Young age and high BMI are predictors of early revision surgery after primary anterior cruciate ligament reconstruction: a cohort study from the Swedish and Norwegian knee ligament registries based on 30,747 patients

Snaebjörnsson, Thorkell; Svantesson, Eleonor; Sundemo, David; Westin, Olof; Sansone, Mikael; Engebretsen, Lars; Senorski, Eric Hamrin

doi:10.1007/s00167-019-05487-2

Cited by 66 publications

(71 citation statements)

References 41 publications

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“…Smoking status was not related to the risk of subsequent C-ACL injury in this review. This is in line with studies showing no effect of smoking status and the risk of revision surgery after ACLR [ 111 , 112 ]. Although smokers seem to have worse self-reported and clinical outcomes and increased risk of complications after ACLR [ 112 ], being a smoker seems not to influence the risk of further injury to either knee.…”

Section: Discussionsupporting

confidence: 91%

Risk Factors for Contra-Lateral Secondary Anterior Cruciate Ligament Injury: A Systematic Review with Meta-Analysis

2021

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Background The risk of sustaining a contra-lateral anterior cruciate ligament (C-ACL) injury after primary unilateral ACL injury is high. C-ACL injury often contributes to a further decline in function and quality of life, including failure to return to sport. There is, however, very limited knowledge about which risk factors that contribute to C-ACL injury. Objective To systematically review instrinsic risk factors for sustaining a C-ACL injury. Methods A systematic review with meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Four databases (MEDLINE, CINAHL, EMBASE, Sport Discus) were searched from inception to January 2020. Inclusion criteria were prospective or retrospective studies investigating any intrinsic risk factor for future C-ACL injury. Meta-analysis was performed and expressed as odds ratios (OR) if two or more articles assessed the same risk factor. Results 44 moderate-to-high quality studies were eventually included in this review, whereof 35 studies were eligible for meta-analysis, including up to 59 000 individuals. We identified seven factors independently increasing the odds of sustaining a C-ACL injury (in order of highest to lowest OR): (1) returning to a high activity level (OR 3.26, 95% CI 2.10–5.06); (2) Body Mass Index < 25 (OR 2.73, 95% CI 1.73–4.36); (3) age ≤ 18 years (OR 2.42, 95% CI 1.51–3.88); (4) family history of ACL injury (OR 2.07, 95% CI 1.54–2.80); (5) primary ACL reconstruction performed ≤ 3 months post injury (OR 1.65, 95% CI: 1.32–2.06); (6) female sex (OR 1.35, 95% CI 1.14–1.61); and (7) concomitant meniscal injury (OR 1.21, 95% CI 1.03–1.42). The following two factors were associated with decreased odds of a subsequent C-ACL injury: 1) decreased intercondylar notch width/width of the distal femur ratio (OR 0.43, 95% CI 0.25–0.69) and 2) concomitant cartilage injury (OR 0.83, 95% CI 0.69–1.00). There were no associations between the odds of sustaining a C-ACL injury and smoking status, pre-injury activity level, playing soccer compared to other sports or timing of return to sport. No studies of neuromuscular function in relation to risk of C-ACL injury were eligible for meta-analysis according to our criteria. Conclusion This review provides evidence that demographic factors such as female sex, young age (≤ 18 years) and family history of ACL injury, as well as early reconstruction and returning to a high activity level increase the risk of C-ACL injury. Given the lack of studies related to neuromuscular factors that may be modifiable by training, future studies are warranted that investigate the possible role of factors such as dynamic knee stability and alignment, muscle activation and/or strength and proprioception as well as sport-specific training prior to return-to-sport for C-ACL injuries. PROSPERO: CRD42020140129.

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Section: Discussionsupporting

confidence: 91%

Risk Factors for Contra-Lateral Secondary Anterior Cruciate Ligament Injury: A Systematic Review with Meta-Analysis

2021

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“…Unavoidably, this limitation is common in many studies with a similar design 23,24 and with registries. 9,20,21,28 On the other hand, the use of a clear outcome such as ipsilateral ACL revision or contralateral ACL reconstruction leaves no room for interpretation and makes the results of this study comparable with other series with similar populations. Finally, the limited number of patients belonging to specific subgroups (eg, young and active) could have impaired the calculation of HRs and survival rates.…”

Section: Discussionmentioning

confidence: 54%

More Than a 2-Fold Risk of Contralateral Anterior Cruciate Ligament Injuries Compared With Ipsilateral Graft Failure 10 Years After Primary Reconstruction

et al. 2020

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Background: Failure of anterior cruciate ligament (ACL) reconstruction or an injury to the ACL in the contralateral knee represents a devastating event for patients, especially those young and physically active. However, controversies are still present regarding long-term failure rates and risk factors. Purpose: To assess the long-term rate of ipsilateral graft failure and contralateral ACL injuries after ACL reconstruction performed at a single center using the same surgical technique with a hamstring autograft and to investigate the effect of sex, age, and preinjury activity level as predictors of second ACL injuries. Study Design: Case series; Level of evidence, 4. Methods: The study cohort consisted of 244 consecutive patients (mean age, 30.7 years) who underwent ACL reconstruction with a single bundle plus lateral plasty technique using the hamstring tendon between November 2007 and May 2009. The number of subsequent ACL injuries (ipsilateral ACL revision or contralateral ACL reconstruction) was determined at a minimum follow-up of 10 years. Survivorship of either knee and subgroup analysis included sex, age, preoperative Tegner activity level, timing of ACL reconstruction, body mass index, and smoking status. Results: Ipsilateral ACL revision was performed in 8 (3.4%) patients and contralateral ACL reconstruction in 19 (7.8%) patients. Only 1 patient had both ipsilateral and contralateral injuries. No predictors were found for ipsilateral ACL revision, while age <18 years and preoperative Tegner level ≥7 had a higher risk of contralateral ACL reconstruction. The highest rate of a second ACL reconstruction procedure was in young (<18 years) and active (Tegner ≥7) patients, in whom the 10-year survival of either knee was 61.1%. Six years after primary ACL reconstruction, the rate of contralateral ACL reconstruction was significantly higher than that of ipsilateral ACL revision (hazard ratio, 2.4-3.6). Conclusion: In the long term, a second injury to either the ipsilateral or the contralateral knee in young and active populations could reach 40%, with a more than double-fold risk of contralateral ACL reconstruction compared with ipsilateral ACL revision.

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“…We expect younger individuals to undergo better recovery after surgery, however, it is known that younger individuals undergo higher chance of ACL revision. ( 25 …”

Section: Discussionmentioning

confidence: 99%

Determinants of Return to Play After Anterior Cruciate Ligament Reconstruction

et al. 2020

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Objective: To systematically review and meta-analyze the performance of return to play (RTP) and non-RTP patients in different assessment tools after anterior cruciate ligament reconstructions (ACLR). Methods: Out of 182 studies searched on PubMed, 11 presented RTP and non-RTP groups assessing the performance of young individuals, practitioners of different sports, with different tools. Results: There was higher limb symmetry (7.13% [95%CI 4.55; 9.70], p < 0.001), Tegner activity scale (2.41 [95%CI 0.18; 4.64], p = 0.03), functional scores such as International Knee Documentation Committee (x7.44 [95%CI 4.69; 10.19], p < 0.001), Knee Osteoarthritis Outcome score for quality of life (14.75 [95%CI 10.96; 18.54], p < 0.001) and for sports/recreation (11.86 [95%CI 8.87; 14.86], p < 0.001); and lower knee laxity (-0.25 mm [95%CI -0.36; -0.14], p < 0.001) in RTP compared to non-RTP patients following ACLR. Conclusion: We confirmed that these different tools can differentiate RTP for non-RTP patients, which may contribute to the physician’s decision about the ideal time for RTP. Level of Evidence III, Systematic review of Level III studies.

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Young age and high BMI are predictors of early revision surgery after primary anterior cruciate ligament reconstruction: a cohort study from the Swedish and Norwegian knee ligament registries based on 30,747 patients

Cited by 66 publications

References 41 publications

Risk Factors for Contra-Lateral Secondary Anterior Cruciate Ligament Injury: A Systematic Review with Meta-Analysis

Risk Factors for Contra-Lateral Secondary Anterior Cruciate Ligament Injury: A Systematic Review with Meta-Analysis

More Than a 2-Fold Risk of Contralateral Anterior Cruciate Ligament Injuries Compared With Ipsilateral Graft Failure 10 Years After Primary Reconstruction

Determinants of Return to Play After Anterior Cruciate Ligament Reconstruction

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