Ten-Year Risk Factors for Inferior Knee Injury and Osteoarthritis Outcome Score After Anterior Cruciate Ligament Reconstruction: A Study of 874 Patients From the Swedish National Knee Ligament Register

2018 ◽  
Vol 46 (12) ◽  
pp. 2851-2858 ◽  
Author(s):  
Eric Hamrin Senorski ◽  
Eleonor Svantesson ◽  
Kurt P. Spindler ◽  
Eduard Alentorn-Geli ◽  
David Sundemo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Risk Factor ◽  
Acl Reconstruction ◽  
Knee Injury ◽  
Cruciate Ligament ◽  
Knee Ligament ◽  
Related Risk ◽  
Anterior Cruciate

Background: Factors relating to the patient and anterior cruciate ligament (ACL) reconstruction may help to identify prognostic factors of long-term outcome after reconstruction. Purpose: To determine 10-year risk factors for inferior knee function after ACL reconstruction. Study Design: Cohort study; Level of evidence, 2. Methods: Prospectively collected data from the Swedish National Knee Ligament Register were extracted for patients who underwent ACL reconstruction between January 2005 and December 2006. Patients who had no data at the 10-year follow-up for the Knee injury and Osteoarthritis Outcome Score (KOOS) were excluded. Multivariable proportional odds regression modeling was used to assess 10-year patient- and surgery-related risk factors across all the KOOS subscales and the KOOS4 (mean score of 4 subscales: pain, knee-related symptoms, function in sport and recreation, and knee-related quality of life). Results: A total of 874 (41%) patients were included (male, 51.5%; median age at the time of ACL reconstruction, 27.5 years [range, 11.2-61.5 years]). An increase in the severity of concomitant articular cartilage injuries resulted in a reduced KOOS on 4 subscales (odds ratio, 0.64-0.80; P < .05). A higher preoperative KOOS pain score increased the odds of a higher score on the pain, symptoms, and sport subscales and the KOOS4. In addition, a higher preoperative body mass index was a significant risk factor for lower scores on 3 KOOS subscales and the KOOS4. No patient- or surgery-related predictor was significant across all KOOS subscales. Conclusion: This 10-year risk factor analysis identified several factors that can affect long-term knee function after ACL reconstruction. Most risk factors were related to preoperative patient-reported outcome and potentially modifiable. On the other hand, most of the surgery-related risk factors were nonmodifiable. Nevertheless, this information may be helpful to physicians and physical therapists counseling patients on their expectations of outcome after ACL reconstruction.

Deep venous thrombosis and pulmonary embolism after anterior cruciate ligament reconstruction

2019 ◽  
Vol 101-B (1) ◽  
pp. 34-40 ◽  
Author(s):  
J. Kraus Schmitz ◽  
V. Lindgren ◽  
P-M. Janarv ◽  
M. Forssblad ◽  
A. Stålman
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Risk Factor ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Knee Ligament ◽  
Patient Reported ◽  
Anterior Cruciate

Aims The aim of this study was to investigate the incidence, risk factors, and outcome of venous thromboembolism (VTE) following anterior cruciate ligament (ACL) reconstruction in a nationwide cohort. Patients and Methods All ACL reconstructions, primary and revision, that were recorded in the Swedish Knee Ligament Register (SKLR) between 2006 and 2013 were linked with data from the Swedish National Board of Health and Welfare. The incidence of VTE was determined by entries between the day of surgery until 90 days postoperatively based on diagnosis codes and the prescription of anticoagulants. Risk factors, outcome, and the use of thromboprophylaxis were analyzed. Descriptive statistics with multivariate analysis were used to describe the findings. Results The cohort consisted of 26 014 primary and revision ACL reconstructions. There were 89 deep venous thromboses (DVTs) and 12 pulmonary emboli (PEs) with a total of 95 VTEs (0.4 %). Six patients with a PE had a simultaneous DVT. The only independent risk factor for VTE was age greater than or equal to 40 years (odds ratio 2.31, 95% confidence interval 1.45 to 3.70; p < 0.001). Thromboprophylaxis was prescribed to 9461 patients (36%) and was equally distributed between those with and those without a VTE (37.9% vs 36.4%). All patient-reported outcome measures (PROMs) one and two years postoperatively were significantly lower in those with VTE. Conclusion The incidence of VTE following ACL reconstruction is 0.4%, and the only significant risk factor is age. Patients with VTE had worse postoperative clinical outcome than patients without VTE. We recommend against the routine use of thromboprophylaxis, but it should be considered in older patients.

The 50 Most Cited Articles in the Indications, Risk Factors, Techniques, and Outcomes of ACL Revision Surgery

2020 ◽  
Author(s):  
Hayley E. Ennis ◽  
Kevin Bondar ◽  
Johnathon McCormick ◽  
Clark Jia-Long Chen ◽  
Chester J. Donnally ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Risk Factor ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Ligament Injury ◽  
Future Research ◽  
Revision Acl Reconstruction ◽  
Anterior Cruciate ◽  
Number Of Citations

AbstractThe rate of anterior cruciate ligament (ACL) retear remains high and revision ACL reconstruction has worse outcomes compared with primaries. To make advances in this area, a strong understanding of influential research is necessary. One method for systematically evaluating the literature is by citation analysis. This article aims to establish and evaluate “classic” articles. With consideration of these articles, this article also aims to evaluate gaps in the field and determine where future research should be directed. The general approach for data collection and analysis consisted of planning objectives, employing a defined strategy, reviewing search results using a multistep and multiauthor approach with specific screening criteria, and analyzing data. The collective number of citations for all publications within the list was 5,203 with an average of 104 citations per publication. “Biomechanical Measures during Landing and Postural Stability Predict Second Anterior Cruciate Ligament Injury after Anterior Cruciate Ligament Reconstruction and Return to Sport” by Paterno et al contained both the highest number of total citations and the highest number of citations per year, with 403 total citations and 43.9 citations per year. The most recurring level of evidence were level II (n = 18) and level III (n = 17). “Clinical Outcomes” was the most common article type (n = 20) followed by “Risk Factors” (n = 10). The American Journal of Sports Medicine had the highest recorded Cite Factor with over 50% of the articles (n = 27) published. The most productive authors included R.W. Wright (n = 6), S.D. Barber-Westin (n = 5), F.R. Noyes (n = 5), and K.P. Spindler (n = 5). Historically, influential studies have been published in the realms of clinical outcome and risk factor identification. It has been established that revision ACL reconstruction has worse outcomes and more high-level studies are needed. Additionally, prospective studies that apply the knowledge for current known risk factor mitigation are needed to determine if graft tear rates can be lowered.

Equivalent Knee Injury and Osteoarthritis Outcome Scores 12 and 24 Months After Anterior Cruciate Ligament Reconstruction: Results From the Swedish National Knee Ligament Register

2017 ◽  
Vol 45 (9) ◽  
pp. 2085-2091 ◽  
Author(s):  
Kristian Samuelsson ◽  
Robert A. Magnussen ◽  
Eduard Alentorn-Geli ◽  
Ferid Krupic ◽  
Kurt P. Spindler ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cohort Study ◽  
Acl Reconstruction ◽  
Knee Injury ◽  
Cruciate Ligament ◽  
Mean Difference ◽  
Level Of Evidence ◽  
Knee Ligament ◽  
Anterior Cruciate

Background: It is not clear whether Knee injury and Osteoarthritis Outcome Score (KOOS) results will be different 1 or 2 years after anterior cruciate ligament (ACL) reconstruction. Purpose: To investigate within individual patients enrolled in the Swedish National Knee Ligament Register whether there is equivalence between KOOS at 1 and 2 years after primary ACL reconstruction. Study Design: Cohort study; Level of evidence, 2. Methods: This cohort study was based on data from the Swedish National Knee Ligament Register during the period January 1, 2005, through December 31, 2013. The longitudinal KOOS values for each individual at the 1- and 2-year follow-up evaluations were assessed through the two one-sided test (TOST) procedure with an acceptance criterion of 4. Subset analysis was performed with patients classified by sex, age, graft type, and type of injury (meniscal and/or cartilage injury). Results: A total of 23,952 patients were eligible for analysis after exclusion criteria were applied (10,116 women, 42.2%; 13,836 men, 57.8%). The largest age group was between 16 and 20 years of age (n = 6599; 27.6%). The most common ACL graft was hamstring tendon (n = 22,504; 94.0%), of which the combination of semitendinosus and gracilis was the most common. A total of 7119 patients reported on the KOOS Pain domain at both 1- and 2-year follow-ups, with a mean difference of 0.21 (13.1 SD, 0.16 SE [90% CI, −0.05 to 0.46], P < .001). The same results were found for the other KOOS subscales: symptoms (mean difference −0.54, 14.1 SD, 0.17 SE [90% CI, −0.81 to −0.26], P < .001), activities of daily living (mean difference 0.45, 10.8 SD, 0.13 SE [90% CI, 0.24 to 0.66], P < .001), sports and recreation (mean difference −0.35, 22.7 SD, 0.27 SE [90% CI, −0.79 to 0.09], P < .001), quality of life (mean difference −0.92, 20.0 SD, 0.24 SE [90% CI, −1.31 to −0.53], P < .001), and the combined KOOS-4 score (mean difference −0.41, 14.5 SD, 0.17 SE [90% CI, −0.70 to −0.13], P < .001). Analyses within specific subsets of patients showed equivalent results between the 2 follow-up evaluations. Conclusion: Equivalent results within patients were found in KOOS values at 1- and 2-year follow-ups after ACL reconstruction. The finding was consistent across all KOOS subscales and for all evaluated subsets of patients. This result implies that there is no additional value in capturing both 1- and 2-year KOOS outcomes after ACL reconstruction. However, these findings of equivalence at 1- and 2-year endpoints do not alleviate the need for longer follow-up periods.

The Incidence of Subsequent Meniscal Surgery Is Higher in the Anterior Cruciate Ligament–Reconstructed Knee Than in the Contralateral Knee

2017 ◽  
Vol 45 (14) ◽  
pp. 3216-3222 ◽  
Author(s):  
Brent R. Davis ◽  
Jason Chen ◽  
Maria C.S. Inacio ◽  
Rebecca Love ◽  
Heather A. Prentice ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Absolute Risk ◽  
Cruciate Ligament ◽  
Free Survival ◽  
Contralateral Knee ◽  
Meniscal Surgery ◽  
Anterior Cruciate ◽  
Reconstructed Knee

Background: A goal of anterior cruciate ligament (ACL) reconstruction is to provide a meniscal protective effect for the knee. Purpose: (1) To evaluate whether there was a different likelihood of subsequent meniscal surgery in the ACL-reconstructed knee or in the normal contralateral knee and (2) to compare the risk factors associated with subsequent meniscal surgery in the ACL-reconstructed knee and contralateral knee. Study Design: Cohort study; Level of evidence, 3. Methods: Using an integrated health care system’s ACL reconstruction registry, patients undergoing primary ACL reconstruction, with no meniscal injury at the time of index surgery and a normal contralateral knee, were evaluated. Subsequent meniscal tears associated with ACL graft revision were excluded. Subsequent meniscal surgery in either knee was the outcome of interest. Sex, age, and graft type were assessed as potential risk factors. Survival analysis was used to compare meniscal surgery–free survival rates and to assess risk factors of subsequent meniscal surgery. Results: Of 4087 patients, there were 32 (0.78%) patients who underwent subsequent meniscal surgery in the index knee and 9 (0.22%) in the contralateral knee. The meniscal surgery–free survival rate at 4 years was 99.08% (95% CI, 98.64%-99.37%) in the index knee and 99.65% (95% CI, 99.31%-99.82%) in the contralateral knee. There was a 3.73 (95% CI, 1.73-8.04; P < .001) higher risk of subsequent meniscal surgery in the index knee compared with the contralateral knee, or a 0.57% absolute risk difference. After adjustments, allografts (hazard ratio [HR], 5.06; 95% CI, 1.80-14.23; P = .002) and hamstring autografts (HR, 3.11; 95% CI, 1.06-9.10; P = .038) were risk factors for subsequent meniscal surgery in the index knee compared with bone–patellar tendon–bone (BPTB) autografts. Conclusion: After ACL reconstruction, the overall risk of subsequent meniscal surgery was low. However, the relative risk of subsequent meniscal surgery in the ACL-reconstructed knee was higher compared with the contralateral knee. Only graft type was found to be a risk factor for subsequent meniscal surgery in the ACL-reconstructed knee, with a higher risk for allografts and hamstring autografts compared with BPTB autografts.

Risk factors for progression of articular cartilage damage after anatomical anterior cruciate ligament reconstruction

2018 ◽  
Vol 100-B (3) ◽  
pp. 285-293 ◽  
Author(s):  
A. Nakamae ◽  
N. Adachi ◽  
M. Deie ◽  
M. Ishikawa ◽  
T. Nakasa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Articular Cartilage ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Cartilage Damage ◽  
Significant Risk ◽  
Articular Cartilage Damage ◽  
Anterior Cruciate

Aims To investigate the risk factors for progression of articular cartilage damage after anatomical anterior cruciate ligament (ACL) reconstruction. Patients and Methods A total of 174 patients who underwent second-look arthroscopic evaluation after anatomical ACL reconstruction were enrolled in this study. The graded condition of the articular cartilage at the time of ACL reconstruction was compared with that at second-look arthroscopy. Age, gender, body mass index (BMI), ACL reconstruction technique, meniscal conditions, and other variables were assessed by regression analysis as risk factors for progression of damage to the articular cartilage. Results In the medial compartment, multivariable logistic regression analysis indicated that partial medial meniscectomy (odds ratio (OR) 6.82, 95% confidence interval (CI) 2.11 to 22.04, p = 0.001), pivot-shift test grade at the final follow-up (OR 3.53, CI 1.39 to 8.96, p = 0.008), BMI (OR 1.15, CI 1.03 to 1.28, p = 0.015) and medial meniscal repair (OR 3.19, CI 1.24 to 8.21, p = 0.016) were significant risk factors for progression of cartilage damage. In the lateral compartment, partial lateral meniscectomy (OR 10.94, CI 4.14 to 28.92, p < 0.001) and side-to-side differences in anterior knee laxity at follow-up (OR 0.63, p = 0.001) were significant risk factors. Conclusion Partial meniscectomy was found to be strongly associated with the progression of articular cartilage damage despite r anatomical ACL reconstruction. Cite this article: Bone Joint J 2018;100-B:285–93.

scholarly journals Sana: A Gamified Rehabilitation Management System for Anterior Cruciate Ligament Reconstruction Recovery

2020 ◽  
Vol 10 (14) ◽  
pp. 4868
Author(s):  
Tanaka Kungwengwe ◽  
Richard Evans
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Self Efficacy ◽  
Cruciate Ligament ◽  
Rehabilitation Management ◽  
Design Development ◽  
Secondary Osteoarthritis ◽  
User Experience Design ◽  
Anterior Cruciate

The anterior cruciate ligament (ACL) provides stabilization support for the back and forth motion of the knee joint. ACL ruptures account for 50% of all sports-related knee injuries with approximately 76.6% of them requiring reconstructive surgery, necessitating long-term patient rehabilitation. Compliance with rehabilitation management programs, following ACL reconstruction, is fundamental for the successful restoration of the knee’s kinematics and reducing the risk of secondary osteoarthritis. Existing recovery programs are often paper-based and require patients to perform exercises at home, unsupervised, resulting in a low level of self-efficacy; by promoting self-efficacy in home-based settings, rehabilitation outcomes can improve. This paper reports the design development of the Sana system, a mobile and wearable application that adopts behavioral design principles and gamification theory to improve long-term post-operative outcomes for ACL reconstruction recovery. A feasibility study was conducted from 15 October 2019–13 May 2020, employing the double diamond framework and a human-centered design approach (BS EN ISO 9241-210: 2019). Eighteen participants were recruited, including eight domain experts (in fields such as user experience design, human factors, and physiotherapy), and ten representative users who had undergone long-term rehabilitation for musculoskeletal injuries.

Incidence and Risk Factors of Subsequent Meniscal Surgery After Successful Anterior Cruciate Ligament Reconstruction: A Retrospective Study With a Minimum 2-Year Follow-up

2020 ◽  
Vol 48 (14) ◽  
pp. 3525-3533
Author(s):  
Yuka Kimura ◽  
Eiji Sasaki ◽  
Yuji Yamamoto ◽  
Shizuka Sasaki ◽  
Eiichi Tsuda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Anterior Laxity ◽  
Meniscal Surgery ◽  
Anterior Cruciate ◽  
Femoral Tunnel Drilling ◽  
Primary Acl Reconstruction

Background: One of the goals of anterior cruciate ligament (ACL) reconstruction is a meniscal protective effect on the knee. Despite the advancement of ACL reconstruction techniques, subsequent meniscal tears after ACL reconstruction remain a problem, and the risk factors for recurring lesions are still unclear. Purpose: To investigate the incidence of subsequent meniscal surgery after primary ACL reconstruction without revision ACL surgery and to determine the risk factors associated with this reoperation. Study Design: Case series; Level of evidence, 4. Methods: Overall, 518 patients who underwent primary ACL reconstruction between 2004 and 2012 at one instution participated in this study. Data on body mass index, graft type and femoral tunnel-drilling technique of ACL reconstruction, and location and type of meniscal injury and its treatment at ACL reconstruction were collected from medical records. Clinical outcomes were investigated, including side-to-side difference of anterior laxity, pivot-shift grade, and subsequent meniscal surgery without ACL insufficiency (at minimum 2-year follow-up). Results: The prevalence of tears to the medial meniscus (MM) at the primary ACL reconstruction was 43.6% (226/518), 140 of which were repaired; on the contrary, tears of the lateral meniscus (LM) had a prevalence of 55.8% (289/518), 42 of which were repaired. At a mean 30.3 months (range, 8-124 months) after ACL reconstruction, 20 patients (3.9%; 14 MM tears, 3 LM tears, 3 MM + LM tears) required meniscal surgery without ACL reinjury or recurrence of instability. Of these, 14 MMs and 3 LMs had been repaired at primary ACL reconstruction. The failure rates of repaired MM and LM were 10.0% (14/140) and 7.1% (3/42), respectively. The failure rate of MM repair using the all-inside technique (6/36) was significantly higher compared with no treatment, inside-out repair, or partial resection ( P = .045). In multiple regression analysis, the presence of MM injury at the time of ACL reconstruction (odds ratio [OR], 7.81; P = .003), the side-to-side difference of postoperative anterior tibial translation (OR, 1.91; P = .032), and follow-up period after ACL reconstruction (OR, 1.02; P = .003) were risk factors of subsequent meniscal surgery after ACL reconstruction. Conclusion: Incidence of subsequent meniscal surgery after successful ACL reconstruction was <5%. Presence of MM tear at the time of ACL reconsturuction, small amount of increased anterior laxity, and long-term period after ACL reconstruction were predictive of subsequent meniscal surgery.

scholarly journals Intermediate- to Long-Term Results of Combined Anterior Cruciate Ligament Reconstruction and Autologous Chondrocyte Implantation

2017 ◽  
Vol 5 (2) ◽  
pp. 232596711769359 ◽  
Author(s):  
Andrew N. Pike ◽  
Tim Bryant ◽  
Takahiro Ogura ◽  
Tom Minas
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Autologous Chondrocyte Implantation ◽  
Cruciate Ligament ◽  
Chondral Defects ◽  
Chondrocyte Implantation ◽  
Anterior Cruciate ◽  
Autologous Chondrocyte

Background: Cartilage injury associated with anterior cruciate ligament (ACL) ruptures is common; however, relatively few reports exist on concurrent cartilage repair with ACL reconstruction. Autologous chondrocyte implantation (ACI) has been utilized successfully for treatment of moderate to large chondral defects. Hypothesis: ACL insufficiency with relatively large chondral defects may be effectively managed with concurrent ACL reconstruction and ACI. Study Design: Case series; Level of evidence, 4. Methods: Patients undergoing concurrent ACL primary or revision reconstruction with ACI of single or multiple cartilage defects were prospectively evaluated for a minimum 2 years. Pre- and postoperative outcome measures included the modified Cincinnati Rating Scale (MCRS), Western Ontario and McMaster Universities Osteoarthritis Index, visual analog pain scales, and postsurgery satisfaction surveys. ACI graft failure or persistent pain without functional improvement were considered treatment failures. Results: Twenty-six patients were included, with 13 primary and 13 revision ACL reconstructions performed. Mean defect total surface area was 8.4 cm2, with a mean follow-up of 95 months (range, 24-240 months). MCRS improved from 3.62 ± 1.42 to 5.54 ± 2.32, Western Ontario and McMaster Universities Osteoarthritis Index from 45.31 ± 17.27 to 26.54 ± 17.71, and visual analog pain scale from 6.19 ± 1.27 to 3.65 ± 1.77 (all Ps <.001). Eight patients were clinical failures, 69% of patients were improved at final follow-up, and 92% stated they would likely undergo the procedure again. No outcome correlation was found with regard to age, body mass index, sex, defect size/number, follow-up time, or primary versus revision ACL reconstruction. In subanalysis, revision ACL reconstructions had worse preoperative MCRS scores and greater defect surface areas. However, revision MCRS score improvements were greater, resulting in similar final functional scores when compared with primary reconstructions. Conclusion: Challenging cases of ACL tears with large chondral defects treated with concurrent ACL reconstruction and ACI can lead to moderately improved pain and function at long-term follow-up. Factors associated with clinical failure are not clear. When combined with ACI, patients undergoing revision ACL reconstructions have worse function preoperatively compared with those undergoing primary reconstructions but have similar final outcomes.

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