Patient demographics and surgical characteristics in ACL revision: a comparison of French, Norwegian, and North American cohorts

Abstract

Purpose The goal of this paper is to compare patient factors, intra-operative findings, and surgical techniques between patients followed in large cohorts in France, Norway, and North America. Methods Data collected on 2286 patients undergoing revision ACLR were obtained. These data included 1216 patients enrolled in the Multicenter ACL Revision Study (MARS) in North America, 793 patients undergoing revision ACLR and recorded in the Norwegian Knee Ligament Registry (NKLR), and 277 patients recorded in the revision ACL database of the Société Française d’Arthroscopie (SFA) in France. Data collected from each database included patient demographics (age, sex, height, and weight), graft choice and reason for failure of the primary ACLR, time from primary to revision ACLR, pre-revision patient-reported outcome scores (KOOS, subjective IKDC), associated intra-articular findings and treatments at revision, and graft choice for revision reconstruction. Results Patient demographics in the three databases were relatively similar. Graft choice for primary and revision ACLR varied significantly, with more allografts used in the MARS cohort. Hamstring autograft was favored in the NKRL, while BTB autograft was most common in the SFA cohort. Reasons for failure of the primary ACLR were comparable, with recurrent trauma noted in 46 to 56% of patients in each of the three cohorts. Technical error was cited in 44 to 51% of patients in the MARS and SFA cohorts, but was not clearly elucidated in the NKLR cohort. Biologic failure of the primary graft was more common in the MARS cohort. Differences in associated intra-articular findings were noted at the time of revision ACLR, with significantly more high grade cartilage lesions noted in the MARS group. Conclusions Significant differences exist between patient populations followed in revision ACL cohorts throughout the world that should be considered when applying findings from such cohorts to different patient populations.

Thirty-year Experience with ACL reconstruction using Patellar Tendon: A Critical Evaluation of Revision and Reoperation

“…19 In a comparison of 3 international cohorts of revision ACLR procedures, namely the Multicenter ACL Revision Study (MARS) database (United States), Norwegian Cruciate Ligament Register (NKLR) database (Norway), and Société Française d'Arthroscopie (SFA) database (France), revision rates were highly variable in different regions of the world. 18,21,37 Our observed revision rate for both primary and revision cases has remained similar over the past 5 years, and it is comparable to the rates reported in the American literature. Frank and colleagues 10 A significant difference in revision rate was found between patients undergoing reconstruction with BTB autograft versus BTB allograft (1.3% [23/511] vs 2.7% [18/ 674], P ¼ .03).…”

Revision Anterior Cruciate Ligament Reconstruction in Military Personnel

“…It's unclear whether most patients are still participating in high-level competitive sports by the time they rerupture their ACL graft. The average age in most large revision ACL reconstruction cohorts ranges from the mid-20s to early-30s, 23,31,32 a time when many may not have the ability or desire to continue regular participation in high-level competitive athletics.…”

Quadriceps tendon grafts does not cause patients to have inferior subjective outcome after anterior cruciate ligament (ACL) reconstruction than do hamstring grafts: a 2-year prospective randomised controlled trial

“…The ACL is primarily reconstructed using one of two autografts: the patellar tendon (PT) or the hamstring tendon (STG). The choice between these two graft types typically depends on physician preference, with an overall predominance of STG autografts in Denmark and Sweden but not in Norway 4–6. The STG predominance is mainly caused by the ease of STG harvest and that PT autograft is associated with anterior knee pain 7 8.…”