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Multicenter Study
. 2013 Jul;41(7):1534-40.
doi: 10.1177/0363546513490277. Epub 2013 May 30.

The rate of subsequent surgery and predictors after anterior cruciate ligament reconstruction: two- and 6-year follow-up results from a multicenter cohort

Carolyn M Hettrich  1 , Warren R Dunn, Emily K Reinke; MOON Group; Kurt P Spindler
Collaborators, Affiliations
Multicenter Study

The rate of subsequent surgery and predictors after anterior cruciate ligament reconstruction: two- and 6-year follow-up results from a multicenter cohort

Carolyn M Hettrich et al. Am J Sports Med. 2013 Jul.

Abstract

Background: Subsequent surgeries have a profound effect on patient satisfaction and outcome after primary anterior cruciate ligament reconstruction (ACLR). There have been no prospective studies to date describing the rate and predictors (surgical and patient variables) of all subsequent knee surgeries at short-term and midterm follow-up along with analyses of surgical and patient variables that are associated with subsequent surgeries.

Purpose: To report the rate and predictors of all subsequent surgeries at short-term and midterm follow-up along with associated patient variables.

Study design: Case-control study; Level of evidence, 3.

Methods: A total of 980 patients (540 male) were prospectively enrolled in a Multicenter Orthopaedic Outcomes Network (MOON) cohort from January 2002 to December 2003. The 2- and 6-year follow-up information for subsequent procedures was obtained. Operative reports were obtained, and all procedures were categorized.

Results: One hundred eighty-five patients underwent a subsequent surgery on the ipsilateral leg (18.9%) and 100 on the contralateral knee (10.2%) at 6-year follow-up. On the ipsilateral knee, there was a 7.7% rate of ACL revisions, a 13.3% rate of cartilage procedures, a 5.4% rate of arthrofibrosis procedures, and a 2.4% rate of procedures related to hardware. For the contralateral knee, there was a 6.4% rate of primary ACL ruptures. Younger age at the index surgery and the use of allografts were predictors (risk factors) for subsequent surgery. Revision ACLR, female sex, body mass index, and surgical exposure were not significant predictors.

Conclusion: At 6-year follow-up, 18.9% of patients who had undergone ACLR underwent subsequent surgeries on the ipsilateral knee. The rates between an ipsilateral ACLR graft versus a contralateral normal ACL tear were similar (7.7% vs 6.4%, respectively). Younger age and the use of allografts were risk factors for subsequent surgery.

Keywords: anterior cruciate ligament reconstruction; subsequent surgery.

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Figures

Figure 1
Figure 1
Branching diagram depicting categories and subcategories of subsequent surgical procedures. Articular cartilage procedures included chondroplasty, microfracture, autologous chondrocyte implantation, and osteochondral autograft transplantation. The meniscus categories include both meniscectomy and repair. ACLR = anterior cruciate ligament reconstruction; LOA/MUA = lysis of adhesions/manipulation under anesthesia; ITB= iliotibial band; ROH = removal of hardware.
Figure 2
Figure 2
Plot depicting the odds ratio for subsequent surgery. For age, it is the ratio of subsequent surgery at 34 vs. 17 years of age, BMI (body mass index) is for 28 vs. 22. All femoral fixation devices are as compared to interference screws, and grafts (tibialis anterior and hamstring are both compared to bone-tendon-bone). BMI = body mass index; HG = hamstring; BTB = bone-tendon-bone; IS = interference screw.
Figure 3
Figure 3
Chart depicting the risk for subsequent surgery based on age.
See this image and copyright information in PMC

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