Risk Factors for Revision Anterior Cruciate Ligament Reconstruction and Frequency With Which Patients Change Surgeons

Abstract

Background:Revision surgery is a known complication after anterior cruciate ligament (ACL) reconstruction (ACLR), but the proportion of patients who seek a different surgeon for their revision procedure is unknown.Purpose:To determine the rate and risk factors for revision ACLR in New Zealand and to find the proportion of patients undergoing revision ACLR who see a different surgeon compared with their primary procedure as well as the factors that may influence this decision.Study Design:Case series; Level of evidence, 4.Methods:Data from New Zealand’s single government insurer, the Accident Compensation Corporation (ACC), were analyzed. All primary ACLR procedures performed between January 1, 2009, and December 31, 2014 were evaluated, and revision ACLR procedures performed between January 1, 2009, and December 31, 2016, were evaluated to allow for a minimum 2-year follow-up period. Cases undergoing subsequent revision were divided into those with the same or a different surgeon compared with the primary procedure. Risk factors for revision and change of surgeons were assessed, including age, sex, time from injury to surgery, time between primary and revision procedures, surgeon volume, and ethnicity.Results:A total of 15,212 primary ACLR procedures were recorded in 14,926 patients. The mean patient age was 29.2 years, and 61% were male patients. There were 676 subsequent revision procedures and 510 contralateral procedures during the study period, resulting in a 5-year survival rate of 95.5% for the ACL graft and 96.5% for the contralateral ACL. Risk factors for revision surgery included male sex, age <20 years, and <1 year from injury to surgery. Of the revision procedures, 44.5% (n = 301) were performed by a different surgeon compared with primary ACLR. For primary ACLR procedures performed by low-volume surgeons, 75.0% of patients requiring revision ACLR changed surgeons, compared with 21.5% for high-volume surgeons (≤10 vs >50 primary ACLR/y; hazard ratio, 10.70 [95% CI, 6.01-19.05]; P < .001). Other factors associated with change of surgeons included older age, longer time between primary and revision surgery, and Asian and Maori ethnicities.Conclusion:A significant proportion of patients change surgeons when requiring revision ACLR. In the absence of formal follow-up systems such as registries, surgeons, particularly those with a low volume of ACLRs, may underestimate their personal revision rate.

Early Return to Play After Anterior Cruciate Ligament Reconstruction: Is It Worth the Risk?

“…According to a widely accepted theory, younger, more active patients tend to put more demand on the graft; thus, increasing the risk of re-injury and elongation [ 29 ]. Lower age has been confirmed as a risk factor in several studies [ 9 , 14 , 29 , 30 ]; however, it was not significant at the 0.05 level in our analysis. It should be noted that our patient population consisted mainly of young adult athletes; adolescents and amateur sportsmen were excluded.…”

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

“…With regard to previous studies of the patient characteristics of patients who suffer an ACL re-rupture, several physically and surgically related risk factors have been identified. 27,28 Factors such as time from reconstruction to RTS have conflicting results, with studies reporting an association between an J o u r n a l P r e -p r o o f early RTS, before and 12 months after reconstruction, and an increased risk of ACL re-injury 12,14 and studies reporting no association. 29 A recent meta-analysis of studies from the Scandinavian Knee Ligament Registries reported that younger age (under 20 years), hamstring tendon, timing of surgery, associated medial collateral ligament injury and lower 2-year Knee injury and Osteoarthritis Outcome Score (KOOS) after primary ACL reconstruction are risk factors for undergoing an ACL revision.…”

Effect of Leg Dominance on Medium- to Long-Term Functional Outcomes, Quality of Life, and Revision Rates After Isolated ACL Reconstruction

“…Age <18 years, male sex, and a shorter time from injury to surgery (within 6 months) were found to increase the risk of revision. Similarly, Sutherland et al 21 found that younger age, male sex, and a shorter time from injury to primary surgery were associated with the risk of revision surgery, with a 5-year ACL graft survival rate of 95.5%. In contrast, in a long-term study, Grassi et al 7 could not identify any significant predictors for ipsilateral revision ACLR.…”