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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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
Risk Factor Analysis for Graft Failure after Anterior Cruciate Ligament Reconstruction with or without mLET Abstract Presentation 7 minutes Filip R Hendrikx, MD, BELGIUM Koen Lagae, MD, BELGIUM Annemieke Van Haver, PhD, MSc, BELGIUM Peter Verdonk, MD, PhD, BELGIUM
Higher Return To Pre-Injury Activity Levels Following ACL Reconstruction With Bone-Patellar Tendon-Bone Versus Hamstring Tendon Autograft In High Activity Patients: Results From The New Zealand ACL Registry Abstract Presentation 6 minutes Simon W. Young, MD, FRACS, NEW ZEALAND Richard Rahardja, MBChB, BMedSc(Hons), NEW ZEALAND Mark G. Clatworthy, FRACS, NEW ZEALAND Paul Monk, DPhil (Oxon), FRCS, NEW ZEALAND Hamish Love, FRACS, NEW ZEALAND
Local Anaesthetic Infiltration (Lia) Is Equally Effective As Adductor Nerve Blocks For Pain Relief In Anterior Cruciate Ligament (Acl) Reconstructions. Abstract Presentation 8 minutes Mohammad Abou Salhab, MBChB, MSc, UNITED KINGDOM Sonal Sonwalkar , FRCA, UNITED KINGDOM Sanjeev Anand, MD, UNITED KINGDOM Martin Stone, MD, UNITED KINGDOM
Dynamic Radiostereometry Evaluation Of Two Different Anterior Cruciate Ligament Reconstruction Techniques: Does Single Bundle Reconstruction Plus Lateral Plasty Cause Knee Over-Constraint? Abstract Presentation 4 minutes Alberto Grassi, PhD, ITALY Stefano Di Paolo, Eng, PhD, ITALY Piero Agostinone, MD, QATAR Gian Andrea Lucidi, MD, ITALY Erika Pinelly, MsC, ITALY Marco Bontempi, PhD, ITALY Laura Bragonzoni, Prof., ITALY Stefano Zaffagnini, MD, Prof., ITALY
Quadriceps Tendon Vs. Hamstring Tendon Autograft In Primary Anterior Cruciate Ligament Reconstruction: A Matched-Pairs Study With A Mean Follow-Up Of 6.5 Years Award Winner 5 minutes Armin Runer, PD MD, GERMANY Aline Suter, MD, AUSTRIA Tommaso Roberti di Sarsina, MD, ITALY Caroline Hepperger, PhD, AUSTRIA Peter Gföller, MD, AUSTRIA Christian Hoser, MD, AUSTRIA Robert Csapo, PhD, AUSTRIA Christian Fink, MD, Prof., AUSTRIA
Tunnel Position In Anterior Cruciate Ligament Reconstruction Varies Between High Volume And Low Volume Surgeons Abstract Presentation 6 minutes Jonathan D Hughes, MD, PhD, UNITED STATES Christopher M. Gibbs, MD, UNITED STATES Akere Atte, MD, PharmD, UNITED STATES Anmol Almast, BS, UNITED STATES Mikael Sansone, MD, PhD, SWEDEN Jon Karlsson, MD, PhD, Prof., SWEDEN Volker Musahl, MD, Prof., UNITED STATES
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

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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