Advertisement

Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 26, Issue 4, pp 1182–1189 | Cite as

Patient and surgical characteristics that affect revision risk in dynamic intraligamentary stabilization of the anterior cruciate ligament

  • Philipp Henle
  • Kathrin S. Bieri
  • Manuel Brand
  • Emin Aghayev
  • Jessica Bettfuehr
  • Janosch Haeberli
  • Martina Kess
  • Stefan Eggli
KNEE

Abstract

Purpose

Failure of dynamic intraligamentary stabilization (DIS) that requires revision surgery of the anterior cruciate ligament (ACL) has not been studied. The aim of this study was to investigate the incidence of revision ACL surgery, and the patient characteristics and surgery-related factors that are associated with an increased risk of ACL revision after DIS.

Methods

This study analysed a prospective, consecutively documented single-centre case series using standardized case report forms over a 2.5-year follow-up period. The primary endpoint was revision ACL surgery. We used Kaplan–Meier analysis to examine the revision-free survival time, and a multiple logistic regression model of potential risk factors including age, sex, BMI, smoking status, previous contralateral ACL injury, Tegner activity score, interval to surgery, rupture pattern, hardware removal, and postoperative side-to-side difference in knee laxity. Relative risk was calculated for subgroups of significant risk factors.

Results

In total, 381 patients (195 male) with a mean age of 33 ± 12 years were included in the analysis. The incidence of revision ACL surgery was 30/381 (7.9%). Younger age (p = 0.001), higher Tegner activity score (p = 0.003), and increased knee laxity (p = 0.015) were significantly associated with revision ACL surgery. The increased relative risk for patients who were less than 24 years old, participated in activities at a Tegner level >5 points, or had >2 mm of side-to-side difference in knee laxity was 1.6, 3.7, and 2.3, respectively.

Conclusion

Young age, high level of sport activity, and high knee laxity observed in follow-up examinations increased the likelihood for revision surgery after DIS. Patients undergoing DIS should be informed of their potentially increased risk for therapy failure and carefully monitored during recovery.

Level of evidence

Case series, Level IV.

Keywords

Anterior cruciate ligament Dynamic intraligamentary stabilization ACL repair Failure Revision surgery Risk factors Outcomes ACL suture Ligamys 

Notes

Acknowledgements

The authors thank Edith Hofer for her hard work in coordinating, supervising, and completing the collection of the comprehensive dataset for each patient. They also thank Kelly Goodwin and Christopher Ritter for manuscript editing.

Author’s contribution

PH was one of the treating surgeons, conceived the study, interpreted the data and helped drafting the manuscript. KSB participated in the design of the study, conducted statistical analyses, interpreted the data and drafted the manuscript. EA participated in the design of the study, helped to interpret the data, to perform the statistical analysis, and supervised the drafting of the manuscript. JH participated in the design of the study, helped to interpret the data and revised the manuscript. JB participated in the design of the study, supervised the statistical analyses and revised the manuscript. MB helped in data acquisition and revised the manuscript. MK helped in data acquisition and revised the manuscript. SE was one of the treating surgeons, supervised the complete study and revised the manuscript. All authors have read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

PH and SE act as clinical advisers for Mathys AG Bettlach, Switzerland. The PhD project of KSB is partially funded by Mathys AG Bettlach, Switzerland. JB is employed by Mathys AG Bettlach, Switzerland.

Funding

No funding was received for this study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

167_2017_4574_MOESM1_ESM.pdf (474 kb)
Supplementary material 1 (PDF 473 kb)
167_2017_4574_MOESM2_ESM.pdf (76 kb)
Supplementary material 2 (PDF 75 kb)
167_2017_4574_MOESM3_ESM.pdf (418 kb)
Supplementary material 3 (PDF 418 kb)

References

  1. 1.
    Andernord D, Desai N, Bjornsson H, Ylander M, Karlsson J, Samuelsson K (2015) Patient predictors of early revision surgery after anterior cruciate ligament reconstruction: a cohort study of 16,930 patients with 2-year follow-up. Am J Sports Med 43:121–127CrossRefPubMedGoogle Scholar
  2. 2.
    Andriolo L, Filardo G, Kon E, Ricci M, Della Villa F, Della Villa S et al (2015) Revision anterior cruciate ligament reconstruction: clinical outcome and evidence for return to sport. Knee Surg Sports Traumatol Arthrosc 23:2825–2845CrossRefPubMedGoogle Scholar
  3. 3.
    Barber-Westin SD, Noyes FR (2011) Objective criteria for return to athletics after anterior cruciate ligament reconstruction and subsequent reinjury rates: a systematic review. Phys Sportsmed 39:100–110CrossRefPubMedGoogle Scholar
  4. 4.
    Barrett GR, Luber K, Replogle WH, Manley JL (2010) Allograft anterior cruciate ligament reconstruction in the young, active patient: Tegner activity level and failure rate. Arthroscopy 26:1593–1601CrossRefPubMedGoogle Scholar
  5. 5.
    Biau DJ, Tournoux C, Katsahian S, Schranz PJ, Nizard RS (2006) Bone-patellar tendon-bone autografts versus hamstring autografts for reconstruction of anterior cruciate ligament: meta-analysis. BMJ 332:995–1001CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    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 37:2362–2367CrossRefPubMedGoogle Scholar
  7. 7.
    Buchler L, Regli D, Evangelopoulos DS, Bieri K, Ahmad SS, Krismer A et al (2016) Functional recovery following primary ACL repair with dynamic intraligamentary stabilization. Knee 23:549–553CrossRefPubMedGoogle Scholar
  8. 8.
    Cimino F, Volk BS, Setter D (2010) Anterior cruciate ligament injury: diagnosis, management, and prevention. Am Fam Physician 82:917–922PubMedGoogle Scholar
  9. 9.
    Crawford SN, Waterman BR, Lubowitz JH (2013) Long-term failure of anterior cruciate ligament reconstruction. Arthroscopy 29:1566–1571CrossRefPubMedGoogle Scholar
  10. 10.
    Duffee RA, Hewett ET, Kaeding CC (2014) Revision ACL reconstruction—introduction to patient-related risk factors for acl graft failures. Springer, New York, pp 1–10Google Scholar
  11. 11.
    Eggli S, Kohlhof H, Zumstein M, Henle P, Hartel M, Evangelopoulos DS et al (2015) Dynamic intraligamentary stabilization: novel technique for preserving the ruptured ACL. Knee Surg Sports Traumatol Arthrosc 23:1215–1221CrossRefPubMedGoogle Scholar
  12. 12.
    Engelman GH, Carry PM, Hitt KG, Polousky JD, Vidal AF (2014) Comparison of allograft versus autograft anterior cruciate ligament reconstruction graft survival in an active adolescent cohort. Am J Sports Med 42:2311–2318CrossRefPubMedGoogle Scholar
  13. 13.
    Evangelopoulos DS, Kohl S, Schwienbacher S, Gantenbein B, Exadaktylos A, Ahmad SS (2015) Collagen application reduces complication rates of mid-substance ACL tears treated with dynamic intraligamentary stabilization. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-015-3838-7 CrossRefPubMedGoogle Scholar
  14. 14.
    Gabler CM, Jacobs CA, Howard JS, Mattacola CG, Johnson DL (2015) Comparison of graft failure rate between autografts placed via an anatomic anterior cruciate ligament reconstruction technique: a systematic review, meta-analysis, and meta-regression. Am J Sports Med. doi: 10.1177/0363546515584043 PubMedCrossRefGoogle Scholar
  15. 15.
    Grassi A, Ardern CL, Marcheggiani Muccioli GM, Neri MP, Marcacci M, Zaffagnini S (2016) Does revision ACL reconstruction measure up to primary surgery? A meta-analysis comparing patient-reported and clinician-reported outcomes, and radiographic results. Br J Sports Med 50:716–724CrossRefPubMedGoogle Scholar
  16. 16.
    Henle P, Roder C, Perler G, Heitkemper S, Eggli S (2015) Dynamic intraligamentary stabilization (DIS) for treatment of acute anterior cruciate ligament ruptures: case series experience of the first three years. BMC Musculoskelet Disord 16:27CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Hewett TE, Di Stasi SL, Myer GD (2013) Current concepts for injury prevention in athletes after anterior cruciate ligament reconstruction. Am J Sports Med 41:216–224CrossRefPubMedGoogle Scholar
  18. 18.
    Kaeding CC, Pedroza AD, Reinke EK, Huston LJ, Consortium M, Spindler KP (2015) Risk factors and predictors of subsequent ACL injury in either knee after ACL reconstruction: prospective analysis of 2488 primary ACL reconstructions from the MOON cohort. Am J Sports Med 43:1583–1590CrossRefGoogle Scholar
  19. 19.
    Kohl S, Evangelopoulos DS, Schar MO, Bieri K, Muller T, Ahmad SS (2016) Dynamic intraligamentary stabilisation: initial experience with treatment of acute ACL ruptures. Bone Joint J 98-B:793–798CrossRefPubMedGoogle Scholar
  20. 20.
    Laboute E, Savalli L, Puig P et al (2010) Analysis of return to competition and repeat rupture for 298 anterior cruciate ligament reconstructions with patellar or hamstring tendon autograft in sportspeople. Ann Phys Rehabil Med 53:598–614CrossRefPubMedGoogle Scholar
  21. 21.
    Lam MH, Fong DT, Yung P, Ho EP, Chan WY, Chan KM (2009) Knee stability assessment on anterior cruciate ligament injury: clinical and biomechanical approaches. Sports Med Arthrosc Rehabil Ther Technol 1:20PubMedPubMedCentralGoogle Scholar
  22. 22.
    Liechti DJ, Chahla J, Dean CS et al (2016) Outcomes and risk factors of rerevision anterior cruciate ligament reconstruction: a systematic review. Arthroscopy. doi: 10.1016/j.arthro.2016.04.017 PubMedCrossRefGoogle Scholar
  23. 23.
    Noyes FR (2010) Noyes’ knee disorders: surgery, rehabilitation, clinical outcomes. Elsevier, Philadelphia, pp 282–283Google Scholar
  24. 24.
    Pinczewski LA, Lyman J, Salmon LJ, Russell VJ, Roe J, Linklater J (2007) A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Am J Sports Med 35:564–574CrossRefPubMedGoogle Scholar
  25. 25.
    Reinhardt KR, Hetsroni I, Marx RG (2010) Graft selection for anterior cruciate ligament reconstruction: a level I systematic review comparing failure rates and functional outcomes. Orthop Clin North Am 41:249–262CrossRefPubMedGoogle Scholar
  26. 26.
    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 21:948–957CrossRefPubMedGoogle Scholar
  27. 27.
    Schlumberger M, Schuster P, Schulz M, Immendorfer M, Mayer P, Bartholoma J et al (2015) Traumatic graft rupture after primary and revision anterior cruciate ligament reconstruction: retrospective analysis of incidence and risk factors in 2915 cases. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-015-3699-0 PubMedCrossRefGoogle Scholar
  28. 28.
    Sernert N, Kartus J, Kohler K et al (1999) Analysis of subjective, objective and functional examination tests after anterior cruciate ligament reconstruction. A follow-up of 527 patients. Knee Surg Sports Traumatol Arthrosc 7:160–165CrossRefPubMedGoogle Scholar
  29. 29.
    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 37:246–251CrossRefPubMedGoogle Scholar
  30. 30.
    Sullivan GM, Artino AR Jr (2013) Analyzing and interpreting data from likert-type scales. J Grad Med Educ 5:541–542CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 191:43–49Google Scholar
  32. 32.
    Tejwani SG, Chen J, Funahashi TT, Love R, Maletis GB (2015) Revision risk after allograft anterior cruciate ligament reconstruction: association with graft processing techniques, patient characteristics, and graft type. Am J Sports Med 43:2696–2705CrossRefPubMedGoogle Scholar
  33. 33.
    Webster KE, Feller JA (2016) Exploring the high reinjury rate in younger patients undergoing anterior cruciate ligament reconstruction. Am J Sports Med 44:2827–2832CrossRefPubMedGoogle Scholar
  34. 34.
    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 42:641–647CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2017

Authors and Affiliations

  • Philipp Henle
    • 1
  • Kathrin S. Bieri
    • 2
  • Manuel Brand
    • 4
  • Emin Aghayev
    • 2
  • Jessica Bettfuehr
    • 3
  • Janosch Haeberli
    • 1
  • Martina Kess
    • 1
  • Stefan Eggli
    • 1
  1. 1.Department of Knee Surgery and Sports TraumatologySonnenhof Orthopaedic CenterBernSwitzerland
  2. 2.Swiss RDL, Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
  3. 3.Institute of Mathematical Statistics and Actuarial ScienceUniversity of BernBernSwitzerland
  4. 4.Faculty of MedicineUniversity of BernBernSwitzerland

Personalised recommendations