Summary

This study systematically identifies risk factors for graft rupture following Anterior Cruciate Ligament Reconstruction (ACLR), emphasizing the effectiveness of specific stabilization techniques and the influence of postoperative posterior tibial slope on graft integrity.

Abstract

Background

Anterior Cruciate Ligament (ACL) injuries are prevalent among athletes and result in significant impacts on their athletic pursuits and quality of life. Following Anterior Cruciate Ligament (ACL) Reconstruction (ACLR), graft rupture is a complication for which the risk factors are not clearly identified. Identification and stratification of contributing factors will assist in the mitigation of graft rupture in post-ACLR patients.

Objectives
The purpose of this study was to identify and quantify the risk factors for graft rupture after ACLR.

Study Design & Methods
A systematic review with meta-analysis based on PRISMA guidelines was performed in 5 databases - Central, PubMed, SCOPUS, SportDiscus, Web of Science from inception to August 2023. Randomised Controlled Trials (RCTs) addressing the rates of graft ruptures in ACLR patients of all ages and gender were included. Meta-analyses using a random effect model (effect measure: odds ratio [OR] with 95% confidence interval [CI]) were performed where possible.

Results

A total of 18 RCTs met the inclusion criteria. Meta-analysis of 5 factors was conducted, while isolated reporting of 6 additional factors was noted. ACLR augmentation with both Lateral Extra-articular Tenodesis (LET) (OR 3.09; 95% CI 1.70-5.63; I2 = 0%) and anterolateral stabilisation techniques, including Anterolateral Ligament (ALL) reconstruction and anterolateral structural augmentation (ALSA), (OR 7.35; 95% CI 2.30-23.45; I2 = 0%) significantly decreased the risk of graft failure. A greater postoperative posterior tibial slope (PTS), of 11.9 ± 2.0 degrees compared to 9.4 ± 2.2 degrees, was positively correlated with increased risk of re-rupture (SMD 1.21; 95% CI 0.26-2.15; I2 = 56%).
Comparisons between hamstring and patellar graft selections (OR 1.30; 95% CI 0.40-4.19; I2 = 0%), as well as ipsilateral and contralateral donor sites (OR 0.76; 95% CI 0.14-4.11; I2 = 0%), yielded no significant correlations.

Conclusion

Augmentation of ACLR with additional stabilisation techniques such as LET, ALL and ALSA resulted in lower graft rupture rates. However, a greater postoperative PTS was shown to significantly increase the risk of graft rupture. Other factors like graft type and side of donor site did not have a significant effect on graft rupture rates.