ACL Reconstruction Patients Have Increased Risk of Knee Arthroplasty at 15 Years of Follow-up

Visnes, Håvard; Gifstad, Tone; Persson, Andreas; Lygre, Stein Håkon Låstad; Engebretsen, Lars; Drogset, Jon Olav; Furnes, Ove

doi:10.2106/jbjs.oa.22.00023

Cited by 5 publications

(3 citation statements)

References 23 publications

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“…A possible explanation could be that the cartilage lesion increases the risk of knee arthroplasty substantially more than ACL and meniscal injury do, thereby limiting the functional impact of the latter. Visnes et al found a 3-times increased risk of knee arthroplasty in 30 to 39-year-old patients and a doubled risk in 40 to 49-year-old patients after ACL surgery compared with the general population 41 . In our cartilage cohort, the corresponding values were a 416-times increased risk and a 49-times increased risk, respectively.…”

Section: Risk Of Arthroplastymentioning

confidence: 99%

The Long-Term Risk of Knee Arthroplasty in Patients with Arthroscopically Verified Focal Cartilage Lesions

Birkenes

Furnes

Lygre

et al. 2023

Journal of Bone and Joint Surgery

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Background:Focal cartilage lesions are common in the knee. The risk of later ipsilateral knee arthroplasty remains unknown. The purposes of the present study were to evaluate the long-term cumulative risk of knee arthroplasty after arthroscopic identification of focal cartilage lesions in the knee, to investigate the risk factors for subsequent knee arthroplasty, and to estimate the subsequent cumulative risk of knee arthroplasty compared with that in the general population.Methods:Patients who had undergone surgical treatment of focal cartilage lesions at 6 major Norwegian hospitals between 1999 and 2012 were identified. The inclusion criteria were an arthroscopically classified focal cartilage lesion in the knee, an age of ≥18 years at the time of surgery, and available preoperative patient-reported outcomes (PROMs). The exclusion criteria were osteoarthritis or “kissing lesions” at the time of surgery. Demographic data, later knee surgery, and PROMs were collected with use of a questionnaire. A Cox regression model was used to adjust for and investigate the impact of risk factors, and Kaplan-Meier analysis was performed to estimate cumulative risk. The risk of knee arthroplasty in the present cohort was compared with that in the age-matched general Norwegian population.Results:Of the 516 patients who were eligible, 322 patients (328 knees) consented to participate. The mean age at the time of the index procedure was 36.8 years, and the mean duration of follow-up was 19.8 years. The 20-year cumulative risk of knee arthroplasty in the cartilage cohort was 19.1% (95% CI, 14.6% to 23.6%). Variables that had an impact on the risk of knee arthroplasty included an ICRS grade of 3 to 4 (hazard ratio [HR], 3.1; 95% CI, 1.1 to 8.7), an age of ≥40 years at time of cartilage surgery (HR, 3.7; 95% CI, 1.8 to 7.7), a BMI of 25 to 29 kg/m2 (HR, 3.9; 95% CI, 1.7 to 9.0), a BMI of ≥30 kg/m2 (HR, 5.9; 95% CI, 2.4 to 14.3) at the time of follow-up, autologous chondrocyte implantation (ACI) at the time of the index procedure (HR, 3.4; 95% CI, 1.0 to 11.4), >1 focal cartilage lesion (HR, 2.1; 95% CI, 1.1 to 3.7), and a high preoperative visual analog scale (VAS) score for pain at the time of the index procedure (HR, 1.1; 95% CI, 1.0 to 1.1). The risk ratio of later knee arthroplasty in the cartilage cohort as compared with the age-matched general Norwegian population was 415.7 (95% CI, 168.8 to 1,023.5) in the 30 to 39-year age group.Conclusions:In the present study, we found that the 20-year cumulative risk of knee arthroplasty after a focal cartilage lesion in the knee was 19%. Deep lesions, higher age at the time of cartilage surgery, high BMI at the time of follow-up, ACI, and >1 cartilage lesion were associated with a higher risk of knee arthroplasty.Level of Evidence:Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Section: Risk Of Arthroplastymentioning

confidence: 99%

The Long-Term Risk of Knee Arthroplasty in Patients with Arthroscopically Verified Focal Cartilage Lesions

Birkenes

Furnes

Lygre

et al. 2023

Journal of Bone and Joint Surgery

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“… 2 , 3 Individuals who experience sports injuries are at risk of developing locomotory diseases. 3 , 4 Sports injuries adversely affect athletes in the present and the future because they affect athletes’ quality of life and longevity. Thus, sports injury prevention has become an important social issue from medical and public health perspectives.…”

Section: Introductionmentioning

confidence: 99%

Goal Orientation and Desire for Approval Were Associated With Sports Injuries Among Young Japanese Athletes

Kimotsuki,

Ogasawara,

Iwasaki

et al. 2024

AJPM Focus

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“…Recurrent instability also results in downstream consequences, including further damage to structures essential for knee stability, as well as accelerated progression of osteoarthritis. 19 Multiple factors are responsible for the incidence of graft failure after ACLR. 2 , 13 Tunnel malposition of the femoral tunnel has been shown to be the cause of more than 80% of graft failures after ACLR.…”

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confidence: 99%

Failure Rates and Complications After Multiple-Revision ACL Reconstruction: Comparison of the Over-the-Top and Transportal Drilling Techniques

Özbek,

Winkler,

Nazzal

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: Multiple-revision anterior cruciate ligament reconstruction (ACLR) presents several technical challenges, often due to residual hardware, tunnel widening, malposition, or staged surgeries. Purpose: To compare failure and complication rates between the over-the-top (OTT) and transportal drilling (TD) techniques in patients undergoing surgery for failed revision ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: The medical records of patients with at least 2 revision ACLRs using either the OTT or TD technique were reviewed retrospectively. Data on patient demographics, graft characteristics, number of revisions, concomitant procedures, complications, and failures were collected. Between-group comparisons of continuous and categorical variables were conducted with the independent-samples t test and the Fisher exact or chi-square test, respectively. Results: A total of 101 patients undergoing multiple-revision ACLR with OTT (n = 37, 37%) and TD (n = 64, 63%) techniques were included for analysis. The mean follow-up time was 60 months (range, 12-196 months). There were no significant differences in age, sex, body mass index, laterality, or follow-up length between groups ( P > .05). Allograft was the graft used most frequently (n = 64; 67.3%) with no significant differences between groups in graft diameter ( P > .05). There were no statistically significant differences between groups regarding rate of concurrent medial and lateral meniscus, cartilage, or lateral extra-articular procedures ( P > .05). There was also no significant66 between-group difference in complication rate (OTT: n = 2 [5.4%]; TD: n = 8 [13%]) or graft failure rate (OTT: n = 4 [11%]; TD: n = 14 [22%]) ( P > .05 for both). Conclusion: The results of this study showed notably high failure and complication rates in challenging multiple-revision ACLR. Complication and failure rates were similar between techniques, demonstrating that the OTT technique is a valuable alternative that can be used in a revision ACLR, particularly as a single-stage approach when the single-stage TD technique is not possible.

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ACL Reconstruction Patients Have Increased Risk of Knee Arthroplasty at 15 Years of Follow-up

Cited by 5 publications

References 23 publications

The Long-Term Risk of Knee Arthroplasty in Patients with Arthroscopically Verified Focal Cartilage Lesions

The Long-Term Risk of Knee Arthroplasty in Patients with Arthroscopically Verified Focal Cartilage Lesions

Goal Orientation and Desire for Approval Were Associated With Sports Injuries Among Young Japanese Athletes

Failure Rates and Complications After Multiple-Revision ACL Reconstruction: Comparison of the Over-the-Top and Transportal Drilling Techniques

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