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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Concurrent Treatment Of A Displaced Bucket Handle And Anterior Cruciate Ligament Reconstruction: A Higher Risk Of Stiffness? Abstract Presentation 5 minutes Etienne Deroche, MD, FRANCE Cécile Batailler, MD, PhD, FRANCE John Swan, MBBS, FRANCE Sebastien Lustig, MD, PhD, Prof., FRANCE Elvire Servien, MD, PhD, Prof., FRANCE
Tranexamic Acid Has No Effect On Post-Operative Hemarthrosis Or Pain Control Following Acl Reconstruction Using Bone Patella Tendon Bone Autograft: A Double-Blinded Randomized Control Trial Abstract Presentation 5 minutes Jordan W Fried, BM, UNITED STATES David Bloom, BA, UNITED STATES Eoghan T. Hurley, MB, BCh, MCh, IRELAND Samuel Baron, MD, UNITED STATES Kirk Anthony Campbell, MD, UNITED STATES Eric Jason Strauss, MD Laith M. Jazrawi, MD, UNITED STATES Michael J Alaia, MD, UNITED STATES
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
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
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
Quadriceps Tendon Autograft Has Lower MRI Signal Than Hamstring Tendon Autograft In Anterior Cruciate Ligament Reconstructions Of Adolescent Athletes Abstract Presentation 5 minutes David Alcoloumbre, MD, UNITED STATES Alexandra Hunter Aitchison, UNITED STATES Douglas Mintz, MD, UNITED STATES Frank A. Cordasco, MD, MS, UNITED STATES Daniel W. Green, MD, MS, UNITED STATES
Ligamentous Laxity, Male Sex, Chronicity, Meniscus Injury And Posterior Tibial Slope Are Associated With A High-Grade Pre-Operative Pivot Shift: A Post Hoc Analysis Of The Stability Study Abstract Presentation 6 minutes Lachlan Batty, FRACS, AUSTRALIA Andrew Firth, PhD, CANADA Gilbert Moatshe, MD, PhD, NORWAY Dianne M. Bryant, PhD, CANADA S. Mark A. Heard, MD, FRCS, CANADA Robert G. McCormack, MD, CANADA Alex Rezansoff, MD, FRCSC, CANADA Devin Clarke Peterson, MD, FRCSC, Dip Sport Med, CANADA Davide Bardana, MD, CANADA Peter B. MacDonald, MD, FRCS, Dip Sport Med, CANADA Tim Spalding, FRCS(Orth), UNITED KINGDOM Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, QATAR
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
Relationship Between Posterior Tibial Slope And Sagittal Plane Mechanics During Jump Landing After Anterior Cruciate Ligament Reconstruction Abstract Presentation 6 minutes Robert A. Duerr, MD, UNITED STATES Jennifer Perry, MS, UNITED STATES Robert A Magnussen, MD, MPH, UNITED STATES David C. Flanigan, MD, UNITED STATES Benjamin Ormseth, BS, UNITED STATES Robert Siston, PhD, UNITED STATES Andrew Garrone, MD, UNITED STATES Christopher C. Kaeding, MD, UNITED STATES Laura C. Schmitt, PT, PhD, UNITED STATES

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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

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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