Summary: Analysis of risk factors of postoperative ACL graft failure in a large cohort of ACLR patients with and without a monoloop lateral extra-articular tenodesis (mLET).

Introduction

Anterior cruciate ligament reconstruction (ACLR) is a well-established procedure to treat symptomatic ACL insufficient knees, but graft failure remains a feared complication. The purpose of this study is to analyze risk factors of postoperative graft failure in a large cohort of ACLR patients with and without a monoloop lateral extra-articular tenodesis (mLET).

Methods

A single center, two-surgeon, non-randomized clinical trial, with retrospective analysis of prospectively collected data focused on a population of 748 patients with an acute primary ACL tear. All patients were treated with quadrupled semitendinosus ACLR with minimal follow-up of 2 years (mean follow-up 50 months (24-89). Patient demographics were recorded. Categorical variables were sex (461M (61.6%), 287F (38.4%)), age below 25 years old (N=271, 36.2%), smoking (N=126, 16.8%), soccer (N=264, 35.3%), Tegner activity score (8 or higher) (N=273, 36.5%), meniscal injury (N= 318, 42.5%) and mLET (N=211, 28.2%). Primary outcome was graft failure, defined as the need for revision or symptomatic ACL instability. Statistical analysis was performed to identify predictors of ACL graft failure (univariate analysis, binary logistic regression analysis and model reduction). Finally, a subgroup analysis was performed on the populations at high risk to study the effect of mLET on graft failure.

Results

Mean age at surgery was 31 (13-61), mean weight 75.9kg (47-125), mean length 175cm (152-202), mean BMI 24.4 3 (18-39). Overall, graft failure was observed in 25/748 (3.34%) patients.
Following the predictive model, the likelihood of graft failure increased by a factor of 29.3 (p <0.001) if age below 25 years old; factor 7.4 if isolated ACLR without mLET (p=0.002); 4.4 (p=0.002) if playing soccer, 3.1 (p=0.021) if smoking, 2.8 (p=0.023) if associated meniscus injury.
The addition of mLET to ACLR reduced the risk of graft failure by a factor of 11.3 (p=0.002) in the age group below 25 years old. In patients with concomitant meniscal lesions, mLET reduced the likelihood of graft failure by a factor of 8 (p=0.01) and in soccer players by a factor of 5.2 (p=0.016). None of the smokers experienced graft failure after mLET.

Conclusions

In this large cohort study, the likelihood of ACLR graft failure was significantly increased in patients below 25 years old (RR 29.3), in isolated ACLR without mLET (RR 7.4), in soccer players (RR 4.4), in smokers (RR 3.1) and when concomitant meniscal injuries were diagnosed (RR 2.8). In contrast, the addition of mLET, as the only surgically modifiable predictor, actively reduced the risk of ACL graft failure in the study population, especially in the groups at risk (below 25, soccer, meniscus injury, smoker).

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Impingement Due to Graft Buckling Is More Prevalent after ACL Reconstructions with an Adjustable-Loop Compared to a Fixed-Loop Abstract Presentation 5 minutes Julian De Rover, NETHERLANDS Inge Van Den Akker-Scheek, PhD, NETHERLANDS Hugo Christiaan van der Veen, MD, PhD, NETHERLANDS
High Rate of Initially Overlooked Kaplan Fiber Complex Injuries in Patients With Isolated Anterior Cruciate Ligament Injury Abstract Presentation 5 minutes Ryan M Bell, BS, UNITED STATES Daniel P. Berthold, Association.-Prof., GERMANY Lukas Willinger, MD, GERMANY Matthew R. Levasseur, MD, UNITED STATES Daniel Marrero, MD, UNITED STATES Lukas Nawid Muench, MD, GERMANY Andreas B. Imhoff, MD, Prof. Emeritus, GERMANY Elmar Herbst, MD, PhD, GERMANY Mark P. Cote, PT, DPT, MSCTR, UNITED STATES Robert A. Arciero, MD, UNITED STATES Cory M. Edgar, MD, PhD, UNITED STATES
Xenograft For Anterior Cruciate Ligament Reconstruction Was Associated With High Graft Processing Infection. Abstract Presentation 6 minutes Willem M. van der Merwe, MBChB, FCS(SA)Ortho, SOUTH AFRICA Martin Lind, MD, PhD, Prof., DENMARK Peter Faunoe, MD, DENMARK Kees van Egmond, MD, NETHERLANDS Stefano Zaffagnini, MD, Prof., ITALY Maurilio Marcacci, MD, ITALY Ramon Cugat Bertomeu, MD, PhD, SPAIN Rene E. Verdonk, Prof Em, MD, PhD, BELGIUM Ernique Ibanez, MD, PhD, SPAIN Giulio Maria Marcheggiani Muccioli, MD, PhD, Associate Professor, 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
Validation of a Risk Calculator to Personalize Graft Choice and Reduce Rupture Rates for Anterior Cruciate Ligament Reconstruction Abstract Presentation 6 minutes 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
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, PhD, EMBA, FRCS, 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
Full-Thickness Peroneus Longus Tendon Autograft For Anterior Cruciate Ligament Reconstruction: Outcomes And Donor Site Morbidity ePoster Presentation Tarun Goyal, MBBS, MS, DNB, MCh, FRCS (Edin), INDIA Souvik Paul, MBBS, MS Orthopedics (AIIMS), DNB, MCh, Dip SICOT, INDIA Lakshmana Das Sekar, MS, DNB Orthopaedics, INDIA Arghya Kundu Choudhury, MS, MCh Joint replacement and reconstruction, INDIA
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
Creating A Crosswalk For Knee Outcomes After ACLR From The KOOS(5) To The IKDC-SKF Abstract Presentation 6 minutes Jessica L. Johnson, DPT, PhD, UNITED STATES Aaron Boulton, PhD, UNITED STATES Kurt Paul Spindler, MD, UNITED STATES Laura J. Huston, MS, UNITED STATES Tim Spalding, FRCS(Orth), UNITED KINGDOM Laura Asplin, UNITED KINGDOM May Arna Risberg, PT, PhD, NORWAY Lynn Snyder-Mackler, PT, ScD, FAPTA, UNITED STATES
Quantitative Evaluation of Lateral Articular Cartilage Quality on Magnetic Resonance Imaging at 2-years following Anterior Cruciate Ligament Reconstruction With Or Without A Lateral Extra-Articular Tenodesis Abstract Presentation 6 minutes Andrew Firth, PhD, CANADA Dianne M. Bryant, PhD, CANADA Jaques Milner , CANADA Stephany Pritchett, MD, FRCPC, DABR, CANADA David Holdsworth, PhD, Canada Stability Study Group, CANADA Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, QATAR

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Risk Factor Analysis for Graft Failure after Anterior Cruciate Ligament Reconstruction with or without mLET

Risk Factor Analysis for Graft Failure after Anterior Cruciate Ligament Reconstruction with or without mLET

Introduction

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Results

Conclusions

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Risk Factor Analysis for Graft Failure after Anterior Cruciate Ligament Reconstruction with or without mLET

Risk Factor Analysis for Graft Failure after Anterior Cruciate Ligament Reconstruction with or without mLET

Introduction

Methods

Results

Conclusions

More ISAKOS 2021: Global Content