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Rates of revision and surgeon-reported graft rupture following ACL reconstruction: early results from the New Zealand ACL Registry

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

There remains a lack of consensus on the patient factors associated with graft rupture following anterior cruciate ligament (ACL) reconstruction. This study aimed to identify the rate of revision and surgeon-reported graft rupture and clarify the patient risk factors for failure.

Methods

Analysis was conducted on prospective data captured by the New Zealand ACL registry. All primary isolated ACL reconstructions recorded between April 2014 and December 2018 were reviewed to identify the rate of revision and surgeon-reported graft rupture. Univariate and multivariate survival analysis was performed to identify patient factors associated with revision and graft rupture.

Results

A total of 7402 primary isolated ACL reconstructions were reviewed and had a mean follow-up time of 23.1 (SD ± 13.9) months. There were 258 surgeon-reported graft ruptures (3.5%) of which 175 patients underwent subsequent revision ACL reconstruction (2.4%). Patients younger than 18 years had the highest risk of revision (adjusted HR = 7.29, p < 0.001) and graft rupture (adjusted HR = 4.26, p < 0.001) when compared to patients aged over 36 years. Male patients had a higher risk of revision (adjusted HR = 2.00, p < 0.001) and graft rupture (adjusted HR = 1.70, p < 0.001) when compared to their female counterparts. Patients who underwent ACL reconstruction within 6 months of their injury had a two times increased risk of revision compared to patients who had surgery after 12 months (adjusted HR = 2.15, p = 0.016).

Conclusion

Younger age, male sex and a shorter injury-to-surgery time interval increased the risk of revision, while younger age and male sex increased the risk of surgeon-reported graft rupture.

Level of evidence

II.

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Acknowledgements

The authors would like to acknowledge Charlotte Smith from the New Zealand ACL registry for her ongoing support and assistance with data administration. RR would to like to acknowledge the Maurice and Phyllis Paykel Trust for providing student support.

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Authors and Affiliations

  1. University of Auckland, 85 Park Road, Auckland, 1023, New Zealand

    Richard Rahardja, Mark Zhu, Andrew Paul Monk & Simon W. Young

  2. Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand

    Simon W. Young

  3. Department of Orthopaedic Surgery, Auckland Hospital, Auckland, New Zealand

    Mark Zhu & Andrew Paul Monk

  4. Forte Sports, Christchurch, New Zealand

    Hamish Love

  5. Department of Orthopaedic Surgery, Middlemore Hospital, Auckland, New Zealand

    Mark G. Clatworthy

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  1. Richard Rahardja
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  2. Mark Zhu
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Correspondence to Richard Rahardja.

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Conflict of interest

We, the authors, declare that we have no conflicts of interest with relation to this study. MGC reports that he does consulting for Johnson & Johnson, receives fellowship funding from Johnson & Johnson and Arthrex, and receives royalties from Arthrex, none of which are related to this study.

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Health and Disability Ethics Committee approval as an audit activity.

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Appendix

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Table 4 Cox regression analysis: patients with minimum 2-year follow-up
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Rahardja, R., Zhu, M., Love, H. et al. Rates of revision and surgeon-reported graft rupture following ACL reconstruction: early results from the New Zealand ACL Registry. Knee Surg Sports Traumatol Arthrosc 28, 2194–2202 (2020). https://doi.org/10.1007/s00167-019-05773-z

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