Surgical Predictors of Clinical Outcomes After Revision Anterior Cruciate Ligament Reconstruction

Allen, Christina R.; Anderson, Allen F.; Cooper, Daniel E.; DeBerardino, Thomas M.; Dunn, Warren R.; Haas, Amanda K.; Huston, Laura J.; Lantz, Brett A.; Mann, Barton J.; Nwosu, Sam; Spindler, Kurt P.; Stuart, Michael J.; Wright, Rick W.; Albright, John P.; Amendola, Annunziato; Andrish, Jack T.; Annunziata, Christopher C.; Arciero, Robert A.; Bach, Bernard R.; Baker, Champ L.; Bartolozzi, Arthur R.; Baumgarten, Keith M.; Bechler, Jeffery R.; Berg, Jeffrey H.; Bernas, Geoffrey A.; Brockmeier, Stephen F.; Brophy, Robert H.; Bush‐Joseph, Charles A.; Butler, J. Brad; Campbell, John D.; Carey, James L.; Carpenter, James E.; Cole, Brian J.; Cooper, Jonathan M.; Cox, Charles L.; Creighton, R. Alexander; Dahm, Diane L.; David, Tal S.; Flanigan, David C.; Frederick, Robert W.; Ganley, Theodore J.; Garofoli, Elizabeth A.; Gatt, Charles J.; Gecha, Steven R.; Giffin, J. Robert; Hame, Sharon L.; Hannafin, Jo A.; Harner, Christopher D.; Harris, Norman Lindsay; Hechtman, K S; Hershman, Elliott B.; Hoellrich, Rudolf G.; Hosea, Timothy M.; Johnson, David C.; Johnson, Timothy S.; Jones, Morgan H.; Kaeding, Christopher C.; Kamath, Ganesh V.; Klootwyk, Thomas E.; Levy, Bruce A.; Benjamin, C.; Maiers, G. Peter; Marx, Robert G.; Matava, Matthew J.; Mathien, Gregory M.; McAllister, David R.; McCarty, Eric C.; McCormack, Robert G.; Miller, Bruce S.; Nissen, Carl W.; O’Neill, Daniel F.; Owens, Brett D.; Parker, Richard D.; Purnell, Mark L.; Ramappa, Arun J.; Rauh, Michael A.; Rettig, Arthur C.; Sekiya, Jon K.; Shea, Kevin G.; Sherman, Orrin H.; Slauterbeck, James R.; Smith, Matthew V.; Spang, Jeffrey T.; Svoboda, Steven J.; Taft, Timothy N.; Tenuta, Joachim J.; Tingstad, Edwin M.; Vidal, Armando F.; Viskontas, Darius; White, R. A. S.; Williams, James S.; Wolcott, Michelle; Wolf, Brian R.; York, James J.

doi:10.1177/0363546517712952

Cited by 31 publications

(6 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Despite a large body of the literature regarding single anterior cruciate ligament (ACL) graft failures, only a few studies emphasizing multiple ACL graft failures have been published [ 1 , 5 , 12 , 13 , 15 , 16 ]. Prior studies have shown that undergoing more than one revision ACL-R is a predictor for worse patient-reported outcomes (PROs) and subsequent graft failures [ 2 , 17 ]. Additionally, the majority of patients that have sustained multiple ACL graft failures present with meniscal tears and cartilage lesions [ 5 , 12 , 13 , 15 , 16 ], which are well-known negative predictors for long-term knee function.…”

Section: Introductionmentioning

confidence: 99%

A high tibial slope, allograft use, and poor patient-reported outcome scores are associated with multiple ACL graft failures

Winkler

Wagala

Hughes

et al. 2021

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

Purpose To compare clinical outcomes, radiographic characteristics, and surgical factors between patients with single and multiple anterior cruciate ligament (ACL) graft failures. It was hypothesized that patients experiencing multiple ACL graft failures exhibit lower patient-reported outcome scores (PROs) and a higher (steeper) posterior tibial slope (PTS) than patients with single ACL graft failure. Methods Patients undergoing revision ACL reconstruction with a minimum follow-up of 12 months were included in this retrospective cohort study. Based on the number of ACL graft failures, patients were assigned either to the group “single ACL graft failure “or” multiple ACL graft failures “. The PTS was measured on strict lateral radiographs. Validated PROs including the International Knee Documentation Committee (IKDC) subjective knee form, Knee Injury and Osteoarthritis Outcome Score, Lysholm Score, Tegner Activity Scale, ACL-Return to Sport after Injury Scale, and Visual Analogue Scale for pain were collected. Results Overall, 102 patients were included with 58 patients assigned to the single ACL graft failure group and 44 patients to the multiple ACL graft failures group. Quadriceps tendon autograft was used significantly more often (55% vs. 11%, p < 0.001) and allografts were used significantly less often (31% vs. 66%, p < 0.001) as the graft for first revision ACL reconstruction in patients with single versus multiple ACL graft failures. Patients with multiple ACL graft failures were associated with statistically significantly worse PROs (IKDC: 61.7 ± 19.3 vs. 77.4 ± 16.8, p < 0.05; Tegner Activity Scale: 4 (range, 0–7) vs. 6 (range 2–10), p < 0.05), higher PTS (12 ± 3° vs. 9 ± 3°, p < 0.001), and higher rates of subsequent surgery (73% vs. 14%, p < 0.001) and complications (45% vs. 17%, p < 0.05) than patients with single ACL graft failure. Conclusion Compared to single ACL graft failure in this study multiple ACL graft failures were associated with worse PROs, higher PTS, and allograft use. During the first revision ACL reconstruction, it is recommended to avoid the use of allografts and to consider slope-reducing osteotomies to avoid multiple ACL graft failures and improve PROs. Level of evidence Level 3.

show abstract

Section: Introductionmentioning

confidence: 99%

A high tibial slope, allograft use, and poor patient-reported outcome scores are associated with multiple ACL graft failures

Winkler

Wagala

Hughes

et al. 2021

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

show abstract

“…Due to the increasing number of anterior cruciate ligament (ACL) reconstructions, the number of ACL revision surgeries has risen accordingly [1][2][3][4][5][6]. ACL surgery is a frequently Abstract Purpose To investigate the effect of tibial tunnel orientation on graft-bending angle and stress distribution in the ACL graft.…”

Section: Introductionmentioning

confidence: 99%

Peak stresses shift from femoral tunnel aperture to tibial tunnel aperture in lateral tibial tunnel ACL reconstructions: a 3D graft-bending angle measurement and finite-element analysis

Bracht

Tampere

Beekman

et al. 2017

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

show abstract

“…In contrast to the MARS group age did not show any impact on clinical and functional outcome [ 2 ]. One reason might be the lower median age of 26 yrs.…”

Section: Discussionmentioning

confidence: 99%

Joint effusion, anteroposterior stability, muscle strength and degree of patellofemoral osteoarthritis significantly impact outcome following revision ACL reconstruction

et al. 2021

View full text Add to dashboard Cite

Purpose: Effusion, impaired muscle function and knee instability are considered as some of the most important factors effecting outcome following anterior cruciate ligament reconstruction (ACL-R) but the impact on revision ACL-R remains unclear. It was hypothesized that these factors will significantly worsen clinical outcome following revision ACL-R. Methods Seventy knees (13 female and 57 male) were followed retrospectively after revision ACL-R at a mean follow-up of 47.8 ± 20.7 months. Clinical examination was based on the International Knee Documentation Evaluation Form-2000 (IKDC), Tegner activity scale. Instrumented measurement of anterior tibial translation was performed using the Rolimeter® (DJO Global, Freiburg, Germany). Bilateral circumference of the thigh was measured 10 and 20 cm proximal to the medial joint space. Cartilage was assessed according to Outerbridge classification during both primary and revision ACL-R. Results Tegner activity scale decreased significantly from 7.8 ± 1.4 points at primary ACL-R to 7 ± 1.8 points at revision ACL-R, and 5.8 ± 1.7 points at the time of follow up (p < 0.001). Joint effusion (r = − 0.47, p < 0.01) and side to side differences in single leg hop test (r = − 0.48, p < 0.1) significantly correlated with inferior outcome. Cartilage lesions were found in 67% of the patients at the time of revision ACL-R compared to 38% at the time of primary ACL-R. According to the IKDC classification A was graded in three patients (4.3%), B in 35 (50%), C in 29 (41.4%) and D in three (4.3%). Joint effusion was measured in 35% of patients at the time of follow-up. Degeneration at the patellofemoral compartment of > grad 2 was responsible for IKDC grade C and D (p = 0.035). Instrumented anteroposterior site-to-site difference of ≥3 mm showed significant impact on clinical outcome (p < 0.019). Conclusion The study has shown that chronic effusion, quadriceps dysfunction, cartilage lesions especially at the patellofemoral compartment and side to side difference in anteroposterior stability significantly influences patient outcome after revision ACL-R. These factors require special attention when predicting patient’s outcome. Level of evidence Level-IV, case-controlled study.

show abstract

Surgical Predictors of Clinical Outcomes After Revision Anterior Cruciate Ligament Reconstruction

Cited by 31 publications

References 27 publications

A high tibial slope, allograft use, and poor patient-reported outcome scores are associated with multiple ACL graft failures

A high tibial slope, allograft use, and poor patient-reported outcome scores are associated with multiple ACL graft failures

Peak stresses shift from femoral tunnel aperture to tibial tunnel aperture in lateral tibial tunnel ACL reconstructions: a 3D graft-bending angle measurement and finite-element analysis

Joint effusion, anteroposterior stability, muscle strength and degree of patellofemoral osteoarthritis significantly impact outcome following revision ACL reconstruction

Contact Info

Product

Resources

About