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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
References
  1. Samitier G, Marcano AI, Alentorn-Geli E, Cugat R, Farmer KW, Moser MW. Failure of anterior cruciate ligament reconstruction. Arch Bone Jt Surg 2015;3:220-40.
  2. Brown CH Jr, Carson EW. Revision anterior cruciate ligament sur-gery. Clin Sports Med 1999;18:109-71.
    CrossRef
  3. Wright RW, Magnussen RA, Dunn WR, Spindler KP. Ipsilateral graft and contralateral ACL rupture at five years or more follow-ing ACL reconstruction: a systematic review. J Bone Joint Surg Am 2011;93:1159-65.
    Pubmed KoreaMed CrossRef
  4. Wright RW, Huston LJ, Spindler KP, et al. Descriptive epidemiol-ogy of the multicenter ACL revision study (MARS) cohort. Am J Sports Med 2010;38:1979-86.
    Pubmed KoreaMed CrossRef
  5. Conte EJ, Hyatt AE, Gatt CJ Jr, Dhawan A. Hamstring auto-graft size can be predicted and is a potential risk factor for anterior cruciate ligament reconstruction failure. Arthroscopy 2014;30:882-90.
    Pubmed CrossRef
  6. Hettrich CM, Dunn WR, Reinke EK; MOON Group, Spindler KP. The rate of subsequent surgery and predictors after anterior cru-ciate ligament reconstruction: two- and 6-year follow-up results from a multicenter cohort. Am J Sports Med 2013;41:1534-40.
    Pubmed KoreaMed CrossRef
  7. Tan SH, Lau BP, Khin LW, Lingaraj K. The importance of patient sex in the outcomes of anterior cruciate ligament reconstruc-tions: a systematic review and meta-analysis. Am J Sports Med 2016;44:242-54.
    Pubmed CrossRef
  8. Bernard M, Hertel P, Hornung H, Cierpinski T. Femoral insertion of the ACL. Radiographic quadrant method. Am J Knee Surg 1997;10:14-21; discussion 21-2.
  9. Webster KE, Feller JA, Leigh WB, Richmond AK. Younger patients are at increased risk for graft rupture and contralateral injury after anterior cruciate ligament reconstruction. Am J Sports Med 2014;42:641-7.
    Pubmed CrossRef
  10. Shelbourne KD, Gray T, Haro M. Incidence of subsequent injury to either knee within 5 years after anterior cruciate ligament reconstruction with patellar tendon autograft. Am J Sports Med 2009;37:246-51.
    Pubmed CrossRef
  11. Chen JL, Allen CR, Stephens TE, et al. Differences in mechanisms of failure, intraoperative findings, and surgical characteristics be-tween single- and multiple-revision ACL reconstructions: a MARS cohort study. Am J Sports Med 2013;41:1571-8.
    Pubmed KoreaMed CrossRef
  12. Greis PE, Bardana DD, Holmstrom MC, Burks RT. Meniscal injury: I. basic science and evaluation. J Am Acad Orthop Surg 2002;10:168-76.
    Pubmed CrossRef
  13. Kartus JT, Russell VJ, Salmon LJ, et al. Concomitant partial men-iscectomy worsens outcome after arthroscopic anterior cruciate ligament reconstruction. Acta Orthop Scand 2002;73:179-85.
    Pubmed CrossRef
  14. Laxdal G, Kartus J, Ejerhed L, et al. Outcome and risk factors af-ter anterior cruciate ligament reconstruction: a follow-up study of 948 patients. Arthroscopy 2005;21:958-64.
    Pubmed CrossRef
  15. Pullen WM, Bryant B, Gaskill T, Sicignano N, Evans AM, DeMaio M. Predictors of revision surgery after anterior cruciate ligament reconstruction. Am J Sports Med 2016;44:3140-5.
    Pubmed CrossRef
  16. Leys T, Salmon L, Waller A, Linklater J, Pinczewski L. Clinical re-sults and risk factors for reinjury 15 years after anterior cruciate ligament reconstruction: a prospective study of hamstring and patellar tendon grafts. Am J Sports Med 2012;40:595-605.
    Pubmed CrossRef
  17. Jorge PB, Escudeiro D, Severino NR, et al. Positioning of the femoral tunnel in anterior cruciate ligament reconstruction: func-tional anatomical reconstruction. BMJ Open Sport Exerc Med 2018;4:e000420.
    Pubmed KoreaMed CrossRef
  18. Harner CD, Giffin JR, Dunteman RC, Annunziata CC, Fried-man MJ. Evaluation and treatment of recurrent instability after anterior cruciate ligament reconstruction. Instr Course Lect 2001;50:463-74.
  19. Howell SM, Barad SJ. Knee extension and its relationship to the slope of the intercondylar roof. Implications for positioning the tibial tunnel in anterior cruciate ligament reconstructions. Am J Sports Med 1995;23:288-94.
    Pubmed CrossRef
  20. Webb JM, Salmon LJ, Leclerc E, Pinczewski LA, Roe JP. Posterior tibial slope and further anterior cruciate ligament injuries in the anterior cruciate ligament-reconstructed patient. Am J Sports Med 2013;41:2800-4.
    Pubmed CrossRef
  21. Carey JL, Dunn WR, Dahm DL, Zeger SL, Spindler KP. A sys-tematic review of anterior cruciate ligament reconstruction with autograft compared with allograft. J Bone Joint Surg Am 2009;91:2242-50.
    Pubmed KoreaMed CrossRef
  22. Barbour SA, King W. The safe and effective use of allograft tissue--an update. Am J Sports Med 2003;31:791-7.
    Pubmed CrossRef
  23. Prodromos C, Joyce B, Shi K. A meta-analysis of stability of autografts compared to allografts after anterior cruciate liga-ment reconstruction. Knee Surg Sports Traumatol Arthrosc 2007;15:851-6.
    Pubmed CrossRef
  24. Bernstein J. Early versus delayed reconstruction of the anterior cruciate ligament: a decision analysis approach. J Bone Joint Surg Am 2011;93:e48.
    Pubmed CrossRef
  25. Karlsson J, Kartus J, Magnusson L, Larsson J, Brandsson S, Er-iksson BI. Subacute versus delayed reconstruction of the anterior cruciate ligament in the competitive athlete. Knee Surg Sports Traumatol Arthrosc 1999;7:146-51.
    Pubmed CrossRef
  26. Harner CD, Irrgang JJ, Paul J, Dearwater S, Fu FH. Loss of motion after anterior cruciate ligament reconstruction. Am J Sports Med 1992;20:499-506.
    Pubmed CrossRef
  27. Barrett AM, Craft JA, Replogle WH, Hydrick JM, Barrett GR. Anterior cruciate ligament graft failure: a comparison of graft type based on age and Tegner activity level. Am J Sports Med 2011;39:2194-8.
    Pubmed CrossRef

November 2021, 8 (2)
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