Summary: Analysis of risk factors of postoperative ACL graft failure in a large cohort of ACLR patients with and without a monoloop lateral extra-articular tenodesis (mLET).

Introduction

Anterior cruciate ligament reconstruction (ACLR) is a well-established procedure to treat symptomatic ACL insufficient knees, but graft failure remains a feared complication. The purpose of this study is to analyze risk factors of postoperative graft failure in a large cohort of ACLR patients with and without a monoloop lateral extra-articular tenodesis (mLET).

Methods

A single center, two-surgeon, non-randomized clinical trial, with retrospective analysis of prospectively collected data focused on a population of 748 patients with an acute primary ACL tear. All patients were treated with quadrupled semitendinosus ACLR with minimal follow-up of 2 years (mean follow-up 50 months (24-89). Patient demographics were recorded. Categorical variables were sex (461M (61.6%), 287F (38.4%)), age below 25 years old (N=271, 36.2%), smoking (N=126, 16.8%), soccer (N=264, 35.3%), Tegner activity score (8 or higher) (N=273, 36.5%), meniscal injury (N= 318, 42.5%) and mLET (N=211, 28.2%). Primary outcome was graft failure, defined as the need for revision or symptomatic ACL instability. Statistical analysis was performed to identify predictors of ACL graft failure (univariate analysis, binary logistic regression analysis and model reduction). Finally, a subgroup analysis was performed on the populations at high risk to study the effect of mLET on graft failure.

Results

Mean age at surgery was 31 (13-61), mean weight 75.9kg (47-125), mean length 175cm (152-202), mean BMI 24.4 3 (18-39). Overall, graft failure was observed in 25/748 (3.34%) patients.
Following the predictive model, the likelihood of graft failure increased by a factor of 29.3 (p <0.001) if age below 25 years old; factor 7.4 if isolated ACLR without mLET (p=0.002); 4.4 (p=0.002) if playing soccer, 3.1 (p=0.021) if smoking, 2.8 (p=0.023) if associated meniscus injury.
The addition of mLET to ACLR reduced the risk of graft failure by a factor of 11.3 (p=0.002) in the age group below 25 years old. In patients with concomitant meniscal lesions, mLET reduced the likelihood of graft failure by a factor of 8 (p=0.01) and in soccer players by a factor of 5.2 (p=0.016). None of the smokers experienced graft failure after mLET.

Conclusions

In this large cohort study, the likelihood of ACLR graft failure was significantly increased in patients below 25 years old (RR 29.3), in isolated ACLR without mLET (RR 7.4), in soccer players (RR 4.4), in smokers (RR 3.1) and when concomitant meniscal injuries were diagnosed (RR 2.8). In contrast, the addition of mLET, as the only surgically modifiable predictor, actively reduced the risk of ACL graft failure in the study population, especially in the groups at risk (below 25, soccer, meniscus injury, smoker).

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The Lateral Femoral Notch Sign Entails Increased Rotatory Laxity After Acl-Injury. Pivot Shift Quantification With Surgical Navigation System Abstract Presentation 5 minutes Gian Andrea Lucidi, MD, ITALY Piero Agostinone, MD, ITALY Stefano Di Paolo, Eng, ITALY Alberto Grassi, PhD, ITALY Luca Macchiarola, MD, ITALY Giacomo Dal Fabbro, MD, ITALY Nicola Pizza, MD, ITALY Stefano Zaffagnini, MD, Prof., ITALY
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Coach Education Improves Implementation Of ACL Injury Prevention Programs: A Cluster-Randomized Controlled Trial Abstract Presentation 5 minutes Daphne Ling, PhD, MPH, TAIWAN Caroline Boyle, UNITED STATES Brandon Schneider, MS, UNITED STATES Joseph Janosky, DrPHc, MS, PT, ATC, UNITED STATES James Kinderknecht, UNITED STATES Robert G. Marx, MD, UNITED STATES
Concurrent Treatment Of A Displaced Bucket Handle And Anterior Cruciate Ligament Reconstruction: A Higher Risk Of Stiffness? Abstract Presentation 5 minutes Etienne Deroche, MD, FRANCE Cécile Batailler, MD, PhD, FRANCE John Swan, MBBS, FRANCE Sebastien Lustig, MD, PhD, FRANCE Elvire Servien, MD, PhD, Prof., FRANCE
Second-Look Arthroscopic Evaluation And Clinical Outcomes After Anatomical Double-Bundle Anterior Cruciate Ligament Reconstruction With Generalized Joint Laxity Or Hyperextended Knee Abstract Presentation 6 minutes Yasunari Oniki, MD, PhD, JAPAN Taiki Murakami, JAPAN Eiichi Nakamura, MD, PhD, JAPAN
Does In Vivo Kinematics Following Acl Reconstruction With Or Without Lateral Extraarticular Tenodesis Correlate With Preoperative Quantitative Pivot Shift? Abstract Presentation 5 minutes Christopher M. Gibbs, MD, UNITED STATES Philipp Wilhelm Winkler, MD, AUSTRIA Jonathan D Hughes, MD, UNITED STATES Adam Popchak, DPT, PhD, UNITED STATES Daisuke Chiba, MD, PhD, JAPAN Bryson P. Lesniak, MD, UNITED STATES William Anderst, PhD, UNITED STATES Volker Musahl, MD, Prof., UNITED STATES
The Effect Of Lateral Extraarticular Tenodesis On In Vivo Cartilage Contact In Combined Anterior Cruciate Ligament Reconstruction ePoster Presentation Kyohei Nishida , MD, PhD, JAPAN Tom Gale, MS, UNITED STATES Daisuke Chiba, MD, PhD, JAPAN Felipe Martin Suntaxi, MS, UNITED STATES Bryson P. Lesniak, MD, UNITED STATES Freddie H. Fu, MD, UNITED STATES William Anderst, PhD, UNITED STATES Volker Musahl, MD, Prof., UNITED STATES
Factors associated with anterior cruciate ligament (ACL) reconstruction among ACL injuries in Alberta, Canada ePoster Presentation Yuba Raj Paudel, MPH, CANADA Mark F. Sommerfeldt, MD, CANADA Donald C. Voaklander, PhD, CANADA
Predicting Subjective Failure of ACL Reconstruction: A Machine Learning Analysis of the Norwegian Knee Ligament Register and Patient Reported Outcomes Award Winner 5 minutes R. Kyle Martin, MD, FRCSC, UNITED STATES Solvejg Wastvedt, BA, UNITED STATES Ayoosh Pareek, MD, UNITED STATES Andreas Persson, MD, PhD, NORWAY Havard Visnes, MD, PT, PhD, NORWAY Anne Marie Fenstad, MSc, NORWAY Gilbert Moatshe, MD, PhD, NORWAY Julian Wolfson, PhD, UNITED STATES Lars Engebretsen, MD, PhD, NORWAY
Sex Related Outcomes Following Anterior Cruciate Ligament Reconstruction (Aclr): A Systematic Review and Meta-Analysis Abstract Presentation 5 minutes Anthony Charles Mok, BS, UNITED STATES Andrew J Fancher, BS, UNITED STATES Matthew L Vopat, MD, UNITED STATES Jordan Charles Baker, BS, UNITED STATES Armin Tarakemeh, BS, UNITED STATES Mary K. Mulcahey, MD, UNITED STATES Scott Mullen, MD, UNITED STATES Paul Schroeppel, MD, UNITED STATES Kimberly J. Templeton, MD, UNITED STATES Bryan Vopat, UNITED STATES
Nerve injury during anterior cruciate ligament reconstruction: A comparison between patellar and hamstring tendon grafts harvest Abstract Presentation 5 minutes Jonathan Singer, MD, ISRAEL Ehud Rath, Prof., ISRAEL Mustafa Yassin, MD, ISRAEL Shlomo Bronak, MD, ISRAEL Barak Haviv, MD, ISRAEL

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Risk Factor Analysis for Graft Failure after Anterior Cruciate Ligament Reconstruction with or without mLET

Risk Factor Analysis for Graft Failure after Anterior Cruciate Ligament Reconstruction with or without mLET

Introduction

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Conclusions

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Risk Factor Analysis for Graft Failure after Anterior Cruciate Ligament Reconstruction with or without mLET

Risk Factor Analysis for Graft Failure after Anterior Cruciate Ligament Reconstruction with or without mLET

Introduction

Methods

Results

Conclusions

More ISAKOS 2021: Global Content