Purpose
To assess patient history, physical examination findings, magnetic resonance imaging
(MRI) and 3-dimensional computed tomographic (3D CT) measurements of those with anterior
cruciate ligament (ACL) graft failure compared with primary ACL tear patients to better
discern risk factors for ACL graft failure.
Methods
We performed a retrospective review comparing patients who underwent revision ACL
reconstruction (ACLR) with a primary ACLR group with minimum 1-year follow-up. Preoperative
history, examination, and imaging data were collected and compared. Measurements were
made on MRI, plain radiographs, and 3D CT. Inclusion criteria were patients who underwent
primary ACLR by a single surgeon at a single center with minimum 1-year follow-up
or ACL graft failure with revision ACLR performed by the same surgeon.
Results
A total of 109 primary ACLR patients, mean age 33.7 years (range 15 to 71), enrolled
between July 2016 and July 2018 and 90 revision ACLR patients, mean age 32.9 years
(range 16 to 65), were included. The revision ACLR group had increased Beighton score
(4 versus 0; P < .001) and greater side-to-side differences in quadricep circumference (2 versus
0 cm; P < .001) compared with the primary ACLR group. A family history of ACL tear was significantly
more likely in the revision group (47.8% versus 16.5%; P < .001). The revision group exhibited significantly increased lateral posterior tibial
slope (7.9° versus 6.2°), anterolateral tibial subluxation (7.1 versus 4.9 mm), and
anteromedial tibia subluxation (2.7 versus 0.5 mm; all P < .005). In the revision group, femoral tunnel malposition occurred in 66.7% in the
deep-shallow position and 33.3% in the high-low position. The rate of tibial tunnel
malposition was 9.7% from medial to lateral and 54.2% from anterior to posterior.
Fifty-six patients (77.8%) had tunnel malposition in ≥2 positions. Allograft tissue
was used for the index ACLR in 28% in the revision group compared with 14.7% in the
primary group.
Conclusion
Beighton score, quadriceps circumference side-to-side difference, family history of
ACL tear, lateral posterior tibial slope, anterolateral tibial subluxation, and anteromedial
tibia subluxation were all significantly different between primary and revision ACLR
groups. In addition, there was a high rate of tunnel malposition in the revision ACLR
group.
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Article Info
Publication History
Published online: September 06, 2020
Accepted:
August 23,
2020
Received:
December 21,
2019
Footnotes
See commentary on page 206
The authors report the following potential conflicts of interest or sources of funding: C.G.Z. reports other, Smith & Nephew. R.F.L. reports personal fees, Arthrex , Smith & Nephew, Ossur; grants, AOSSM , OREF , Minnesota Medical Foundation; editorial board, American Journal of Sports Medicine, Journal of Experimental Orthopaedics, Knee Surgery Sports Traumatology and Arthroscopy. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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