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
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© 2005 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
