Advertisement

Incidence and Risk Factors for Graft Rupture and Contralateral Rupture After Anterior Cruciate Ligament Reconstruction

      Purpose: The aim of this study was to determine the rates of contralateral anterior cruciate ligament (ACL) rupture and of ACL graft rupture after ACL reconstruction using either patellar tendon or hamstring tendon autograft, and to identify any patient characteristics that may increase this risk. Type of Study: Case series. Methods: Over a 2-year period, 760 endoscopic ACL reconstructions were performed in 743 patients. Bone-patellar tendon-bone autograft was used in 316 patients and 4-strand hamstring tendon in 427 patients. Those patients with a previous contralateral ACL rupture or those who underwent a simultaneous bilateral ACL reconstruction were excluded, leaving 675 knees (675 patients) for review. Persons not involved in the index operation or the care of the patient conducted follow-up assessment by telephone interview conducted 5 years after surgery. Patients were questioned about the incidence of ACL graft rupture, contralateral ACL rupture, symptoms of instability or significant injury, family history of ACL injury, and activity level according to the International Knee Documentation Committee scale. From our prospective database we obtained further information on graft source, meniscal or articular surface injury, and gender. Binary logistic regression was used to measure the relative association between the measured variables and the risk of graft rupture and contralateral ACL rupture. Results: Five years after primary ACL reconstruction, 612 of the 675 patients (90.7%) were assessed. ACL graft rupture occurred in 39 patients (6%) and contralateral ACL rupture occurred in 35 patients (6%). Three patients suffered both a graft rupture and a contralateral ACL injury. The odds of ACL graft rupture were increased 3-fold by a contact mechanism of initial injury. Return to level 1 or 2 sports increased the risk of contralateral ACL injury by a factor of 10. The risk of sustaining an ACL graft rupture was greatest in the first 12 months after reconstruction. No other studied variable increased the risk of repeat ACL injury. Conclusions: After reconstruction, repeat ACL injury occurred in 12% of patients over 5 years. Twelve months after reconstruction, the ACL graft is at no greater risk than the contralateral ACL, suggesting that adequate graft and muscular function for most activities is achieved by this time. Risk factors for repeat ACL injury identified included a return to competitive side-stepping, pivoting, or jumping sports, and the contact mechanism of the index injury. Female patients were at no greater risk of repeat ACL injury than male patients and graft choice did not affect the rate of repeat ACL injury. Level of Evidence Level IV, case series.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Arendt E.
        • Dick R.
        Knee injury patterns among men and women in collegiate basketball and soccer.
        Am J Sports Med. 1995; 23: 694-701
        • Caraffa A.
        • Cerulli G.
        • Projetti M.
        • Aisa G.
        • Rizzo A.
        Prevention of anterior cruciate ligament injuries in soccer.
        Knee Surg Sports Traumatol Arthrosc. 1996; 4: 19-21
        • Ettlinger C.
        • Johnson R.
        • Shealy J.
        A method to help reduce the risk of serious knee sprains incurred in alpine skiing.
        Am J Sports Med. 1995; 23: 531-537
        • Ferrari J.
        • Bach B.
        • Bush-Joseph C.
        • Wang T.
        • Bojcuk J.
        Anterior cruciate ligament reconstruction in men and womenr.
        Arthroscopy. 2001; 17: 588-596
        • Harner C.D.
        • Paulos L.E.
        • Greenwald A.E.
        • Rosenberg T.D.
        • Cooley V.C.
        Detailed analysis of patients with bilateral anterior cruciate ligament injuries.
        Am J Sports Med. 1994; 22: 37-43
        • Hewett T.
        • Lindfield T.
        • Ricobene J.
        • Noyes F.
        The effect of neuromuscular training on the incidence of knee injury in female athletes. A prospective study.
        Am J Sports Med. 1999; 27: 699-706
        • Oates K.
        • Eenenaam P.V.
        • Briggs K.
        • Homa K.
        • Sterett W.
        Comparative injury rates of uninjured, anterior cruciate ligament-deficient, and reconstructed knees in a skiing population.
        Am J Sports Med. 1999; 27: 606-610
        • Orchard J.
        • Seward H.
        • McGiven J.
        • Hood S.
        Intrinsic and extrinsic risk factors for anterior cruciate ligament injury in Australian footballers.
        Am J Sports Med. 2001; 29: 196-200
        • Rozzi S.
        • Lephart S.
        • Gear W.
        • Fu F.
        Knee joint laxity and neuromuscular characteristics of male and female soccer and basketball players.
        Am J Sports Med. 1999; 27: 312-319
      1. Prevention of noncontact ACL injuries.
        Ed 1. American Academy of Orthopaedic Surgeons, Rosemont, IL1999
        • LaPrade R.F.
        • Burnett Q.M.
        • Daniel D.M.
        Femoral intercondylar notch stenosis and correlation to anterior cruciate ligament injuriesr.
        Am J Sports Med. 1994; 22: 198-204
        • Souryal T.
        • Moore H.
        • Evans J.P.
        Bilaterality in anterior cruciate ligament injuriesr.
        Am J Sports Med. 1988; 16: 449-454
        • Aglietti P.
        • Buzzi R.
        • Zaccherotti G.
        • Biase P.D.
        Patellar tendon versus doubled semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction.
        Am J Sports Med. 1994; 22: 211-218
        • Corry I.
        • Webb J.
        • Clingeleffer A.
        • Pinczewski L.
        Arthroscopic reconstruction of the anterior cruciate ligament. A comparison of patellar tendon autograft and four-strand hamstring tendon autograft.
        Am J Sports Med. 1999; 27: 444-454
        • Marder R.A.
        • Raskind J.R.
        • Carroll M.
        Prospective evaluation of arthroscopically assisted anterior cruciate ligament reconstruction; patellar tendon versus semitendinosus and gracilis tendons.
        Am J Sports Med. 1991; 19: 478-484
        • O’Neill D.B.
        Arthroscopically assisted reconstruction of the anterior cruciate ligament; A prospective randomized analysis of three techniques.
        J Bone Joint Surg Am. 1996; 78: 803-813
        • Pinczewski L.
        • Deehan D.
        • Salmon L.
        • Russell V.
        • Clingeleffer A.
        A five-year comparison of patellar tendon versus four-strand hamstring tendon autograft for arthroscopic reconstruction of the anterior cruciate ligament.
        Am J Sports Med. 2002; 30: 523-536
        • Shaieb M.
        • Kan D.
        • Chang S.
        • Marumoto J.
        • Richardson A.
        A prospective randomized comparison of patellar tendon versus semitendinosus and gracilis tendon autografts for anterior cruciate ligament reconstruction.
        Am J Sports Med. 2002; 30: 214-220
        • Anderson A.F.
        Rating Scales.
        in: Fu F. Harner C. Vince K. Knee surgery. Williams & Wilkins, Baltimore1994: 275-296
        • Souryal T.
        • Freeman T.
        Intercondylar notch size and anterior cruciate ligament injuries in athletesr.
        Am J Sports Med. 1993; 21: 535-539
        • Schickendantz M.
        • Weiker G.
        The predictive value of radiographs in the evaluation of unilateral and bilateral anterior cruciate ligament injuries.
        Am J Sports Med. 1993; 21: 110-114
        • Anderson A.
        • Lipscomb A.
        • Liudahl K.
        • Addlestone R.
        Analysis of the intercondylar notch by computed tomography.
        Am J Sports Med. 1987; 15: 547-552
        • Spindler K.P.
        • Schils J.P.
        • Bergfeld J.A.
        Prospective study of osseous, articular, and meniscal lesions in recent anterior cruciate ligament tears by magnetic resonance imaging and arthroscopy.
        Am J Sports Med. 1993; 21: 551-558
        • Speer K.
        • Warren R.
        • Wickiewicz T.
        • Horowitz L.
        • Henderson L.
        Observations on the injury mechanisms of anterior cruciate ligament in skiers.
        Am J Sports Med. 1995; 23: 77-81
        • Barrett G.
        • Noojin F.
        • Hartzog C.
        • Nash C.
        Reconstruction of the anterior cruciate ligament in females. A comparison of hamstring and patellar tendon autograft.
        Arthroscopy. 2002; 18: 46-54
        • Anderson A.
        • Dome D.
        • Gautam S.
        • Awh M.
        • Rennirt G.
        Correlation of anthropometric measurements, strength, anterior cruciate ligament size and intercondylar notch characteristics to sex differences in anterior cruciate ligament tear rates.
        Am J Sports Med. 2001; 29: 58-65
        • Gwinn D.
        • Wilckens J.
        • McDevitt E.
        • Ross G.
        • Kao T.
        The relative incidence of anterior cruciate ligament injury in men and women at the United States Naval Academy.
        Am J Sports Med. 2000; 28: 98-102
        • Ireland M.
        • Ballantyne B.
        • Little K.
        • McClay I.
        A radiographic analysis of the relationship between the size and shape of the intercondylar notch and anterior cruciate ligament injury.
        Knee Surg Sports Traumatol Arthrosc. 2001; 9: 200-205
        • Barber-Westin S.
        • Noyes F.
        • Andrews M.
        A rigorous comparison between the sexes of results and complications after anterior cruciate ligament reconstruction.
        Am J Sports Med. 1997; 25: 514-525
        • Noojin F.
        • Barrett G.
        • Hartzog C.
        • Nash C.
        Clinical comparison of intraarticular anterior cruciate ligament reconstruction using autogenous semitendinosus and gracilis tendons in men versus women.
        Am J Sports Med. 2000; 28: 783-789
        • Flynn K.
        • Pedersen C.
        • Birmingham T.
        • Kirkley A.
        • Fowler P.
        The familial predisposition toward tearing the anterior cruciate ligament. Presented at the Biennial Congress of ISAKOS, Auckland, New Zealand2003 (March, 4.21)
        • Corsetti J.
        • Jackson D.
        Failure of anterior cruciate ligament reconstruction. The biologic basis.
        Clin Orthop. 1996; 323: 42-49
        • Clancy W.G.
        • Nelson D.A.
        • Reider B.
        • Narchania R.G.
        Anterior cruciate ligament reconstruction using one-third of the patellar ligament augmented by extra-articular tendon transfers.
        J Bone Joint Surg Am. 1982; 64: 352-359
        • Curtis R.
        • DeLee J.
        • Drez D.
        Reconstruction of the anterior cruciate ligament with freeze dried fascia lata grafts in dogs.
        Am J Sports Med. 1985; 13: 408-414
        • Jackson D.
        • Grood E.
        • Arnoczky S.
        Cruciate reconstruction using freeze dried anterior cruciate ligament allograft and a ligament augmentation device (LAD)r.
        Am J Sports Med. 1987; 15: 528-538
        • Jackson D.
        • Grood E.
        • Arnoczky S.
        Freeze dried anterior cruciate ligament allografts. Preliminary studies in a goat model.
        Am J Sports Med. 1987; 15: 295-303
        • Rougraff B.
        • Shelbourne K.
        • Gerth P.
        • Warner J.
        Arthroscopic and histologic analysis of human patellar tendon autografts used for anterior cruciate ligament reconstruction.
        Am J Sports Med. 1993; 21: 277-284
        • Almekinders L.
        • Moore T.
        • Freedman D.
        • Taft T.
        Post-operative problems following anterior cruciate ligament reconstruction.
        Knee Surg Sports Traumatol Arthrosc. 1995; 3: 78-82
        • Vergis A.
        • Gillquist J.
        Graft failure in intra-articular anterior cruciate ligament reconstructionsr.
        Arthroscopy. 1995; 11: 312-321
        • Jaureguito J.
        • Paulos L.
        Why grafts fail.
        Clin Orthop. 1996; 325: 25-41