Effect of Early Residual Laxity After Anterior Cruciate Ligament Reconstruction on Long-term Laxity, Graft Failure, Return to Sports, and Subjective Outcome at 25 Years

Abstract

Background: In spite of supposedly successful surgery, slight residual knee laxity may be found at follow-up evaluations after anterior cruciate ligament reconstruction (ACLR), and its clinical effect is undetermined. Purpose: To investigate whether a 3- to 5-mm increase in anterior translation 6 months after ACLR affects the risk of graft failure, rate of return to sports, and long-term outcome. Study Design: Cohort study; Level of evidence, 2. Methods: From a cohort of 234 soccer, team handball, and basketball players undergoing ACLR using bone–patellar tendon–bone graft, 151 athletes were included who attended 6-month follow-up that included KT-1000 arthrometer measures. A tight graft was defined as <3-mm side-to-side difference between knees (n = 129), a slightly loose graft as 3 to 5 mm (n = 20), and a loose graft as >5 mm (n = 2). Graft failure was defined as ACL revision surgery, >5-mm side-to-side difference, or anterolateral rotational instability 2+ or 3+ at 2-year follow-up. Finally, a 25-year evaluation was performed, including a clinical examination and questionnaires. Results: The rate of return to pivoting sports was 74% among athletes with tight grafts and 70% among those with slightly loose grafts. Also, return to preinjury level of sports was similar between those with slightly loose and tight grafts (40% vs 48%, respectively), but median duration of the sports career was longer among patients with tight grafts: 6 years (range, 1-25 years) vs 2 years (range, 1-15 years) ( P = .01). Five slightly loose grafts (28%) and 6 tight grafts (5%) were classified as failures after 2 years ( P = .002). Thirty percent (n = 6) of patients with slightly loose grafts and 6% (n = 8) with tight grafts had undergone revision ( P = .004) by follow-up (25 years, range, 22-30 years). Anterior translation was still increased among the slightly loose grafts as compared with tight grafts at long-term follow-up ( P < .05). In patients with tight grafts, 94% had a Lysholm score ≥84 after 24 months and 58% after 25 years, as opposed to 78% ( P = .02) and 33% ( P = .048), respectively, among patients with slightly loose grafts. Conclusion: A slightly loose graft at 6 months after ACLR increased the risk of later ACL revision surgery and/or graft failure, reduced the length of the athlete’s sports career, caused permanent increased anterior laxity, and led to an inferior Lysholm score.

Effect of Early Residual Laxity After Anterior Cruciate Ligament Reconstruction on Long-term Laxity, Graft Failure, Return to Sports, and Subjective Outcome at 25 Years: Letter to the Editor

“…Vignos et al 6 reported that tunnel placement during ACLR surgery has an effect on postoperative knee laxity and clinical outcomes. Lindanger et al, 2 while they reported that most of the patients included in their study were treated with the mini-open method and other patients with the transtibial method, did not provide information about the landmarks used for tunnel placements during the ACLR. We believe that these limitations, which were not reported by the authors, should be taken into account when evaluating this magnificent study, which is one of the longest follow-up ACL studies in the literature.…”

“…The tibial tunnel was positioned anteriorly and medially, whereas the femoral tunnel was in a posterior and proximal position on the femur condyle. 2 The transtibial tunnel placement technique resulted in a more proximal and posterior tunnel position in the femoral notch, as the offset aimer used the back wall of the epicondyle as a reference, and the femoral tunnel position was predefined by the tibial tunnel placement. 6,7,12 Because the tibial tunnel was more anterior, there was an increased risk of graft impingement, and a moderate notch plasty was therefore performed in all cases.…”

“…We read the article entitled “Effect of Early Residual Laxity After Anterior Cruciate Ligament Reconstruction on Long-term Laxity, Graft Failure, Return to Sports, and Subjective Outcome at 25 Years” with great interest. 2 Lindanger et al 2 included 151 patients with anterior cruciate ligament (ACL) rupture in their study. The authors performed ACL reconstruction (ACLR) for 78.2% of patients with a mini-open method and for 21.8% with a transtibial method.…”

Arthroscopic Centralization for Lateral Meniscal Injuries Reduces Laxity in the Anterior Cruciate Ligament–Reconstructed Knee

“…Knee laxity after anterior cruciate ligament (ACL) reconstruction (ACLR) is one of the causes of failure, 25 as well as worsening functional outcomes 4 and reduced patient satisfaction, 20 and is considered to lead to the development of osteoarthritis. 14 The factors associated with postoperative knee laxity, excluding surgical technique, include bony morphology, 5 the anterolateral complex 27 and iliotibial band, 19 and lateral meniscal (LM) injuries.…”

Effect of Early Residual Laxity After Anterior Cruciate Ligament Reconstruction on Long-term Laxity, Graft Failure, Return to Sports, and Subjective Outcome at 25 Years: Response

“…We appreciate the interest in our recent paper ''Effect of Early Residual Laxity After Anterior Cruciate Ligament Reconstruction on Long-term Laxity, Graft Failure, Return to Sports, and Subjective Outcome at 25 Years'' 10 and the chance we are given to respond to questions raised by O ¨zbek and Binnet.…”