Risk Factors Associated With Revision and Contralateral Anterior Cruciate Ligament Reconstructions in the Kaiser Permanente ACLR Registry

Maletis, Gregory B.; Inacio, Maria C.S.; Funahashi, Tadashi T.

doi:10.1177/0363546514561745

Cited by 190 publications

(242 citation statements)

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“…1,2 In an effort to decelerate this degenerative process, arthroscopic anterior cruciate ligament reconstruction (ACLR) using tendon autografts has been one of the most popular surgical interventions worldwide. 3 However, despite the numerous surgical techniques described, ACLR improves the patient's activity level and reduces, but does not eliminate, the risk of joint degeneration and the necessity for further surgery.…”

mentioning

confidence: 99%

Anterior Cruciate Ligament Remnant–Preserving Reconstruction Using a “Lasso-Loop” Knot Configuration

Boutsiadis

Karampalis

Tzavelas

et al. 2015

Arthroscopy Techniques

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Anterior cruciate ligament (ACL) rupture predisposes to altered kinematics and possible knee joint degeneration. Graft fiber maturation and ligamentization may eliminate this risk during ACL reconstruction procedures. ACL remnantesparing techniques support the theory that the preserved tissue enhances revascularization, preserves the mechanoreceptors, and leads to anatomic remodeling. The purpose of this article is to present a simple and reproducible technique of tensioning the preserved ACL remnant over the femur. A nonabsorbable suture is passed through the ACL remnant with a "lasso-loop" technique using a curved rotator cuff hook. Femoral and tibial tunnel preparation is performed according to a standard surgical technique for the EndoButton device (Smith & Nephew Endoscopy, Andover, MA). The free ends of the ACL remnant suture are retrieved through the tibial tunnel and passed through each outside hole of the EndoButton device. The hamstring graft is passed through the tibial and femoral tunnels and fixed to the femoral cortex by flipping the EndoButton and to the tibia by an interference screw. Finally, non-sliding half-stitch locking knots are made to secure the ACL remnant suture on the EndoButton device, by use of a knot pusher. This technique offers simple and secure tensioning of the ACL remnant on the fixation device.A nterior cruciate ligament (ACL) rupture is one of the most common knee injuries, predisposing to altered knee kinematics, loss of neuromuscular feedback, increased medial compartment contact, and shear forces. 1,2 In an effort to decelerate this degenerative process, arthroscopic anterior cruciate ligament reconstruction (ACLR) using tendon autografts has been one of the most popular surgical interventions worldwide. 3 However, despite the numerous surgical techniques described, ACLR improves the patient's activity level and reduces, but does not eliminate, the risk of joint degeneration and the necessity for further surgery. 2,3 Restoration of normal ACL anatomy requires anatomic remodeling, fiber maturation, and ligamentization of the applied graft. Early ACL remnantesparing techniques support the theory of preserving the proprioceptive receptors, enhancing the revascularization process, and finally, achieving "cellular ligamentization." 4 However, ACL remnanteretaining procedures can be technically demanding and predispose to cyclops lesion formation. 5 The purpose of this study is to present a simple and reproducible technique of tensioning the preserved ACL remnant over the femur using a "lasso loop" reeved through the femoral EndoButton (EndoButton CL; Smith & Nephew Endoscopy, Andover, MA). 6 Surgical Technique Joint Assessment and Graft PreparationThe patient is positioned supine with a thigh tourniquet and a standard leg holder allowing full knee range of motion. With a 4.0-mm 30 arthroscope, standard anterolateral and anteromedial (AM) portals are made. The knee joint is evaluated, and other associated lesions are assessed and addressed appropriately. The ACL tear i...

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mentioning

confidence: 99%

Anterior Cruciate Ligament Remnant–Preserving Reconstruction Using a “Lasso-Loop” Knot Configuration

Boutsiadis

Karampalis

Tzavelas

et al. 2015

Arthroscopy Techniques

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“…After ACLR, males tend to sustain more ACL graft ruptures [28,94,119,127] and females tend to sustain more contralateral ACL injuries [127,165,166,194]. In a systematic review and meta-analysis of the importance of patient sex in the outcome of ACLR, females had a higher revision rate (relative risk, 1.15; 95% CI, 1.02-1.28), but graft rupture (33 studies included) or failure (18 studies included) did not differ compared with males.…”

Section: Epidemiology and Aetiology Of An Additional Acl Injurymentioning

confidence: 99%

“…Patients with BPTB graft sustain more contralateral ACL injuries or undergo more contralateral ACLR than after HT [119,127,171].…”

Section: Risk Factors For Sustaining An Additional Acl Injurymentioning

confidence: 99%

“…ACL registers show a revision rate of 3.3-7.7% for the primary ACLR after 5-6 years of follow-up [4,86,114,120,127,200], and a rate of 3.8-6.5% for ACLR in the contralateral knee [4,86,114,127,200]. Ahldén et al [4] reported that the total additional ACLR rate during a 5-years period for female football players aged 15-18 years were 22% compared with 9.8% for males in the same age group.…”

Section: Predictors For Undergoing An Additional Aclrmentioning

confidence: 99%

“… Primary ACLR at an younger age [124,127,168,226]  BMI <25 [127]  ACLR performed by lower-volume surgeons or at lower-volume hospitals [124].…”

Section: Predictors For Undergoing An Additional Aclrmentioning

confidence: 99%

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One Anterior Cruciate Ligament injury is enough!: Focus on female football players

Fältström¹

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Optimizing anterior cruciate ligament reconstruction: Individualizing the decision‐making process using data from the Kaiser Permanente ACLR Registry: 2018 OREF award paper

Maletis

Funahashi

Inacio

et al. 2021

Journal Orthopaedic Research

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Despite years of study, controversy remains regarding the optimal graft for anterior cruciate ligament reconstruction (ACLR), suggesting that a single graft type is not ideal for all patients. A large community based ACLR Registry that collects prospective data is a powerful tool that captures information and can be analyzed to optimize surgery for individual patients. The studies highlighted in this paper were designed to optimize and individualize ACLR surgery and have led to changes in surgeon behavior and improvements in patient outcomes. Kaiser Permanente (KP) is an integrated health care system with 10.6 million members and more than 50 hospitals. Every KP member who undergoes an ACLR is entered into the Registry, and prospectively monitored. The Registry uses a variety of feedback mechanisms to disseminate Registry findings to the ACLRR surgeons and appropriately influence clinical practices and enhance quality of care. Allografts were found to have a 3.0 times higher risk of revision than bone‐patellar tendon‐bone (BPTB) autografts. Allograft irradiation >1.8 Mrad, chemical graft processing, younger patients, BPTB allograft, and male patients were all associated with a higher risk of revision surgery. By providing feedback to surgeons, overall allograft use has decreased by 27% and allograft use in high‐risk patients ≤21 years of age decreased 68%. We have identified factors that influence the outcomes of ACLR. Statement of Clinical Significance: We found that information derived from an ACLR Registry and shared with the participating surgeons directly decreased the use of specific procedures and implants associated with poor outcomes.

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Risk Factors Associated With Revision and Contralateral Anterior Cruciate Ligament Reconstructions in the Kaiser Permanente ACLR Registry

Cited by 190 publications

References 21 publications

Anterior Cruciate Ligament Remnant–Preserving Reconstruction Using a “Lasso-Loop” Knot Configuration

Anterior Cruciate Ligament Remnant–Preserving Reconstruction Using a “Lasso-Loop” Knot Configuration

One Anterior Cruciate Ligament injury is enough!: Focus on female football players

Optimizing anterior cruciate ligament reconstruction: Individualizing the decision‐making process using data from the Kaiser Permanente ACLR Registry: 2018 OREF award paper

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