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Hospital for Special Surgery ACL Registry: 2-Year Outcomes Suggest Low Revision and Return to OR Rates

  • Original Article
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HSS Journal ®

Abstract

Background

Anterior cruciate ligament (ACL) injuries are among the most common knee injuries. Patient outcomes, rate of subsequent operations, and rate of subsequent ACL reconstruction following primary ACL reconstruction need to be evaluated.

Questions/Purposes

This study was designed to answer the following questions: (1) What is the return to surgery (OR) rate following primary ACL reconstruction and (2) what is the revision ACL reconstruction rate?

Methods

Data was drawn from the Hospital for Special Surgery (HSS) ACL Registry. International Knee Documentation Committee (IKDC) Subjective Knee Evaluation, Lysholm-Tegner Scales, Marx Activity Scale, and SF12 were completed by patients at baseline, 1-, and 2-year follow-up. Clinical data and intraoperative data were registered by surgeons on an intraoperative form. Subsequent surgery rates were determined by evaluating the medical records for subsequent surgery, laterality, surgeon, procedure description, and type of anesthesia.

Results

The majority of the ACL reconstructions performed were autograft (76.6%) with the most common graft being bone-patellar tendon-bone (BTB) autograft (47.2%), hamstring autograft (21.9%), and Achilles allograft (18.2%). Average IKDC score improved from 51.9 (SD 16.1) at baseline to 83.5 (SD 14.2) at 2-year follow-up. Females had a 2.5-point lower IKDC and 1.4-point Marx scores compared to males. Of the enrolled patients, 7.3% had revision ACL surgery with 70.4% being ipsilateral ACL surgery. Of the enrolled patients, 10.3% had subsequent knee surgery with 72.3% being ipsilateral knee surgery. Multivariable logistic regression analysis showed that patients less than 18 years of age at the time of their index surgery were over three times more likely to undergo a revision ACL reconstruction compared to older patients and were at four times higher risk than older patients for any subsequent knee surgery.

Conclusion

Understanding ACL surgery, patient outcomes, and risk factors for revision ACL surgery and subsequent knee surgery after primary ACL reconstruction is essential. Patients less than 18 years of age have a higher risk of subsequent knee surgery and subsequent ACL surgery than older patients.

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References

  1. Andernord D, Björnsson H, Petzold M, et al. Surgical predictors of early revision surgery after anterior cruciate ligament reconstruction: results from the Swedish national knee ligament register on 13,102 patients. Am J Sports Med. 2014; 42: 1574-1582. doi:10.1177/0363546514531396.

    Article  PubMed  Google Scholar 

  2. Andernord D, Desai N, Björnsson H, Gillén S, Karlsson J, Samuelsson K. Predictors of contralateral anterior cruciate ligament reconstruction: a cohort study of 9061 patients with 5-year follow-up. Am J Sports Med. 2015; 43: 295-302. doi:10.1177/0363546514557245.

    Article  PubMed  Google Scholar 

  3. Beynnon BD, Vacek PM, Newell MK, et al. The effects of level of competition, sport, and sex on the incidence of first-time noncontact anterior cruciate ligament injury. Am J Sports Med. 2014; 42: 1806-1812. doi:10.1177/0363546514540862.

    Article  PubMed  Google Scholar 

  4. Bollen SR, Scott BW. Rupture of the anterior cruciate ligament—a quiet epidemic? Injury. 1996; 27: 407-409.

    Article  CAS  PubMed  Google Scholar 

  5. Bradley JP, Klimkiewicz JJ, Rytel MJ, Powell JW. Anterior cruciate ligament injuries in the national football league: epidemiology and current treatment trends among team physicians. Arthrosc J Arthrosc Relat Surg. 2002; 18: 502-509. doi:10.1053/jars.2002.30649.

    Article  Google Scholar 

  6. Clarnette R, Graves S, Lekkas C (2016) Overview of the AOA national joint replacement registry ACL registry pilot study. Orthop J Sports Med. 4. doi:10.1177/2325967116S00007.

  7. Csintalan RP, Inacio MCS, Funahashi TT, Maletis GB. Risk factors of subsequent operations after primary anterior cruciate ligament reconstruction. Am J Sports Med. 2014; 42: 619-625. doi:10.1177/0363546513511416.

    Article  PubMed  Google Scholar 

  8. Dunn WR, Lyman S, Lincoln AE, Amoroso PJ, Wickiewicz T, Marx RG. The effect of anterior cruciate ligament reconstruction on the risk of knee reinjury. Am J Sports Med. 2004; 32: 1906-1914.

    Article  PubMed  Google Scholar 

  9. Faunø P, Rahr-Wagner L, Lind M. Risk for revision after anterior cruciate ligament reconstruction is higher among adolescents. Orthop J Sports Med. 2014. doi:10.1177/2325967114552405.

    PubMed  PubMed Central  Google Scholar 

  10. Gifstad T, Foss OA, Engebretsen L, et al. Lower risk of revision with patellar tendon autografts compared with hamstring autografts: a registry study based on 45,998 primary ACL reconstructions in Scandinavia. Am J Sports Med. 2014; 42: 2319-2328. doi:10.1177/0363546514548164.

    Article  PubMed  Google Scholar 

  11. Hettrich CM, Dunn WR, Reinke EK, Spindler KP. The rate of subsequent surgery and predictors following ACL reconstruction: two- and six-year follow-up from a multicenter cohort. Am J Sports Med. 2013; 41: 1534-1540. doi:10.1177/0363546513490277.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kaeding CC, Pedroza AD, Reinke EK, Huston LJ, MOON Consortium, Spindler KP. 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. 2015; 43: 1583-1590. doi:10.1177/0363546515578836.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kamien PM, Hydrick JM, Replogle WH, Go LT, Barrett GR. Age, graft size, and Tegner activity level as predictors of failure in anterior cruciate ligament reconstruction with hamstring autograft. Am J Sports Med. 2013; 41: 1808-1812. doi:10.1177/0363546513493896.

    Article  PubMed  Google Scholar 

  14. Kocher MS, Saxon HS, Hovis WD, Hawkins RJ. Management and complications of anterior cruciate ligament injuries in skeletally immature patients: survey of the Herodicus Society and the ACL Study Group. J Pediatr Orthop. 2002; 22: 452-457.

    PubMed  Google Scholar 

  15. Kvist J, Kartus J, Karlsson J, Forssblad M. Results from the Swedish national anterior cruciate ligament register. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc. 2014; 30: 803-810. doi:10.1016/j.arthro.2014.02.036.

    Article  Google Scholar 

  16. LaPrade CM, Dornan GJ, Granan L-P, LaPrade RF, Engebretsen L. Outcomes after anterior cruciate ligament reconstruction using the Norwegian knee ligament registry of 4691 patients how does meniscal repair or resection affect short-term outcomes? Am J Sports Med. 2015; 43: 1591-1597. doi:10.1177/0363546515577364.

    Article  PubMed  Google Scholar 

  17. Lind M, Menhert F, Pedersen AB. Incidence and outcome after revision anterior cruciate ligament reconstruction results from the Danish registry for knee ligament reconstructions. Am J Sports Med. 2012; 40: 1551-1557. doi:10.1177/0363546512446000.

    Article  PubMed  Google Scholar 

  18. Lyman S, Koulouvaris P, Sherman S, Do H, Mandl LA, Marx RG. Epidemiology of anterior cruciate ligament reconstruction: trends, readmissions, and subsequent knee surgery. J Bone Joint Surg Am. 2009; 91: 2321-2328. doi:10.2106/JBJS.H.00539.

    Article  PubMed  Google Scholar 

  19. Marx RG, Jones EC, Angel M, Wickiewicz TL, Warren RF. Beliefs and attitudes of members of the American Academy of Orthopaedic Surgeons regarding the treatment of anterior cruciate ligament injury. Arthrosc J Arthrosc Relat Surg. 2003; 19: 762-770. doi:10.1016/S0749-8063(03)00398-0.

    Article  Google Scholar 

  20. Persson A, Fjeldsgaard K, Gjertsen J-E, et al. Increased risk of revision with hamstring tendon grafts compared with patellar tendon grafts after anterior cruciate ligament reconstruction a study of 12,643 patients from the Norwegian cruciate ligament registry, 2004–2012. Am J Sports Med. 2014; 42: 285-291. doi:10.1177/0363546513511419.

    Article  PubMed  Google Scholar 

  21. Shelbourne KD, Gray T, Haro M. Incidence of subsequent injury to either knee within 5 years after anterior cruciate ligament reconstruction with patellar tendon autograft. Am J Sports Med. 2009; 37: 246-251. doi:10.1177/0363546508325665.

    Article  PubMed  Google Scholar 

  22. Spindler KP, Wright RW. Anterior cruciate ligament (ACL) tear. N Engl J Med. 2008; 359: 2135-2142. doi:10.1056/NEJMcp0804745.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Wright RW, Magnussen RA, Dunn WR, Spindler KP. Ipsilateral graft and contralateral ACL rupture at five years or more following ACL reconstruction. J Bone Joint Surg Am. 2011; 93: 1159-1165. doi:10.2106/JBJS.J.00898.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

The authors would like to acknowledge the HSS ACL Registry Group for their contribution to this research.

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Authors and Affiliations

  1. Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Moira McCarthy MD, Katherine Mallett BA, Sherrie Vassallo & Joseph Nguyen PhD

  2. Case Western Reserve University, Cleveland, OH, USA

    Matthew Abola BA

Authors
  1. Moira McCarthy MD
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  2. Katherine Mallett BA
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  3. Matthew Abola BA
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  4. Sherrie Vassallo
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  5. Joseph Nguyen PhD
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Corresponding author

Correspondence to Moira McCarthy MD.

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Conflict of Interest

Moira McCarthy, MD, Katherine Mallett, BA, Matthew Abola, BA, Sherrie Vassallo, and Joseph Nguyen, PhD, have declared that they have no conflict of interest.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed Consent

Informed consent was obtained from all patients for being included in the study.

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Additional information

Level of Evidence: Therapeutic Study Level III

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McCarthy, M., Mallett, K., Abola, M. et al. Hospital for Special Surgery ACL Registry: 2-Year Outcomes Suggest Low Revision and Return to OR Rates. HSS Jrnl 13, 119–127 (2017). https://doi.org/10.1007/s11420-016-9532-6

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  • DOI: https://doi.org/10.1007/s11420-016-9532-6

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