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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References
- Incidence of anterior cruciate ligament tears and reconstruction: A 21-year population-based study.Am J Sports Med. 2016; 44: 1502-1507
- Clinical outcomes in revision anterior cruciate ligament reconstruction: A meta-analysis.Arthroscopy. 2018; 34: 289-300
- Revision anterior cruciate ligament reconstruction.Am J Sports Med. 2011; 39: 199-217
- Generalized hypermobility, knee hyperextension, and outcomes after anterior cruciate ligament reconstruction: Prospective, case-control study with mean 6 years follow-up.Arthroscopy. 2017; 33: 1852-1858
- Outcomes and risk factors of rerevision anterior cruciate ligament reconstruction: A systematic review.Arthroscopy. 2016; 32: 2151-2159
- Psychological readiness to return to sport is associated with second anterior cruciate ligament injuries.Am J Sports Med. 2019; 47: 857-862
- Return to sport and reoperation rates in patients under the age of 20 after primary anterior cruciate ligament reconstruction: Risk profile comparing 3 patient groups predicated upon skeletal age.Am J Sports Med. 2019; 47: 628-639
- Posterior tibial slope and further anterior cruciate ligament injuries in the anterior cruciate ligament-reconstructed patient.Am J Sports Med. 2013; 41: 2800-2804
- Lateral tibial posterior slope is increased in patients with early graft failure after anterior cruciate ligament reconstruction.Am J Sports Med. 2015; 43: 2510-2514
- Revision ACL reconstruction outcomes: MOON cohort.J Knee Surg. 2011; 24: 289-294
- Intra-articular findings in primary and revision anterior cruciate ligament reconstruction surgery: A comparison of the MOON and MARS study groups.Am J Sports Med. 2011; 39: 1889-1893
- Differences in mechanisms of failure, intraoperative findings, and surgical characteristics between single- and multiple-revision ACL reconstructions: A MARS cohort study.Am J Sports Med. 2013; 41: 1571-1578
- The prognosis and predictors of sports function and activity at minimum 6 years after anterior cruciate ligament reconstruction: A population cohort study.Am J Sports Med. 2011; 39: 348-359
- Factors Influencing graft choice in revision anterior cruciate ligament reconstruction in the MARS group.J Knee Surg. 2016; 29: 458-463
- The heel height test: A novel tool for the detection of combined anterior cruciate ligament and fibular collateral ligament tears.Arthroscopy. 2017; 33: 2177-2181
- Prospective outcomes of young and middle-aged adults with medial compartment osteoarthritis treated with a proximal tibial opening wedge osteotomy.Arthroscopy. 2012; 28: 354-364
- The geometry of the tibial plateau and its influence on the biomechanics of the tibiofemoral joint.J Bone Joint Surg Am. 2008; 90: 2724-2734
- Comparison of plain radiography, computed tomography, and magnetic resonance imaging in the evaluation of bone tunnel widening after anterior cruciate ligament reconstruction.Knee Surg Sports Traumatol Arthrosc. 2010; 18: 1059-1064
- Measurements of tunnel placements after anterior cruciate ligament reconstruction—A comparison between CT, radiographs and MRI.Knee. 2015; 22: 574-579
- Anatomic ACL reconstruction: The normal central tibial footprint position and a standardised technique for measuring tibial tunnel location on 3D CT.Knee Surg Sports Traumatol Arthrosc. 2017; 25: 1568-1575
- Anatomy and surface geometry of the patellofemoral joint in the axial plane.J Bone Joint Surg Br. 1999; 81: 452-458
- Anterior cruciate ligament graft positioning, tensioning and twisting.Knee Surg Sports Traumatol Arthrosc. 1998; 6: S2-S12
- Tibial attachment area of the anterior cruciate ligament in the extended knee position. Anatomy and cryosections in vitro complemented by magnetic resonance arthrography in vivo.Knee Surg Sports Traumatol Arthrosc. 1994; 2: 138-146
- The anatomic centers of the femoral and tibial insertions of the anterior cruciate ligament: A systematic review of imaging and cadaveric studies reporting normal center locations.Am J Sports Med. 2017; 45: 2180-2188
- Femoral insertion of the ACL. Radiographic quadrant method.Am J Knee Surg. 1997; 10: 14-21
- Arthroscopically pertinent landmarks for tunnel positioning in single-bundle and double-bundle anterior cruciate ligament reconstructions.Am J Sports Med. 2011; 39: 743-752
- Radiographic landmarks for tunnel positioning in double-bundle ACL reconstructions.Knee Surg Sports Traumatol Arthrosc. 2011; 19: 792-800
- A language and environment for statistical computing.R Foundation for Statistical Computing, Vienna, Austria2018
- Axial and sagittal knee geometry as a risk factor for noncontact anterior cruciate ligament tear: A case-control study.Arthroscopy. 2010; 26: 901-906
- Shallow medial tibial plateau and steep medial and lateral tibial slopes: New risk factors for anterior cruciate ligament injuries.Am J Sports Med. 2010; 38: 54-62
- Risk factors for anterior cruciate ligament injury: Assessment of tibial plateau anatomic variables on conventional MRI using a new combined method.Int Orthop. 2011; 35: 1251-1256
- A case-control study of anterior cruciate ligament volume, tibial plateau slopes and intercondylar notch dimensions in ACL-injured knees.J Biomech. 2010; 43: 1702-1707
- The influence of the tibial slope and the size of the intercondylar notch on rupture of the anterior cruciate ligament.J Bone Joint Surg Br. 2011; 93: 1475-1478
- In vivo evidence for tibial plateau slope as a risk factor for anterior cruciate ligament injury: A systematic review and meta-analysis.Am J Sports Med. 2012; 40: 1673-1681
- Increased lateral tibial plateau slope predisposes male college football players to anterior cruciate ligament injury.J Bone Joint Surg Am. 2016; 98: 1001-1006
- Anatomic features of the tibial plateau predict outcomes of ACL reconstruction within 7 years after surgery.Am J Sports Med. 2019; 47: 303-311
- Outcomes after 1-stage versus 2-stage revision anterior cruciate ligament reconstruction.Am J Sports Med. 2017; 45: 1790-1798
- Tibial slope and its effect on force in anterior cruciate ligament grafts: Anterior cruciate ligament force increases linearly as posterior tibial slope increases.Am J Sports Med. 2019; 47: 296-302
- Slope-reducing tibial osteotomy decreases ACL-graft forces and anterior tibial translation under axial load.Knee Surg Sports Traumatol Arthrosc. 2019; 27: 3381-3389
- Proximal tibial anterior closing wedge osteotomy in repeat revision of anterior cruciate ligament reconstruction.Am J Sports Med. 2014; 42: 1873-1880
- Tibial slope correction combined with second revision ACL produces good knee stability and prevents graft rupture.Knee Surg Sports Traumatol Arthrosc. 2015; 23: 2846-2852
- Passive anterior tibial subluxation in anterior cruciate ligament-deficient knees.Am J Sports Med. 2013; 41: 2347-2352
- Static lateral tibial plateau subluxation predicts high-grade rotatory knee laxity in anterior cruciate ligament-deficient knees.Am J Sports Med. 2019; 47: 277-284
- Steep posterior tibial slope, anterior tibial subluxation, deep posterior lateral femoral condyle, and meniscal deficiency are common findings in multiple anterior cruciate ligament failures: An MRI case-control study.Am J Sports Med. 2019; 47: 285-295
- Physiologic preoperative knee hyperextension is a predictor of failure in an anterior cruciate ligament revision cohort: A report from the MARS group.Am J Sports Med. 2018; 46: 2836-2841
- Effect of high-grade preoperative knee laxity on 6-year anterior cruciate ligament reconstruction outcomes.Am J Sports Med. 2018; 46: 2865-2872
- Influence of lateral meniscal posterior root avulsions and the meniscofemoral ligaments on tibiofemoral contact mechanics.Knee Surg Sports Traumatol Arthrosc. 2016; 24: 1469-1477
- Association of meniscal status, lower extremity alignment, and body mass index with chondrosis at revision anterior cruciate ligament reconstruction.Am J Sports Med. 2015; 43: 1616-1622
- Multirater agreement of the causes of anterior cruciate ligament reconstruction failure: A radiographic and video analysis of the MARS cohort.Am J Sports Med. 2015; 43: 310-319
- Causes for failure of ACL reconstruction and influence of meniscectomies after revision.Knee Surg Sports Traumatol Arthrosc. 2011; 19: 196-201
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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