Risk Factors for Revision or Rerupture After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis

Abstract

Background: The rerupture or need for revision after anterior cruciate ligament reconstruction (ACLR) is a serious complication. Preventive strategies that target the early identification of risk factors are important to reduce the incidence of additional surgery. Purpose: To perform a systematic review and meta-analysis to investigate risk factors for revision or rerupture after ACLR. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: Literature searches were performed in PubMed, Embase, and Web of Science from database inception to November 2021 and updated in January 2022. Quantitative, original studies reporting potential adjusted risk factors were included. Odds ratios (ORs) were calculated for potential risk factors. Results: A total of 71 studies across 13 countries with a total sample size of 629,120 met the inclusion criteria. Fifteen factors were associated with an increase in the risk of revision or rerupture after ACLR: male sex (OR, 1.27; 95% CI, 1.14-1.41), younger age (OR, 1.07; 95% CI, 1.05-1.08), lower body mass index (BMI) (OR, 1.03; 95% CI, 1.00-1.06), family history (OR, 2.47; 95% CI, 1.50-4.08), White race (OR, 1.32; 95% CI, 1.08-1.60), higher posterolateral tibial slope (OR, 1.15; 95% CI, 1.05-1.26), preoperative high-grade anterior knee laxity (OR, 2.30; 95% CI, 1.46-3.64), higher baseline Marx activity level (OR, 1.07; 95% CI, 1.02-1.13), return to a high activity level/sport (OR, 2.03; 95% CI, 1.15-3.57), an ACLR within less than a year after injury (OR, 2.05; 95% CI, 1.81-2.32), a concomitant medial collateral ligament (MCL) injury (OR, 1.62; 95% CI, 1.31-2.00), an anteromedial portal or transportal technique (OR, 1.36; 95% CI, 1.22-1.51), hamstring tendon (HT) autografts (vs bone–patellar tendon–bone [BPTB] autografts) (OR, 1.60; 95% CI, 1.40-1.82), allografts (OR, 2.63; 95% CI, 1.65-4.19), and smaller graft diameter (OR, 1.21; 95% CI, 1.05-1.38). The other factors failed to show an association with an increased risk of revision or rerupture after ACLR. Conclusion: Male sex, younger age, lower BMI, family history, White race, higher posterolateral tibial slope, preoperative high-grade anterior knee laxity, higher baseline Marx activity level, return to a high activity level/sport, an ACLR within less than a year from injury, a concomitant MCL injury, an anteromedial portal or transportal technique, HT autografts (vs BPTB autografts), allografts, and smaller graft diameter may increase the risk of revision or rerupture after ACLR. Raising awareness and implementing effective preventions/interventions for risk factors are priorities for clinical practitioners to reduce the incidence of revision or rerupture after ACLR.

Ceiling Effect of the Combined Norwegian and Danish Knee Ligament Registers Limits Anterior Cruciate Ligament Reconstruction Outcome Prediction

“…21 The recording of additional surgical details such as graft diameter/size, ligament augmentation, lateral extra-articular tenodesis, or anterolateral ligament reconstruction may also be of value, given their recent association with outcomes. 1,10,15,16,24,26,42,52 Clinical examination and rehabilitation information such as preoperative knee laxity grade 25,43 could be obtained via third-party sources such as physical therapists or via natural language processing of patient chart notes. 49 Finally, the KOOS may not be the most appropriate patient-reported outcome tool for the patient population, and an alternative measurement of patient function, such as the baseline Marx activity level, could be considered for inclusion in registries moving forward.…”

The Posterior Tibial Slope Is Not Associated With Graft Failure and Functional Outcomes After Anatomic Primary Isolated Anterior Cruciate Ligament Reconstruction

“…Several studies have indicated that ACL graft failure at a young age is caused by a rapid return to sports combined with high activity levels. 9,28,40,43 Keuning et al 22 reported an 8-fold increased risk regarding graft failure in male patients. According to several systematic reviews and meta-analyses, this difference between male and female patients is likely because of a return to high-intensity sports and a shorter time to return to play in male patients.…”

“…According to several systematic reviews and meta-analyses, this difference between male and female patients is likely because of a return to high-intensity sports and a shorter time to return to play in male patients. 26,27,43…”

Relationships between Jumping Performance and Psychological Readiness to Return to Sport 6 Months Following Anterior Cruciate Ligament Reconstruction: A Cross-Sectional Study

“…Reasons for that include the persistence of knee strength and neuromuscular deficits, kinesiophobia, and fear of re-injury [ 5 ]. Increased risks of re-rupture have been reported within the first two years after surgery, especially in the youngest patients [ 6 , 7 ]. For these reasons, in an attempt to reduce risk factors and to determine the appropriate timing for resuming sports activities, test batteries have been developed.…”