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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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Value, Limitations And Recommendations For Use Of Metal-Reduction Knee MRI Sequences Following Anterior Cruciate Ligament Reconstruction Abstract Presentation 6 minutes Brandon Zhao, MD, CANADA Nabil Khan, MBChB, MMED, FCS Orth, CANADA Mark F. Sommerfeldt, MD, CANADA Anukul Panu, MD, CANADA Jacob L Jaremko, MD, PhD, CANADA Catherine May Ting Hui, MD, FRCSC, CANADA
Predicting Subjective Failure of ACL Reconstruction: A Machine Learning Analysis of the Norwegian Knee Ligament Register and Patient Reported Outcomes Award Winner 5 minutes R. Kyle Martin, MD, FRCSC, UNITED STATES Solvejg Wastvedt, BA, UNITED STATES Ayoosh Pareek, MD, UNITED STATES Andreas Persson, MD, PhD, NORWAY Havard Visnes, MD, PT, PhD, NORWAY Anne Marie Fenstad, MSc, NORWAY Gilbert Moatshe, MD, PhD, NORWAY Julian Wolfson, PhD, UNITED STATES Lars Engebretsen, MD, PhD, NORWAY
The Effect of Lateral Extra-Articular Tenodesis on Medial and Lateral Menisci Loading in Response To Simulated Tests of the Pivot Shift and Anterior Laxity Abstract Presentation 6 minutes Niv Marom, MD, ISRAEL Hamid Jahandar, BS, UNITED STATES Zaid Zayyad, MD, MS, UNITED STATES thomas fraychineaud, MD, UNITED STATES Herve Ouanezar, MD, UNITED ARAB EMIRATES Ronak M. Patel, MD, UNITED STATES Carl W Imhauser, PhD, UNITED STATES Thomas L. Wickiewicz, MD, UNITED STATES Andrew D. Pearle, MD, UNITED STATES Danyal H. Nawabi, MD, FRCS(Orth), UNITED STATES
Factors associated with anterior cruciate ligament (ACL) reconstruction among ACL injuries in Alberta, Canada ePoster Presentation Yuba Raj Paudel, MPH, CANADA Mark F. Sommerfeldt, MD, CANADA Donald C. Voaklander, PhD, CANADA
Can Pre-operative MRI Accurately Predict Hamstring Autograft Diameter in Anterior-cruciate Ligament Reconstruction? Abstract Presentation 6 minutes Michael Tan Arnold, BS, UNITED STATES Ignacio Garcia-Mansilla, MD, ARGENTINA Myra Trivellas, MD, UNITED STATES Thomas J. Kremen, 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, Associate Professor, SWEDEN Bjorn Engstrom, MD, PhD, Assoc. Prof., SWEDEN
Comparison of three different Quadriceps Tendon ACL graft to BTB and Semi-T grafts: A biomechanical study ePoster Presentation Marc Jacob Strauss, MD, NORWAY Jonathan Miles, M.S, UNITED STATES Mitchell Iung Kennedy, BS, UNITED STATES Gilbert Moatshe, MD, PhD, NORWAY Grant J Dornan, MS, UNITED STATES Martin Lind, MD, PhD, Prof., DENMARK Lars Engebretsen, MD, PhD, NORWAY Robert F. LaPrade, MD, PhD, UNITED STATES
A Comparison of Lower Limb Strength and Plyometric Ability in Athletes who underwent ACLR with Lateral Extra-Articular Ilio-Tibial Band Tenodesis when compared with Isolated ACLR Surgery. A Biomechanical Study. Abstract Presentation 7 minutes Bláithín Brady, BSc MSc , IRELAND Sarah Crosbie, BSc, IRELAND Neil Welch, BSc MSc PhD, IRELAND Mihai Vioreanu, MD, MCh, FFSEM, FRCSI(Tr&Orth), IRELAND
Survivability Of Primary Anterior Cruciate Ligament Reconstructions In A Physically High Demand Population Abstract Presentation 6 minutes Ashley Bee Anderson, MD, UNITED STATES Travis Dekker, MD, UNITED STATES Veronika Pav, MS, UNITED STATES Timonthy C Mauntel, PhD, UNITED STATES Matthew T. Provencher, MD, UNITED STATES John M. Tokish, MD, UNITED STATES Jon F. Dickens, MD, UNITED STATES
The Lateral Femoral Notch Sign Entails Increased Rotatory Laxity After Acl-Injury. Pivot Shift Quantification With Surgical Navigation System Abstract Presentation 5 minutes Gian Andrea Lucidi, MD, ITALY Piero Agostinone, MD, QATAR Stefano Di Paolo, Eng, PhD, ITALY Alberto Grassi, PhD, ITALY Luca Macchiarola, MD, ITALY Giacomo Dal Fabbro, MD, AUSTRALIA Nicola Pizza, MD, ITALY Stefano Zaffagnini, MD, Prof., ITALY
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

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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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Purpose

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