Influence of Patient Demographics and Graft Types on Acl Second Injury Rates in Ipsilateral Versus Contralateral Knees: A Systematic Review and Meta-Analysis

Nawasreh, Zakariya H.; Adams, Gabrielle; Pryzbylkowski, Olivia; Logerstedt, David

doi:10.26603/ijspt20180561

Cited by 27 publications

(20 citation statements)

References 85 publications

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“…This finding is similar to that in a recent systematic review of smaller studies that reported lower rates of ipsilateral graft ruptures in women. 25 This review also found that women had a higher rate of contralateral knee injuries; however, in our study, we found no difference in contralateral ACL reconstruction rates in women versus men. Subsequent meniscal surgery rates were also lower in women than men.…”

Section: Discussioncontrasting

confidence: 62%

Rates of Adverse Outcomes and Revision Surgery After Anterior Cruciate Ligament Reconstruction: A Study of 104,255 Procedures Using the National Hospital Episode Statistics Database for England, UK

et al. 2019

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Background: After an anterior cruciate ligament (ACL) injury, ACL reconstruction is an elective procedure, and therefore, an understanding of the attributable risk from undergoing ACL reconstruction is necessary for patients to make a fully informed treatment decision. Purpose: To determine the absolute risk of adverse outcomes including reoperation after ACL reconstruction with comparison, where possible, to the rate of adverse events reported in the general population. Study Design: Descriptive epidemiology study. Methods: National hospital data on all ACL reconstructions performed in England between April 1, 1997, and March 31, 2017, were analyzed. Revision cases, bilateral procedures within 6 months, and cases with concurrent cartilage or multiple ligament surgery were excluded. The primary outcome was the occurrence of at least 1 serious complication (myocardial infarction, stroke, pulmonary embolism, infection requiring surgery, fasciotomy, neurovascular injury, or death) within 90 days. Additionally, 5-year rates of revision ACL reconstruction, contralateral ACL reconstruction, and meniscal surgery were investigated. Results: There were 133,270 ACL reconstructions performed, of which 104,255 were eligible for analysis. Within 90 days, serious complications occurred in 675 (0.65% [95% CI, 0.60-0.70]), including 494 reoperations for infections (0.47% [95% CI, 0.43-0.52]) and 129 for pulmonary embolism (0.12% [95% CI, 0.10-0.15]). Of 54,275 procedures with at least 5 years’ follow-up, 1746 (3.22% [95% CI, 3.07-3.37]) underwent revision ACL reconstruction in the same knee, 1553 underwent contralateral ACL reconstruction (2.86% [95% CI, 2.72-3.01]), and 340 underwent meniscal surgery (0.63% [95% CI, 0.56-0.70]). The overall risk of serious complications fell over time (adjusted odds ratio [OR], 0.96 per year [95% CI, 0.95-0.98]); however, older patients (adjusted OR, 1.11 per 5 years [95% CI, 1.07-1.16]) and patients with a greater modified Charlson Comorbidity Index (adjusted OR, 2.41 per 10 units [95% CI, 1.65-3.51]) were at a higher risk. For every 850 (95% CI, 720-1039) ACL reconstructions, 1 pulmonary embolism could be provoked. For every 213 (95% CI, 195-233), 1 native knee joint infection could be provoked. Conclusion: The overall risk of adverse events after ACL reconstruction is low; however, some rare but serious complications, including infections or pulmonary embolism, may occur. Around 3% of patients undergo further ipsilateral or contralateral ACL reconstruction within 5 years. These data will inform shared decision making between clinicians and patients considering their treatment options.

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Section: Discussioncontrasting

confidence: 62%

Rates of Adverse Outcomes and Revision Surgery After Anterior Cruciate Ligament Reconstruction: A Study of 104,255 Procedures Using the National Hospital Episode Statistics Database for England, UK

et al. 2019

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“…Males and females were found to be equally likely to experience a second ACL injury. Although a previous meta-analysis reported that females have higher odds of experiencing a second ACL injury than males, 70 this discrepancy is likely due to the absence of considering return-to-sport percentage in their inclusion criteria. This suggests that their findings might better reflect general populace ACL injury trends.…”

Section: Risk Of a Second Acl Injurymentioning

confidence: 91%

Does sex affect second ACL injury risk? A systematic review with meta-analysis

et al. 2021

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ObjectiveTo determine sex-based differences in risk of a second ACL injury (overall and by laterality) following primary ACL reconstruction in athletes who are attempting to return to sport.DesignSystematic review with meta-analysis.Data sourcesSystematic search of five databases conducted in August 2019.Eligibility criteria for selecting studiesStudies reporting sex-based differences in the incidence of second ACL injury in athletes attempting to return-to-sports and who were followed for at least 1 year following primary ACL reconstruction.ResultsNineteen studies were included in this review, with seven studies excluded from the primary meta-analysis due to high risk of bias. The remaining 12 studies (n=1431 females, n=1513 males) underwent meta-analysis, with all 19 studies included in a sensitivity analysis. Total second ACL injury risk was 21.9% (females: 22.8%, males: 20.3%). Females were found to have 10.7% risk of an ipsilateral ACL injury and 11.8% risk of a contralateral ACL injury. Males were found to have 12.0% risk of an ipsilateral ACL injury and 8.7% risk of a contralateral ACL injury. No statistically significant differences were observed for total second ACL injury risk (risk difference=−0.6%, 95% CI −4.9 to 3.7, p=0.783, I2=41%) or contralateral ACL injury risk (risk difference=1.9%, 95% CI −0.5% to 4.4%, p=0.113, I2=15%) between sexes. Females were found to have a 3.4% absolute risk reduction in subsequent ipsilateral ACL injury risk compared with males (risk difference=−3.4%, 95% CI −6.7% to −0.02%, p=0.037, I2=35%).ConclusionBoth sexes have >20% increased risk of experiencing a second ACL injury. Any difference in the absolute risk of either a subsequent ipsilateral or contralateral ACL injury between sexes appears to be small.RegistrationPROSPERO (CRD42020148369)

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“…1 Unfortunately, a rupture of the reconstructed ACL, an ACL re-rupture, can occur and is regarded as definite treatment failure. Re-ruptures of the ACL occur a median of 20 months after primary reconstruction and the rates typically vary between 3 and 7%, 2,3 but they can be as high as 10% in younger athletes. 3 In addition, re-ruptures have an increased presence of cartilage injuries compared with primary ACL injuries.…”

Section: Introductionmentioning

confidence: 99%

Greater Psychological Readiness to Return to Sport, as Well as Greater Present and Future Knee-Related Self-Efficacy, Can Increase the Risk for an Anterior Cruciate Ligament Re-Rupture: A Matched Cohort Study

Piussi

Beischer

Thomeé

et al. 2022

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Influence of Patient Demographics and Graft Types on Acl Second Injury Rates in Ipsilateral Versus Contralateral Knees: A Systematic Review and Meta-Analysis

Cited by 27 publications

References 85 publications

Rates of Adverse Outcomes and Revision Surgery After Anterior Cruciate Ligament Reconstruction: A Study of 104,255 Procedures Using the National Hospital Episode Statistics Database for England, UK

Rates of Adverse Outcomes and Revision Surgery After Anterior Cruciate Ligament Reconstruction: A Study of 104,255 Procedures Using the National Hospital Episode Statistics Database for England, UK

Does sex affect second ACL injury risk? A systematic review with meta-analysis

Greater Psychological Readiness to Return to Sport, as Well as Greater Present and Future Knee-Related Self-Efficacy, Can Increase the Risk for an Anterior Cruciate Ligament Re-Rupture: A Matched Cohort Study

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