Summary: The overall clinical failure rate of service members with ACLR is nearly 18% with minimum 4- year follow-up, where more patients are likely to fail due to revision surgery than medical separation.

Background

Anterior cruciate ligament tears and anterior cruciate ligament reconstruction (ACLR) are common in young athletes. The modifiable and non-modifiable factors contributing to ACLR failure and reoperation are incompletely understood. The purpose of this study was to determine ACLR failure rates in a physically high-demand population and identify the patient specific risk factors that portend to failure.

Methods

A consecutive series of military service members with ACLR with and without concomitant procedures (meniscus [M] and/or cartilage [C]) done at military facilities between October 2008 to September 2011was completed via the Military Health System Data Repository. Patients had to be continuously enrolled with no history of knee surgeries for two years prior to the primary ACLR. ACLR failure was defined as revision ACLR or the inability to return to the minimum military physical standards (medical separation) within four years following the primary ACLR. Kaplan-Meier survival curves were estimated and evaluated with Wilcoxon test. Cox Proportional Hazard Models calculated hazard ratios (HR) with 95% confidence intervals (95% CI) to identify demographic and surgical factors that influenced ACLR failure for the isolated ACLR (KA), ACLR Meniscus (KMA), ACLR Cartilage (KCA), ACLR Meniscus and Cartilage (KAMC).

Results

Of the 2,735 primary ACLRs included in the study, 17.7% experienced ACLR failure within four years, including 9.5% (261/2,735) undergoing revision ACLR and 8.2% (224/2,735) due to medical separation. The factors that increased failure include: Army Service (HR 2.188, 95% CI: 1.668, 2.870), >180 days from injury to ACLR (HR 1.550, 95% CI: 1.157, 2.076), tobacco use (HR 1.429 95% CI: 1.174, 1.738), and younger patient age (HR 0.977, 95% CI: 0.958, 0.996).

Conclusion

The overall clinical failure rate of service members with ACLR is 17.7% with minimum four year follow-up, where more patients are likely to fail due to revision surgery than medical separation. The cumulative probability of survival at for years was 78.5%. Smoking cessation and treating ACLR patients promptly are modifiable risk factors impacting either graft failure or medical separation.

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Effect Of Graft Choice On 6-Year Outcomes Of Revision Anterior Cruciate Ligament Reconstruction In The Multicenter ACL Revision Study (Mars) Cohort Abstract Presentation 6 minutes Rick W. Wright, MD, UNITED STATES
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
THE OUTCOME OF BALANCE EXERCISES AND AGILITY TRAINING FOR POST ANTERIOR CRUCIATE LIGAMENT (ACL) RECONSTRUCTION: CLINICAL ASSESSMENT Abstract Presentation 7 minutes SITI MAIZATUL AKMAL ISMAIL, Medical Science (Orthopaedic Surgery Sports), MALAYSIA
MRI After ACL Reconstruction Demonstrates that Hamstring Grafts Heal and Integrate at Different Rates Abstract Presentation 6 minutes Sven Edward Putnis, MB ChB FRCS(Tr&Orth), UNITED KINGDOM Takeshi Oshima, MD, PhD, JAPAN Antonio Klasan, MD, AUSTRIA Samuel Grasso, PhD, B. Engineering (Mechanical), AUSTRALIA Thomas Neri, MD, PhD, Prof., FRANCE Myles R. J. Coolican, FRACS, AUSTRALIA Brett A. Fritsch, MBBS BSc(Med), FRACS, FAOrthA, AUSTRALIA David A. Parker, MBBS, BMedSc, FRACS, AUSTRALIA
Posterior Tibial Plateau Impaction Fractures Are Not Associated With Increased Knee Instability: A Quantitative Pivot Shift Analysis Abstract Presentation 8 minutes Brian M Godshaw, MD, UNITED STATES Joshua C Setliff, BA, UNITED STATES Jonathan D Hughes, MD, UNITED STATES Volker Musahl, MD, Prof., UNITED STATES
The Use Of An Internal Brace In A Single Bundle Hamstring Graft And Its Effect On Graft Healing At 1 Year After Anterior Cruciate Ligament Reconstruction ePoster Presentation Claire Bolton, FRACS, MBBS, AUSTRALIA Brett A. Fritsch, MBBS BSc(Med), FRACS, FAOrthA, AUSTRALIA David A. Parker, MBBS, BMedSc, FRACS, AUSTRALIA Bruno M. Giuffré, MD, AUSTRALIA
Comparative Study Of “Concomitant Patellar Tendon Rupture With Anterior cruciate ligament tear and Patellar Tendon Rupture With Multi- Ligamentous Knee Injury –MLKI” Abstract Presentation 6 minutes Silvampatti Ramasamy Sundararajan, MS(Orth), INDIA Rajagopalakrishnan Ramakanth, D.ortho, DNB(ortho), D.SICOT, INDIA S Rajasekaran, MS(Orth),DOrth,DNB,FRCS(Ed),FRCS(Lon),MCh(Liv),PhD, INDIA
Contralateral versus ipsilateral quadriceps graft, for anterior cruciate ligament reconstruction. Abstract Presentation 6 minutes Franco Della Vedova, MD, ARGENTINA Hernan Galan, MD, ARGENTINA Daniel A. Slullitel, MD, Prof., ARGENTINA

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Survivability Of Primary Anterior Cruciate Ligament Reconstructions In A Physically High Demand Population

Survivability Of Primary Anterior Cruciate Ligament Reconstructions In A Physically High Demand Population

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Survivability Of Primary Anterior Cruciate Ligament Reconstructions In A Physically High Demand Population

Survivability Of Primary Anterior Cruciate Ligament Reconstructions In A Physically High Demand Population

Background

Methods

Results

Conclusion

More ISAKOS 2021: Global Content