Factors That Predict Failure in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction

Parkinson, Ben; Robb, Curtis; Thomas, Michael; Thompson, P.; Spalding, Tim

doi:10.1177/0363546517691961

Cited by 93 publications

(93 citation statements)

References 60 publications

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“…10,11 Meniscal deficiency has been reported as the most significant factor to predict graft failure after ACLR. 16 The posterior horn of the medial meniscus is a known secondary stabilizer to anterior tibial translation and thus may help stabilize the ACL-deficient knee. 15,19 In contrast, when the ACL is torn in combination with a meniscus ramp lesion, anterior knee translation may increase.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Outcomes After Primary ACL Reconstruction and Meniscus Ramp Repair

DePhillipo

Dornan

Dekker

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Satisfactory outcomes have been reported after all-inside meniscus ramp repair with combined anterior cruciate ligament reconstruction (ACLR). However, clinical outcomes after ACLR with inside-out meniscus ramp repair are limited.Purpose/Hypothesis: The purpose of this study was to evaluate patient-reported outcomes for patients who underwent ACLR and medial meniscus ramp repair compared with those who underwent isolated ACLR; patients in the 2 groups were matched for age, sex, and sport/activity. The null hypothesis was that there would be no significant differences in clinical outcomes between groups at a minimum of 2 years postoperatively.Study Design: Cohort study; Level of evidence 3. Methods:Patients who underwent primary ACLR with bone-patellar tendon-bone (BPTB) autograft by a single surgeon were retrospectively identified. A subgroup of patients with combined ACLR and meniscus ramp repair with a minimum 2-year postoperative follow-up were matched to a cohort who underwent isolated ACLR. Subjective patient-reported questionnaires, knee stability, and return to level of activity/sport were collected.Results: There were 851 patients who underwent primary ACLR; of these, 158 (18.6%) had medial meniscus ramp lesions confirmed at arthroscopy. The most common clinical characteristics in patients with ramp lesions were chronic injuries (68.4%), contact mechanism (88%), concomitant lateral meniscus tears (63.2%), and concomitant lateral meniscus posterior root tears (22.2%). Further, 50 patients who underwent combined ACLR and meniscus ramp repair with minimum 2-year follow-up were matched to patients who underwent isolated ACLR. Both groups reported significant improvements in subjective outcomes from preoperative to postoperative assessments (P < .001). No significant differences were found in postoperative outcomes for combined ACLR with ramp repair versus isolated ACLR (P > .05). Patients with meniscus ramp repair had increased preoperative knee laxity demonstrated by grade 3 Lachman (44% vs 6%) and pivot-shift (38% vs 12%) test results compared with patients who underwent isolated ACLR (P .005 for both). Conclusion:This study demonstrates similar clinical outcomes, knee stability on postoperative physical examination, and returnto-sport rates for patients who underwent combined ACLR with BPTB autograft and inside-out meniscus ramp repair versus a matched cohort who underwent isolated ACLR. Clinicians should have a high index of suspicion for the presence of ramp lesions in patients with ACL tears who have a contact mechanism of injury, grade 3 Lachman test result, and concomitant lateral meniscal abnormality.

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Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Outcomes After Primary ACL Reconstruction and Meniscus Ramp Repair

DePhillipo

Dornan

Dekker

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…ACL reconstruction failure has been found to be related to patient age, sex, body mass index, time from surgery, graft size, meniscal integrity, tibial tunnel malposition and early return to sport [23,[26][27][28][29][30]. Parkinson et al [31] found that meniscal integrity was the strongest predictor of ACL reconstruction failure. Increased graft laxity was found in ACL reconstruction patients with medial meniscal deficiency [32], and a higher incidence of a residual pivot shift was reported in meniscal-deficient knees [33].…”

Section: Late Post-operative Complicationsmentioning

confidence: 99%

“…Increased graft laxity was found in ACL reconstruction patients with medial meniscal deficiency [32], and a higher incidence of a residual pivot shift was reported in meniscal-deficient knees [33]. Greater stress through the ACL graft in meniscal-deficient knees may explain a higher graft failure rate [31]. Strength testing should be conducted throughout recovery to assess progress and to determine if milestones are met for advancement of function.…”

Section: Late Post-operative Complicationsmentioning

confidence: 99%

Prevention and Management of Post-operative Complications Following ACL Reconstruction

Eckenrode

Carey

Sennett

et al. 2017

Curr Rev Musculoskelet Med

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Purpose of Review The goal of this paper is to review the current management and prevention of post-operative complications after anterior cruciate ligament (ACL) reconstruction. Trends in rehabilitation techniques will be presented, in addition to suggestions for interventions and expected milestones in ACL reconstruction recovery. Recent Findings ACL reconstruction protocols have evolved to more of a criterion-based progression rather than a tissuehealing time frame. Given the evolution of ACL surgical reconstruction techniques and rehabilitation protocols, the risk of post-operative complications can arise both early and late in the recovery process. This paper will discuss the role of preventative measures as it applies to the post-operative patient with ACL reconstruction. Summary Short-term complications following ACL reconstruction include infection and deficits to knee motion and strength, whereas long-term complications include secondary ACL injury to either the involved or contralateral knee and lack of ability to return to high-level sports following this procedure. Future research should continue to address the multifactorial causes of secondary ACL injury and limited ability of patients to return to high level activities.

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“…It is now accepted that ACL reconstruction should be advocated in the young, even before skeletal maturity, and anatomic transphyseal ACL reconstruction can be safely performed to restore functional stability 19,26 . After ACL reconstruction, there is considerable recent evidence that 2 nd ACL injuries occur more frequently in the young 1,21,29,34,37,52 .…”

Section: Introductionmentioning

confidence: 99%

20-Year Outcomes of Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autograft: The Catastrophic Effect of Age and Posterior Tibial Slope

et al. 2017

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Repeat ACL injury after isolated ACL reconstruction is common, occurring in 1 in 3 over 20 years. In the absence of further injury, isolated ACL reconstruction using this technique was associated with good long-term outcomes with respect to patient-reported outcomes and return to sports, regardless of age. However, mild ligament laxity and ACL graft rupture after ACL reconstruction are significantly more common in adolescents, especially adolescent males, compared with adults. PTS of 12° or more is the strongest predictor of repeat ACL injury, and its negative effect is most pronounced in adolescents.

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Factors That Predict Failure in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction

Abstract: Meniscal deficiency is the most significant factor to predict graft failure in single-bundle anatomic ACL reconstruction. Shallow nonanatomic femoral tunnel positioning and younger patient age are additional risk factors for failure, but their relative importance is less.

Cited by 93 publications

References 60 publications

Clinical Characteristics and Outcomes After Primary ACL Reconstruction and Meniscus Ramp Repair

Clinical Characteristics and Outcomes After Primary ACL Reconstruction and Meniscus Ramp Repair

Prevention and Management of Post-operative Complications Following ACL Reconstruction

20-Year Outcomes of Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autograft: The Catastrophic Effect of Age and Posterior Tibial Slope

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