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Traumatic graft rupture after primary and revision anterior cruciate ligament reconstruction: retrospective analysis of incidence and risk factors in 2915 cases

  • Michael Schlumberger
  • Philipp SchusterEmail author
  • Martin Schulz
  • Micha Immendörfer
  • Philipp Mayer
  • Jochen Bartholomä
  • Jörg Richter
Knee

Abstract

Purpose

To determine incidence and risk factors for traumatic graft rupture following primary and revision anterior cruciate ligament (ACL) reconstruction.

Methods

All cases of isolated ACL reconstructions (primary or revision) performed at our institution between January 2007 and December 2010 were included. From this group of 2467 primary reconstructions (32.4 ± 12.2 years) and 448 revision reconstructions (33.0 ± 10.4 years), we identified all patients who underwent revision ACL reconstruction following traumatic graft rupture in further course and all patients who underwent contralateral primary ACL reconstruction until January 2014. Age, gender, time from index procedure and graft diameter (for hamstring autografts) were analysed in terms of being a potential risk factor for graft rupture.

Results

Within a follow-up period of 5.0 ± 1.1 years (3.0–7.0), a total of 82 traumatic graft ruptures were identified, resulting in an incidence of 2.8 %. Seventy-three cases were seen following primary reconstructions (3.0 %), and nine cases following revision reconstructions (2.0 %), respectively (n.s.). Age younger than 25 years was identified as a risk factor for both groups (p = 0.001 and p = 0.008; odds ratio 6.0 and 6.4, respectively). In primary reconstruction, male patients had a higher risk of graft rupture compared with females (3.7 vs. 1.6 %; p = 0.005), and the first year after index procedure was associated with a higher risk of graft rupture compared with the following (p < 0.001). Graft diameter did not influence the risk of graft rupture. Incidence of contralateral ACL rupture was 3.1 %, which was not different to the incidence of graft rupture ipsilaterally (n.s.).

Conclusion

No statistically significant differences were seen between graft rupture incidence of primary and revision ACL reconstructions. Young age (<25 years) and short time to the index procedure (especially within the first year) were confirmed as risk factors for graft rupture in both groups. Male gender was a risk factor for primary reconstructions. Graft diameter had no influence on graft rupture rates. No difference in incidence of graft rupture compared to ACL rupture on the contralateral side was apparent.

Level of evidence

Retrospective case series, Level IV.

Keywords

Anterior cruciate ligament Graft rupture Graft diameter Graft failure Re-rupture Revision 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Arendt E, Dick R (1995) Knee injury patterns among men and women in collegiate basketball and soccer. NCAA data and review of literature. Am J Sports Med 23(6):694–701CrossRefPubMedGoogle Scholar
  2. 2.
    Borchers JR, Pedroza A, Kaeding C (2009) Activity level and graft type as risk factors for anterior cruciate ligament graft failure: a case-control study. Am J Sports Med 37(12):2362–2367CrossRefPubMedGoogle Scholar
  3. 3.
    Bourke HE, Salmon LJ, Waller A, Patterson V, Pinczewski LA (2012) Survival of the anterior cruciate ligament graft and the contralateral ACL at a minimum of 15 years. Am J Sports Med 40(9):1985–1992CrossRefPubMedGoogle Scholar
  4. 4.
    Brophy RH, Schmitz L, Wright RW, Dunn WR, Parker RD, Andrish JT, McCarty EC, Spindler KP (2012) Return to play and future ACL injury risk after ACL reconstruction in soccer athletes from the Multicenter Orthopaedic Outcomes Network (MOON) group. Am J Sports Med 40(11):2517–2522CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Celiktas M, Golpinar A, Kose O, Sutoluk Z, Celebi K, Sarpel Y (2013) Prediction of the quadruple hamstring autograft thickness in ACL reconstruction using anthropometric measures. Acta Orthop Traumatol Turc 47(1):14–18CrossRefPubMedGoogle Scholar
  6. 6.
    Conte EJ, Hyatt AE, Gatt CJ Jr, Dhawan A (2014) Hamstring autograft size can be predicted and is a potential risk factor for anterior cruciate ligament reconstruction failure. Arthroscopy 30(7):882–890CrossRefPubMedGoogle Scholar
  7. 7.
    Deehan DJ, Pinczewski LA (2002) Endoscopic anterior cruciate ligament reconstruction using a four strand hamstring tendon construct. J R Coll Surg Edinb 47(1):428–436PubMedGoogle Scholar
  8. 8.
    Drogset JO, Grontvedt T (2002) Anterior cruciate ligament reconstruction with and without a ligament augmentation device: results at 8-year follow-up. Am J Sports Med 30(6):851–856PubMedGoogle Scholar
  9. 9.
    Hamner DL, Brown CH Jr, Steiner ME, Hecker AT, Hayes WC (1999) Hamstring tendon grafts for reconstruction of the anterior cruciate ligament: biomechanical evaluation of the use of multiple strands and tensioning techniques. J Bone Joint Surg Am 81(4):549–557CrossRefPubMedGoogle Scholar
  10. 10.
    Kamien PM, Hydrick JM, Replogle WH, Go LT, Barrett GR (2013) Age, graft size, and Tegner activity level as predictors of failure in anterior cruciate ligament reconstruction with hamstring autograft. Am J Sports Med 41(8):1808–1812CrossRefPubMedGoogle Scholar
  11. 11.
    Keays SL, Bullock-Saxton JE, Keays AC, Newcombe PA, Bullock MI (2007) A 6-year follow-up of the effect of graft site on strength, stability, range of motion, function, and joint degeneration after anterior cruciate ligament reconstruction: patellar tendon versus semitendinosus and Gracilis tendon graft. Am J Sports Med 35(5):729–739CrossRefPubMedGoogle Scholar
  12. 12.
    Kvist J, Kartus J, Karlsson J, Forssblad M (2014) Results from the Swedish national anterior cruciate ligament register. Arthroscopy 30(7):803–810CrossRefPubMedGoogle Scholar
  13. 13.
    Leys T, Salmon L, Waller A, Linklater J, Pinczewski L (2012) Clinical results and risk factors for reinjury 15 years after anterior cruciate ligament reconstruction: a prospective study of hamstring and patellar tendon grafts. Am J Sports Med 40(3):595–605CrossRefPubMedGoogle Scholar
  14. 14.
    Magnussen RA, Lawrence JT, West RL, Toth AP, Taylor DC, Garrett WE (2012) Graft size and patient age are predictors of early revision after anterior cruciate ligament reconstruction with hamstring autograft. Arthroscopy 28(4):526–531CrossRefPubMedGoogle Scholar
  15. 15.
    Mariscalco MW, Flanigan DC, Mitchell J, Pedroza AD, Jones MH, Andrish JT, Parker RD, Kaeding CC, Magnussen RA (2013) The influence of hamstring autograft size on patient-reported outcomes and risk of revision after anterior cruciate ligament reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) Cohort Study. Arthroscopy 29(12):1948–1953CrossRefPubMedGoogle Scholar
  16. 16.
    Messina DF, Farney WC, DeLee JC (1999) The incidence of injury in Texas high school basketball. A prospective study among male and female athletes. Am J Sports Med 27(3):294–299PubMedGoogle Scholar
  17. 17.
    Orchard J, Seward H, McGivern J, Hood S (2001) Intrinsic and extrinsic risk factors for anterior cruciate ligament injury in Australian footballers. Am J Sports Med 29(2):196–200PubMedGoogle Scholar
  18. 18.
    Paterno MV, Rauh MJ, Schmitt LC, Ford KR, Hewett TE (2012) Incidence of contralateral and ipsilateral anterior cruciate ligament (ACL) injury after primary ACL reconstruction and return to sport. Clin J Sport Med 22(2):116–121CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Paterno MV, Rauh MJ, Schmitt LC, Ford KR, Hewett TE (2014) Incidence of second ACL injuries 2 years after primary ACL reconstruction and return to sport. Am J Sports Med 42(7):1567–1573CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Paterno MV, Schmitt LC, Ford KR, Rauh MJ, Myer GD, Huang B, Hewett TE (2010) Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. Am J Sports Med 38(10):1968–1978CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Roe J, Pinczewski LA, Russell VJ, Salmon LJ, Kawamata T, Chew M (2005) A 7-year follow-up of patellar tendon and hamstring tendon grafts for arthroscopic anterior cruciate ligament reconstruction: differences and similarities. Am J Sports Med 33(9):1337–1345CrossRefPubMedGoogle Scholar
  22. 22.
    Sajovic M, Vengust V, Komadina R, Tavcar R, Skaza K (2006) A prospective, randomized comparison of semitendinosus and gracilis tendon versus patellar tendon autografts for anterior cruciate ligament reconstruction: five-year follow-up. Am J Sports Med 34(12):1933–1940CrossRefPubMedGoogle Scholar
  23. 23.
    Salmon L, Russell V, Musgrove T, Pinczewski L, Refshauge K (2005) Incidence and risk factors for graft rupture and contralateral rupture after anterior cruciate ligament reconstruction. Arthroscopy 21(8):948–957CrossRefPubMedGoogle Scholar
  24. 24.
    Shelbourne KD, Gray T (2009) Minimum 10-year results after anterior cruciate ligament reconstruction: how the loss of normal knee motion compounds other factors related to the development of osteoarthritis after surgery. Am J Sports Med 37(3):471–480CrossRefPubMedGoogle Scholar
  25. 25.
    Shelbourne KD, Gray T, Haro M (2009) Incidence of subsequent injury to either knee within 5 years after anterior cruciate ligament reconstruction with patellar tendon autograft. Am J Sports Med 37(2):246–251CrossRefPubMedGoogle Scholar
  26. 26.
    Thomas S, Bhattacharya R, Saltikov JB, Kramer DJ (2013) Influence of anthropometric features on graft diameter in ACL reconstruction. Arch Orthop Trauma Surg 133(2):215–218CrossRefPubMedGoogle Scholar
  27. 27.
    Treme G, Diduch DR, Billante MJ, Miller MD, Hart JM (2008) Hamstring graft size prediction: a prospective clinical evaluation. Am J Sports Med 36(11):2204–2209CrossRefPubMedGoogle Scholar
  28. 28.
    Webster KE, Feller JA, Leigh WB, Richmond AK (2014) Younger patients are at increased risk for graft rupture and contralateral injury after anterior cruciate ligament reconstruction. Am J Sports Med 42(3):641–647CrossRefPubMedGoogle Scholar
  29. 29.
    Weiler A, Schmeling A, Stohr I, Kaab MJ, Wagner M (2007) Primary versus single-stage revision anterior cruciate ligament reconstruction using autologous hamstring tendon grafts: a prospective matched-group analysis. Am J Sports Med 35(10):1643–1652CrossRefPubMedGoogle Scholar
  30. 30.
    Wilson TW, Zafuta MP, Zobitz M (1999) A biomechanical analysis of matched bone-patellar tendon-bone and double-looped semitendinosus and gracilis tendon grafts. Am J Sports Med 27(2):202–207PubMedGoogle Scholar
  31. 31.
    Woo SL, Hollis JM, Adams DJ, Lyon RM, Takai S (1991) Tensile properties of the human femur-anterior cruciate ligament-tibia complex. The effects of specimen age and orientation. Am J Sports Med 19(3):217–225CrossRefPubMedGoogle Scholar
  32. 32.
    Wright RW, Dunn WR, Amendola A, Andrish JT, Bergfeld J, Kaeding CC, Marx RG, McCarty EC, Parker RD, Wolcott M, Wolf BR, Spindler KP (2007) Risk of tearing the intact anterior cruciate ligament in the contralateral knee and rupturing the anterior cruciate ligament graft during the first 2 years after anterior cruciate ligament reconstruction: a prospective MOON cohort study. Am J Sports Med 35(7):1131–1134CrossRefGoogle Scholar
  33. 33.
    Wright RW, Magnussen RA, Dunn WR, Spindler KP (2011) Ipsilateral graft and contralateral ACL rupture at five years or more following ACL reconstruction: a systematic review. J Bone Joint Surg Am 93(12):1159–1165CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2015

Authors and Affiliations

  • Michael Schlumberger
    • 1
  • Philipp Schuster
    • 1
    Email author
  • Martin Schulz
    • 1
  • Micha Immendörfer
    • 1
  • Philipp Mayer
    • 1
  • Jochen Bartholomä
    • 1
  • Jörg Richter
    • 1
  1. 1.Centre for Arthroscopy and Sports MedicineOrthopedic Hospital MarkgroeningenMarkgroeningenGermany

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