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Factors affecting knee joint instability after primary anterior cruciate ligament reconstruction
Arthrosc Orthop Sports Med 2021;8:47-53
Published online November 1, 2021;  https://doi.org/10.14517/aosm21005
© 2021 Korean Arthroscopy Society and Korean Orthopedic Society for Sports Medicine.

Nam-Hun Lee, Jun-Hyuk Lim, Changhyun Ryu, Jong-Keun Seon

Department of Orthopedic Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
Correspondence to: Jong-Keun Seon, https://orcid.org/0000-0002-6450-2339
Department of Orthopaedic Surgery, Chonnam National University Hospital, Chonnam National University Medical School, 322 Seoyang-ro, Hwasun 58128, Korea. Tel: +82-62-670-9475, Fax: +82-62-670-9476, E-mail: seonbell@chonnam.ac.kr
Received July 7, 2021; Revised October 8, 2021; Accepted October 18, 2021.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Graft failure remains a severe complication of anterior cruciate ligament (ACL) reconstruction, often requiring revision with poor outcomes. The definitive influence of risk factors on graft failure remains unclear. This study aimed to analyze risk factors for failure.
Methods: A total of 206 patients (mean age, 30.8 years) who underwent arthroscopic ACL reconstruction between 2004 and 2014 were enrolled in this study. Medical records including instability based on Lachman test, pivot shift test, and stress radiography were retrospectively reviewed. Knees with instability were examined according to the instability criteria. Predictors of instability that were explored included patient age, sex, body mass index (BMI), time from injury to operation, postoperative Tegner activity level, preoperative instability on stress radiography, tibia and femoral tunnel positions, posterior tibial slope, meniscectomy before or concurrent with ACL reconstruction, and graft type. Multivariable regression analysis was performed to investigate risk factors associated with knee instability.
Results: Of the patients, 9.2% had knee instability or revision after primary ACL reconstruction. Younger age, preoperative instability on stress radiography, tunnel malposition, meniscectomy during ACL reconstruction, and use of allograft were significantly (P < 0.05) associated with instability after ACL reconstruction. Multivariable analysis showed younger age (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.02–1.14; P = 0.01), meniscectomy (OR, 4.06; 95% CI, 1.24–13.28; P = 0.02), and allograft (OR, 12.41; 95% CI, 1.59–96.88; P = 0.02) were significant risk factors.
Conclusion: Sex, BMI, and postoperative Tegner activity scale score were found to be insignificant risk factors for postoperative instability. However, younger age, use of allograft, and additional meniscectomy during surgery were found to be potential risk factors for knee joint instability after ACL reconstruction.
Keywords : Anterior cruciate ligament; Arthroscopy; Risk factor
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