Purpose
The purpose of this study was to evaluate the effect of graft size on patient-reported
outcomes and revision risk after anterior cruciate ligament (ACL) reconstruction.
Methods
A retrospective chart review of prospectively collected cohort data was performed,
and 263 of 320 consecutive patients (82.2%) undergoing primary ACL reconstruction
with hamstring autograft were evaluated. We recorded graft size; femoral tunnel drilling
technique; patient age, sex, and body mass index at the time of ACL reconstruction;
Knee Injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation
Committee score preoperatively and at 2 years postoperatively; and whether each patient
underwent revision ACL reconstruction during the 2-year follow-up period. Revision
was used as a marker for graft failure. The relation between graft size and patient-reported
outcomes was determined by multiple linear regression. The relation between graft
size and risk of revision was determined by dichotomizing graft size at 8 mm and stratifying
by age.
Results
After we controlled for age, sex, operative side, surgeon, body mass index, graft
choice, and femoral tunnel drilling technique, a 1-mm increase in graft size was noted
to correlate with a 3.3-point increase in the KOOS pain subscale (P = .003), a 2.0-point increase in the KOOS activities of daily living subscale (P = .034), a 5.2-point increase in the KOOS sport/recreation function subscale (P = .004), and a 3.4-point increase in the subjective International Knee Documentation
Committee score (P = .026). Revision was required in 0 of 64 patients (0.0%) with grafts greater than
8 mm in diameter and 14 of 199 patients (7.0%) with grafts 8 mm in diameter or smaller
(P = .037). Among patients aged 18 years or younger, revision was required in 0 of 14
patients (0.0%) with grafts greater than 8 mm in diameter and 13 of 71 patients (18.3%)
with grafts 8 mm in diameter or smaller.
Conclusions
Smaller hamstring autograft size is a predictor of poorer KOOS sport/recreation function
2 years after primary ACL reconstruction. A larger sample size is required to confirm
the relation between graft size and risk of revision ACL reconstruction.
Level of Evidence
Level III, retrospective comparative study.
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Article info
Publication history
Published online: October 21, 2013
Accepted:
August 21,
2013
Received:
February 19,
2013
Footnotes
This project was partially funded by grants 5R01 AR053684 (Kurt P. Spindler) and K23 AR063767 (R.A.M.) from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases and by grant 5U18-HS016075 (Robert G. Marx) from the Center for Education and Research on Therapeutics (Agency for Healthcare Research and Quality). The project was also supported by the Vanderbilt Sports Medicine Research Fund. Vanderbilt Sports Medicine received unrestricted educational gifts from Smith & Nephew Endoscopy and DonJoy Orthopaedics.
The authors report the following potential conflict of interest or source of funding: D.C.F. receives support from Sanofi and Smith & Nephew. M.H.J. receives support from National Institutes of Health, Smith & Nephew Endoscopy, and DonJoy Orthopaedics and unrestricted research support funding from DJO Surgical, Breg, Arthrex, Smith & Nephew, and Stryker. C.C.K. receives support from Biomet Sports Medicine.
Identification
Copyright
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
