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Validation of a Risk Calculator to Personalize Graft Choice and Reduce Rupture Rates for Anterior Cruciate Ligament Reconstruction

Hana Marmura, MPT, PhD
UNITED STATES

Validation of a Risk Calculator to Personalize Graft Choice and Reduce Rupture Rates for Anterior Cruciate Ligament Reconstruction

Hana Marmura, MPT, PhD, UNITED STATES Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, QATAR Kurt Paul Spindler, MD, UNITED STATES Michael W Kattan, PhD, UNITED STATES Isaac Briskin, MA, UNITED STATES Dianne M. Bryant, PhD, CANADA

University of Western Ontario, London, Ontario, CANADA

2021 Congress Abstract Presentation 6 minutes Not yet rated

Anatomic Location

Knee

Anatomic Structure

Ligaments

Diagnosis / Condition

Tears Instability

Treatment / Technique

Autograft Failed Repair / Reconstruction

Ligaments

ACL

Patient Populations

Pediatric / Adolescent Female Athletes Sport Specific Population

Sports Medicine

Preventative Sports Medicine Outcome Studies

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Summary: Validation of an ACL autograft risk calculator appropriate for shared decision making and clinical practice.

Background

Anterior cruciate ligament reconstructions (ACLR) fail at an alarmingly high rate in young active individuals. The Multicenter Orthopaedic Outcomes Network (MOON) knee group has developed an autograft risk calculator that uses characteristics of the patient and their lifestyle to predict the probability of graft rupture if the surgeon uses a hamstring tendon (HT) or a bone patellar tendon bone (BPTB) graft to reconstruct the ligament. If validated, this risk calculator can be used during the shared decision-making process to make optimal ACLR autograft choices and reduce rupture rates. The STABILITY 1 randomized clinical trial offers a large, rigorously collected dataset of similar young active patients, who received HT autograft with or without lateral extra-articular tenodesis (LET) for ACLR for validation.

Purpose

To validate the ACLR graft rupture risk calculator in a large external dataset, and to investigate the utility of both BPTB and LET for ACLR.

Methods

The model predictors for the risk calculator include age, sex, body mass index, sport played at the time of injury, Marx activity score, pre-operative knee laxity, and graft type. The STABILITY 1 trial dataset was used for external validation. Discriminative ability, calibration, and diagnostic test validity of the model were assessed. Finally, predictor strength in the initial and validation samples were compared.

Results

The model showed acceptable discriminative ability (AUC = 0.73), calibration (Brier score = 0.07), and specificity (85.3%) to detect patients who will suffer a graft rupture. Age, high-grade pre-operative knee laxity and graft type are significant predictors of graft rupture in young active patients. Both BPTB and the addition of LET to HT are protective against graft rupture versus HT autograft alone.

Conclusion

The MOON risk calculator is a valid predictor of ACLR graft rupture appropriate for clinical practice. This study provides further evidence supporting the idea that isolated HT autografts should be avoided for young active patients undergoing ACLR.

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Second-Look Arthroscopic Evaluation And Clinical Outcomes After Anatomical Double-Bundle Anterior Cruciate Ligament Reconstruction With Generalized Joint Laxity Or Hyperextended Knee Abstract Presentation 6 minutes Yasunari Oniki, MD, PhD, JAPAN Taiki Murakami, JAPAN Eiichi Nakamura, MD, PhD, JAPAN
Outcomes Following Anterior Cruciate Ligament Reconstruction in Young Patients: An Observational Study. ePoster Presentation Kunal Mohan, MB MCh MRCSI, IRELAND David Cooper, MB MRCSI, IRELAND Niall McGoldrick, MB MCh FRCS (Tr & Orth), IRELAND Martin Davey, MB MCh MRCSI, IRELAND Megan Diack, MBCHB, MRCSI, MCh, IRELAND Paula McQuail, MB FRCSI, IRELAND Fintan J. Shannon, FRCS (Tr/Orth), IRELAND
Pre-Operative Tunnel Widening Does Not Significantly Influence The Outcomes Of A Single-Stage Only Approach To Revision Acl Reconstruction: An Analysis Of 409 Consecutive Patients Abstract Presentation 5 minutes Adnan Saithna, MD, FRCS, UNITED STATES Charles Pioger, MD, FRANCE Johnny Rayes, MD, MSc, FEBOT, CANADA Ibrahim Haidar, MD, LEBANON Thomas Fradin, MD, FRANCE Cédric Ngbilo, MD, SWITZERLAND Thais Dutra Vieira, MD, FRANCE Etienne Cavaignac, MD,PhD, FRANCE Bertrand Sonnery-Cottet, MD, PhD, FRANCE
The Outcome Of Non-circular (Rectangle, Oval) Femoral Tunnel ACL Reconstruction, Does It Improve The Outcome Of ACL Reconstruction Surgery? Abstract Presentation 6 minutes S. Ali Ghasemi, MD, UNITED STATES Joseph McCahon, DO, UNITED STATES Arthur R Bartolozzi, MD, UNITED STATES
Clinical Outcomes Of Primary Acl Reconstruction With Tibial Attachment Preserving Quadrupled Hamstring Graft: Does Graft Size Matter? - A Prospective Study With Review Of Literature Abstract Presentation 5 minutes Shaival Dalal, M.S.MRCS(Edinburgh), UNITED KINGDOM Ghislain N. Aminake, MBBS, MMed(Ortho),MRCPS(Glasg), CAMEROON Randy Guro, BSc, UNITED KINGDOM Amit Pramod Chandratreya, FRCS(Tr&Orth), MS(Orth), MCh(Orth), UNITED KINGDOM Rahul Kotwal, FRCS(Ortho), UNITED KINGDOM
Lower Socioeconomic Status Adversely Affects Access To Care And The Rate Of Instability Events And Bucket Handle Meniscus Tears Following Anterior Cruciate Ligament Tears Abstract Presentation 6 minutes Edward S. Chang, MD, UNITED STATES Blake M. Bodendorfer, MD, UNITED STATES Andrew Curley, MD, UNITED STATES David X. Wang, MD, UNITED STATES Christine Conroy, MD, UNITED STATES Mark Hopkins, MD, UNITED STATES Brian McCormick, MD, UNITED STATES Caroline Fryar, MD, UNITED STATES
Changes In Muscle Strength And Hop Performance After ACL Reconstruction. A Randomized Controlled Trial Comparing Patellar Tendon And Hamstring Tendon Autografts With Standard Or Accelerated Rehabilitation Abstract Presentation 6 minutes Riccardo Cristiani, MD, PhD, SWEDEN Christina Mikkelsen, PT, SWEDEN Peter Olov Wange, MD, SWEDEN Daniel Olsson, PhD, SWEDEN Anders Stalman, MD, PhD, Professor, SWEDEN Bjorn Engstrom, MD, PhD, Assoc. Prof., SWEDEN
PROSPECTIVE RANDOMIZED STUDY: Double-bundle against single-bundle ACL reconstruction using allografts Abstract Presentation 5 minutes Edmundo Berumen Nafarrate, PhD, Prof., MEXICO Carlos Alejandro Vega Najera, MD, MEXICO Joel Alejandro Cabral, MD, MEXICO Jesus Javier Tonche, MD, MEXICO Ivan Ramos Moctezuma, Eng, MEXICO Luis Sigala Gonzalez, Eng, MEXICO Avril Pérez Fontes, MD, MEXICO Fatima Quintana Trejo, Eng, MEXICO Carlos Leal, MD, Prof., COLOMBIA
Skeletally Immature Patients with Classic Anterior Cruciate Ligament Bone Bruise Patterns Have a Higher Chance of Having an Intact Anterior Cruciate Ligament than Skeletally Mature Patients Abstract Presentation 6 minutes Aaron Baessler, MD, UNITED STATES Jessica M Buchman, MD, UNITED STATES Dexter Witte, MD, UNITED STATES Tyler Brolin, MD, UNITED STATES Thomas Ward Throckmorton, MD Frederick M. Azar, MD, UNITED STATES David Lee Bernholt, MD, UNITED STATES
Coach Education Improves Implementation Of ACL Injury Prevention Programs: A Cluster-Randomized Controlled Trial Abstract Presentation 5 minutes Daphne Ling, PhD, MPH, TAIWAN Caroline Boyle, UNITED STATES Brandon Schneider, MS, UNITED STATES Joseph Janosky, DrPHc, MS, PT, ATC, UNITED STATES James Kinderknecht, UNITED STATES Robert G. Marx, MD, UNITED STATES

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Validation of a Risk Calculator to Personalize Graft Choice and Reduce Rupture Rates for Anterior Cruciate Ligament Reconstruction

Validation of a Risk Calculator to Personalize Graft Choice and Reduce Rupture Rates for Anterior Cruciate Ligament Reconstruction

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Methods

Results

Conclusion

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Validation of a Risk Calculator to Personalize Graft Choice and Reduce Rupture Rates for Anterior Cruciate Ligament Reconstruction

Validation of a Risk Calculator to Personalize Graft Choice and Reduce Rupture Rates for Anterior Cruciate Ligament Reconstruction

Background

Purpose

Methods

Results

Conclusion

More ISAKOS 2021: Global Content