Additional Surgery After Anterior Cruciate Ligament Reconstruction: Can We Improve Technical Aspects of the Initial Procedure?

Dijck, Robbert A.H.E. van; Saris, Daniël B.F.; Willems, Jaap; Fievez, Alex W F M

doi:10.1016/j.arthro.2007.08.012

Cited by 41 publications

(42 citation statements)

References 26 publications

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“…With a longer follow-up, it is likely that a higher incidence of meniscal and cartilage reoperations will be observed. However, the incidence of stiffness-related 20 Attrition is also a limitation of this study. During the study period, 18% of the cases were lost to follow-up, and this could lead us to underascertain the number of reoperations in our cohort of patients.…”

Section: Discussionmentioning

confidence: 78%

Risk Factors of Subsequent Operations After Primary Anterior Cruciate Ligament Reconstruction

et al. 2013

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Section: Discussionmentioning

confidence: 78%

Risk Factors of Subsequent Operations After Primary Anterior Cruciate Ligament Reconstruction

et al. 2013

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“…Decreasing peak posterior ground reaction force for functional activities after ACL reconstruction surgery also should protect the ACL from excessive loading [39]. The posterior ground reaction force generates a knee flexion moment that must be resisted by a knee extension moment generated by the quadriceps muscles through the patellar tendon.…”

Section: Discussionmentioning

confidence: 99%

Effects of a Knee Extension Constraint Brace on Lower Extremity Movements after ACL Reconstruction

Stanley

Creighton

Gross

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Patients have high reinjury rates after ACL reconstruction. Small knee flexion angles and large peak posterior ground reaction forces in landing tasks increase ACL loading. Questions/purposes We determined the effects of a knee extension constraint brace on knee flexion angle, peak posterior ground reaction force, and movement speed in functional activities of patients after ACL reconstruction. Patients and Methods Six male and six female patients 3.5 to 6.5 months after ACL reconstruction participated in the study. Three-dimensional videographic and force plate data were collected while patients performed level walking, jogging, and stair descent wearing a knee extension constraint brace, wearing a nonconstraint brace, and not wearing a knee brace. Knee flexion angle at initial foot contact with the ground, peak posterior ground reaction force, and movement speed were compared across brace conditions and between genders. Results Wearing the knee extension constraint brace increased the knee flexion angle at initial foot contact for each activity when compared with the other two brace conditions. Wearing the knee extension constraint brace also decreased peak posterior ground reaction force during walking but not during jogging and stair descent. Conclusions Although the knee extension constraint brace did not consistently reduce the peak posterior ground reaction force in all functional activities, it consistently increased knee flexion angle and should reduce ACL loading as suggested by previous studies. These results suggest the knee extension constraint brace has potential as a rehabilitation tool to alter lower extremity movement patterns of patients after ACL reconstruction to address high reinjury rates. Level of Evidence Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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“…This was correlated with our study which showed that of the 32 rACLR in the reoperations cohort, 20 (62.5%) were performed in patients under 20 years old. Possible causes include younger patients who rupture their ACL may be likely to return to more aggressive cutting and pivoting sports, be less compliant with postoperative instructions, and/or have a genetic predisposition to collagen disruption impacting on their risk for ACL retear as well as meniscal and cartilage damage 1, 24, 29 . Additionally, in older patients, further surgery, especially those with long recovery like revision-rACLR, may be discouraged by the surgeon.…”

Section: Discussionmentioning

confidence: 99%

“…Reoperation rates after primary ACLR are reported as high as 27.6% and have a profound effect on patient outcome and satisfaction 29 . Younger age at the index surgery, female sex, and the use of allografts have been reported as risk factors for subsequent surgery 12, 17, 24 .…”

Section: Introductionmentioning

confidence: 99%

Subsequent Surgery After Revision Anterior Cruciate Ligament Reconstruction: Rates and Risk Factors From a Multicenter Cohort

David

2017

Am J Sports Med

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Background While revision ACL reconstruction (rACLR) can be performed to restore knee stability and improve patient activity level, outcomes after these surgeries are reported to be inferior to primary ACL reconstruction. Further reoperation after rACLR can have an even more profound effect on patient satisfaction and outcome. However, there is a current lack of information regarding the rate and risk factors for subsequent surgery after rACLR. Purpose To report the rate of reoperation, procedures performed, and risk factors for reoperation two years after rACLR. Study Design Cohort Study, Level of Evidence 2 Methods 1205 patients who underwent rACLR were enrolled in the Multicenter ACL Revision Study (“MARS”) between 2006 and 2011, comprising the prospective cohort. Two-year questionnaire follow-up was obtained on 989 (82%), while telephone follow-up was obtained on 1112 (92%). If a patient reported having a subsequent surgery, operative reports detailing the subsequent procedure(s) were obtained and categorized. Multivariate regression analysis was performed to determine independent risk factors for reoperation. Results Of the 1112 patients included in the analysis, 122 patients (11%) underwent a total of 172 subsequent procedures on the ipsilateral knee at 2-year follow-up. Of the reoperation procedures, 27% were meniscus procedures (69% meniscectomy, 26% repair), 19% were subsequent rACLR, 17% were cartilage procedures (61% chondroplasty, 17% microfracture, and 13% mosaicplasty), 11% were hardware removal, and 9% were procedures for arthrofibrosis. Multivariate analysis revealed that patients under 20 years old had twice the odds of patients aged 20–29 to have a reoperation. Use of allograft at the time of rACLR (OR 1.79, p=0.007) was a significant predictor for reoperations at 2 years while staged revision (bone grafting of tunnels before rACLR) (OR 1.93, p=0.052) trended toward significance. Patients with grade IV cartilage damage seen during rACLR were 78% less likely to undergo subsequent operations within 2 years. Sex, BMI, smoking history, Marx activity score, technique for femoral tunnel placement and meniscal tear or meniscal treatment at the time of rACLR showed no significant effect on reoperation rate. Conclusion There is a significant reoperation rate following rACLR at two years (11%) with meniscal procedures most commonly involved. Independent risk factors for subsequent surgery on the ipsilateral knee include age<20 years old and use of allograft tissue at the time of rACLR.

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Additional Surgery After Anterior Cruciate Ligament Reconstruction: Can We Improve Technical Aspects of the Initial Procedure?

Cited by 41 publications

References 26 publications

Risk Factors of Subsequent Operations After Primary Anterior Cruciate Ligament Reconstruction

Risk Factors of Subsequent Operations After Primary Anterior Cruciate Ligament Reconstruction

Effects of a Knee Extension Constraint Brace on Lower Extremity Movements after ACL Reconstruction

Subsequent Surgery After Revision Anterior Cruciate Ligament Reconstruction: Rates and Risk Factors From a Multicenter Cohort

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