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Predictive factors for failure of anterior cruciate ligament reconstruction via the trans-tibial technique

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Factors for graft failure after trans-tibial (TT) ACL reconstruction, including anterolateral ligament (ALL) injury and degree of synovialization, remain unclear. This study is to evaluate the risk factors for graft failures after TT ACL reconstruction including ALL injury and synovialization.

Materials and methods

A total 391 patients who underwent primary TT ACL reconstruction were included. Failure was defined as greater than grade 2 laxity on the Lachman or pivot shift tests or 5 mm of anterior translation on stress radiograph. After applying inclusion/exclusion criteria, 31 patients with failure were categorized as group 1 and 89 patients without failure were categorized as group 2. Chi-square test and Cox proportional hazard analyses were performed.

Results

Preoperatively, 64 patients had ALL injuries (53.3%), 58 had medial meniscal (MM) tears (48.3%), and 62 had lateral meniscal (LM) tears (51.6%). Ninety-three patients (77.5%) had acute injuries and 27 had chronic injuries as per 6-weeks duration. Significant risk factors for failure were LM tear (hazard ratio [HR], 4.018; 95% confidence interval [CI] 1.677–9.629; p = 0.002), chronicity (HR, 6.812; 95% CI 2.758–16.824; p = 0.000), presence of ALL injury (HR, 3.655; 95% CI 1.442–9.265; p = 0.006), and poor synovialization (HR, 3.134; 95% CI 1.298–7.566; p = 0.011) in Cox proportional hazard analysis. If combined MM and LM tears were found, an increased risk of failure was also identified (combined tears: HR, 3.951; 95% CI 1.754–8.901; p = 0.001/preoperative high-grade laxity: HR, 4.546; 95% CI 1.875–11.02; p = 0.001).

Conclusion

Chronic ACL injuries, meniscus tear, preoperative ALL injuries, preoperative high-grade laxity and poor synovialization are significant risk factors. Therefore, these factors should be carefully assessed and properly treated in TT ACL reconstruction.

Level of evidence

IV, retrospective cohort study.

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Author notes

  1. Seong Hwan Kim and Yong-Beom Park contributed equally to this study.

Authors and Affiliations

  1. Department of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University, Namyangju-Si, Kyunggi-Do, South Korea

    Seong Hwan Kim

  2. Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea

    Yong-Beom Park, Dong-Hyun Kim & Han-Jun Lee

  3. Orthopedic Department, Centre Hospitalier de Versailles, Le Chesnay, France

    Nicolas Pujol

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Kim, S.H., Park, YB., Kim, DH. et al. Predictive factors for failure of anterior cruciate ligament reconstruction via the trans-tibial technique. Arch Orthop Trauma Surg 140, 1445–1457 (2020). https://doi.org/10.1007/s00402-020-03483-7

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