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.
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.
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.
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.
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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.
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.
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.
No funding was received for this study.
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 was obtained from all individual participants included in the study.
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Henle, P., Bieri, K.S., Brand, M. et al. Patient and surgical characteristics that affect revision risk in dynamic intraligamentary stabilization of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 26, 1182–1189 (2018). https://doi.org/10.1007/s00167-017-4574-y
- Anterior cruciate ligament
- Dynamic intraligamentary stabilization
- ACL repair
- Revision surgery
- Risk factors
- ACL suture