify significant, independent associations with the need for revision.

Results The portion of patients who returned for revision reconstruction after primary ACL reconstruction was 2.3% (67/2,965). Age (p < 0.001), sport type (p = 0.007), and level of participation (p < 0.001) were significantly different between the nonrevision and revision patients. Graft type preferences varied among surgeons (p < 0.001). Accounting for sport type or level of competition, age (p = 0.014) and surgeon (p = 0.041) were independently associated with revision. Gender, extremity (R vs. L), meniscal or chondral injury, and graft characteristics were not associated with revision.

Conclusion Revision of primary ACL reconstructions is independently associated with age and choice of surgeon at the time of primary reconstruction.

Keywords

ACL - revision - knee - risk factors - reconstruction
 

  • References

  • 1 Gianotti SM, Marshall SW, Hume PA, Bunt L. Incidence of anterior cruciate ligament injury and other knee ligament injuries: a national population-based study. J Sci Med Sport 2009; 12 (6) 622-627
    CrossrefPubMedGoogle Scholar
  • 2 Griffin LY, Albohm MJ, Arendt EA , et al. Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II meeting, January 2005. Am J Sports Med 2006; 34 (9) 1512-1532
    CrossrefPubMedGoogle Scholar
  • 3 Bach Jr BR, Tradonsky S, Bojchuk J, Levy ME, Bush-Joseph CA, Khan NH. Arthroscopically assisted anterior cruciate ligament reconstruction using patellar tendon autograft. Five- to nine-year follow-up evaluation. Am J Sports Med 1998; 26 (1) 20-29
    CrossrefPubMedGoogle Scholar
  • 4 Howe JG, Johnson RJ, Kaplan MJ, Fleming B, Jarvinen M. Anterior cruciate ligament reconstruction using quadriceps patellar tendon graft. Part I. Long-term followup. Am J Sports Med 1991; 19 (5) 447-457
    CrossrefPubMedGoogle Scholar
  • 5 Bach Jr BR. Revision anterior cruciate ligament surgery. Arthroscopy 2003; 19 (1) (Suppl. 01) 14-29
    PubMedGoogle Scholar
  • 6 Baer GS, Harner CD. Clinical outcomes of allograft versus autograft in anterior cruciate ligament reconstruction. Clin Sports Med 2007; 26 (4) 661-681
    CrossrefPubMedGoogle Scholar
  • 7 Biau DJ, Tournoux C, Katsahian S, Schranz P, Nizard R. ACL reconstruction: a meta-analysis of functional scores. Clin Orthop Relat Res 2007; 458 (458) 180-187
    CrossrefPubMedGoogle Scholar
  • 8 Biau DJ, Tournoux C, Katsahian S, Schranz PJ, Nizard RS. Bone-patellar tendon-bone autografts versus hamstring autografts for reconstruction of anterior cruciate ligament: meta-analysis. BMJ 2006; 332 (7548) 995-1001
    CrossrefPubMedGoogle Scholar
  • 9 Spindler KP, Kuhn JE, Freedman KB, Matthews CE, Dittus RS, Harrell Jr FE. Anterior cruciate ligament reconstruction autograft choice: bone-tendon-bone versus hamstring: does it really matter? A systematic review. Am J Sports Med 2004; 32 (8) 1986-1995
    CrossrefPubMedGoogle Scholar
  • 10 Spindler KP, Huston LJ, Wright RW , et al; MOON Group. The prognosis and predictors of sports function and activity at minimum 6 years after anterior cruciate ligament reconstruction: a population cohort study. Am J Sports Med 2011; 39 (2) 348-359
    CrossrefPubMedGoogle Scholar
  • 11 George MS, Dunn WR, Spindler KP. Current concepts review: revision anterior cruciate ligament reconstruction. Am J Sports Med 2006; 34 (12) 2026-2037
    CrossrefPubMedGoogle Scholar
  • 12 Shelbourne KD, Patel DV, Martini DJ. Classification and management of arthrofibrosis of the knee after anterior cruciate ligament reconstruction. Am J Sports Med 1996; 24 (6) 857-862
    CrossrefPubMedGoogle Scholar
  • 13 van Eck CF, Schkrohowsky JG, Working ZM, Irrgang JJ, Fu FH. Prospective analysis of failure rate and predictors of failure after anatomic anterior cruciate ligament reconstruction with allograft. Am J Sports Med 2012; 40 (4) 800-807
    CrossrefPubMedGoogle Scholar
  • 14 Gilbart MK, Chhabra A, Harner C. ACL Surgery- The Pittsburgh Experience. Sports Med Arthrosc 2005; 13 (2) 78-85
    PubMedGoogle Scholar
  • 15 Bach BR. Editorial Comments. Sports Med Arthrosc 2005; 13 (2) 59-60
    CrossrefPubMedGoogle Scholar
  • 16 Wetzler MJ, Getelman MH, Friedman MJ, Bartolozzi AR. Revision anterior cruciate ligament surgery: etiology of failures. Oper Tech Orthop 1998; 6: 64-70
    PubMedGoogle Scholar
  • 17 Lind M, Menhert F, Pedersen AB. The first results from the Danish ACL reconstruction registry: epidemiologic and 2 year follow-up results from 5,818 knee ligament reconstructions. Knee Surg Sports Traumatol Arthrosc 2009; 17 (2) 117-124
    CrossrefPubMedGoogle Scholar
  • 18 Wright RW, Huston LJ, Spindler KP , et al; MARS Group. Descriptive epidemiology of the Multicenter ACL Revision Study (MARS) cohort. Am J Sports Med 2010; 38 (10) 1979-1986
    CrossrefPubMedGoogle Scholar
  • 19 Louboutin H, Debarge R, Richou J , et al. Osteoarthritis in patients with anterior cruciate ligament rupture: a review of risk factors. Knee 2009; 16 (4) 239-244
    CrossrefPubMedGoogle Scholar
  • 20 Parkkari J, Pasanen K, Mattila VM, Kannus P, Rimpelä A. The risk for a cruciate ligament injury of the knee in adolescents and young adults: a population-based cohort study of 46 500 people with a 9 year follow-up. Br J Sports Med 2008; 42 (6) 422-426
    CrossrefPubMedGoogle Scholar
  • 21 Shelbourne KD, Gray T, Haro M. Incidence of subsequent injury to either knee within 5 years after anterior cruciate ligament reconstruction with patellar tendon autograft. Am J Sports Med 2009; 37 (2) 246-251
    CrossrefPubMedGoogle Scholar
  • 22 Wright RW, Magnussen RA, Dunn WR, Spindler KP. Ipsilateral graft and contralateral ACL rupture at five years or more following ACL reconstruction: a systematic review. J Bone Joint Surg Am 2011; 93 (12) 1159-1165
    PubMedGoogle Scholar
  • 23 Borchers JR, Pedroza A, Kaeding C. Activity level and graft type as risk factors for anterior cruciate ligament graft failure: a case-control study. Am J Sports Med 2009; 37 (12) 2362-2367
    CrossrefPubMedGoogle Scholar
  • 24 Salmon L, Russell V, Musgrove T, Pinczewski L, Refshauge K. Incidence and risk factors for graft rupture and contralateral rupture after anterior cruciate ligament reconstruction. Arthroscopy 2005; 21 (8) 948-957
    CrossrefPubMedGoogle Scholar
  • 25 Prodromos CC, Han Y, Rogowski J, Joyce B, Shi K. A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen. Arthroscopy 2007; 23 (12) 1320-1325 .e6
    CrossrefPubMedGoogle Scholar
  • 26 Kamath GV, Murphy T, Creighton RA, Viradia N, Taft TN, Spang JT. Anterior cruciate ligament injury, return to play, and reinjury in the elite collegiate athlete: analysis of an NCAA Division I Cohort. Am J Sports Med 2014; 42 (7) 1638-1643
    CrossrefPubMedGoogle Scholar
  • 27 Waldén M, Hägglund M, Magnusson H, Ekstrand J. Anterior cruciate ligament injury in elite football: a prospective three-cohort study. Knee Surg Sports Traumatol Arthrosc 2011; 19 (1) 11-19
    CrossrefPubMedGoogle Scholar
  • 28 Roos H, Ornell M, Gärdsell P, Lohmander LS, 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
    CrossrefPubMedGoogle Scholar
  • 29 Ichiba A, Kishimoto I. Effects of articular cartilage and meniscus injuries at the time of surgery on osteoarthritic changes after anterior cruciate ligament reconstruction in patients under 40 years old. Arch Orthop Trauma Surg 2009; 129 (3) 409-415
    CrossrefPubMedGoogle Scholar
  • 30 Shelbourne KD, Gray T. Results of anterior cruciate ligament reconstruction based on meniscus and articular cartilage status at the time of surgery. Five- to fifteen-year evaluations. Am J Sports Med 2000; 28 (4) 446-452
    Google Scholar
  • 31 Wu WH, Hackett T, Richmond JC. Effects of meniscal and articular surface status on knee stability, function, and symptoms after anterior cruciate ligament reconstruction: a long-term prospective study. Am J Sports Med 2002; 30 (6) 845-850
    PubMedGoogle Scholar
  • 32 Murawski CD, van Eck CF, Irrgang JJ, Tashman S, Fu FH. Operative treatment of primary anterior cruciate ligament rupture in adults. J Bone Joint Surg Am 2014; 96 (8) 685-694
    CrossrefPubMedGoogle Scholar
  • 33 Harner CD, Giffin JR, Dunteman RC, Annunziata CC, Friedman MJ. Evaluation and treatment of recurrent instability after anterior cruciate ligament reconstruction. Instr Course Lect 2001; 50: 463-474
    PubMedGoogle Scholar
  • 34 McConville OR, Kipnis JM, Richmond JC, Rockett SE, Michaud MJ. The effect of meniscal status on knee stability and function after anterior cruciate ligament reconstruction. Arthroscopy 1993; 9 (4) 431-439
    CrossrefPubMedGoogle Scholar
  • 35 Allen CR, Wong EK, Livesay GA, Sakane M, Fu FH, Woo SL. Importance of the medial meniscus in the anterior cruciate ligament-deficient knee. J Orthop Res 2000; 18 (1) 109-115
    Google Scholar
  • 36 Levy IM, Torzilli PA, Warren RF. The effect of medial meniscectomy on anterior-posterior motion of the knee. J Bone Joint Surg Am 1982; 64 (6) 883-888
    CrossrefPubMedGoogle Scholar
  • 37 Reinhardt KR, Hetsroni I, Marx RG. Graft selection for anterior cruciate ligament reconstruction: a level I systematic review comparing failure rates and functional outcomes. Orthop Clin North Am 2010; 41 (2) 249-262
    CrossrefPubMedGoogle Scholar
  • 38 Foster TE, Wolfe BL, Ryan S, Silvestri L, Kaye EK. Does the graft source really matter in the outcome of patients undergoing anterior cruciate ligament reconstruction? An evaluation of autograft versus allograft reconstruction results: a systematic review. Am J Sports Med 2010; 38 (1) 189-199
    CrossrefPubMedGoogle Scholar
  • 39 Caldwell III PE, Shelton WR. Indications for allografts. Orthop Clin North Am 2005; 36 (4) 459-467
    CrossrefPubMedGoogle Scholar
  • 40 Frank RM, McGill KC, Cole BJ , et al. An institution-specific analysis of ACL reconstruction failure. J Knee Surg 2012; 25 (2) 143-149
    Article in Thieme ConnectPubMedGoogle Scholar
  • 41 Maletis GB, Inacio MC, Funahashi TT. Analysis of 16,192 anterior cruciate ligament reconstructions from a community-based registry. Am J Sports Med 2013; 41 (9) 2090-2098
    CrossrefPubMedGoogle Scholar
  • 42 Lyman S, Koulouvaris P, Sherman S, Do H, Mandl LA, Marx RG. Epidemiology of anterior cruciate ligament reconstruction: trends, readmissions, and subsequent knee surgery. J Bone Joint Surg Am 2009; 91 (10) 2321-2328
    CrossrefPubMedGoogle Scholar
  • 43 Wolf BR, Ramme AJ, Wright RW , et al; MOON Knee Group. Variability in ACL tunnel placement: observational clinical study of surgeon ACL tunnel variability. Am J Sports Med 2013; 41 (6) 1265-1273
    CrossrefPubMedGoogle Scholar