Patient demographics and surgical characteristics in ACL revision: a comparison of French, Norwegian, and North American cohorts

Abstract

Purpose

The goal of this paper is to compare patient factors, intra-operative findings, and surgical techniques between patients followed in large cohorts in France, Norway, and North America.

Methods

Data collected on 2,286 patients undergoing revision anterior cruciate ligament reconstruction (ACLR) were obtained. These data included 1,216 patients enrolled in the Multicenter ACL Revision Study (MARS) in North America, 793 patients undergoing revision ACLR and recorded in the Norwegian Knee Ligament Registry (NKLR), and 277 patients recorded in the revision ACL database of the Société Française d’Arthroscopie (SFA) in France. Data collected from each database included patient demographics (age, sex, height, and weight), graft choice and reason for failure of the primary ACLR, time from primary to revision ACLR, pre-revision patient-reported outcome scores (Knee Injury and Osteoarthritis Outcome Score, subjective International Knee Documentation Committee), associated intra-articular findings and treatments at revision, and graft choice for revision reconstruction.

Results

Patient demographics in the three databases were relatively similar. Graft choice for primary and revision ACLR varied significantly, with more allografts used in the MARS cohort. Hamstring autograft was favoured in the NKRL, while bone–patellar tendon–bone autograft was most common in the SFA cohort. Reasons for failure of the primary ACLR were comparable, with recurrent trauma noted in 46–56 % of patients in each of the three cohorts. Technical error was cited in 44–51 % of patients in the MARS and SFA cohorts, but was not clearly elucidated in the NKLR cohort. Biologic failure of the primary graft was more common in the MARS cohort. Differences in associated intra-articular findings were noted at the time of revision ACLR, with significantly more high-grade cartilage lesions noted in the MARS group.

Conclusions

Significant differences exist between patient populations followed in revision ACL cohorts throughout the world that should be considered when applying findings from such cohorts to different patient populations.

Level of evidence

Retrospective comparative study, Level III.

Appendix

The MARS Group

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John P. Albright, MD	University of Iowa Hospitals and Clinics
Christina R. Allen, MD	University of California, San Francisco
Annunziato Amendola, MD	University of Iowa Hospitals and Clinics
Allen F. Anderson, MD	Tennessee Orthopaedic Alliance
Jack T. Andrish, MD	Cleveland Clinic
Christopher C. Annunziata, MD	Commonwealth Orthopaedics & Rehab
Robert A. Arciero, MD	University of Connecticut Health Center
Bernard R. Bach Jr, MD	Rush University Medical Center
Champ L. Baker, III, MD	The Hughston Clinic
Arthur R. Bartolozzi, MD	3B Orthopaedics, University of Pennsylvania Health System
Keith M. Baumgarten, MD	Orthopedic Institute
Jeffery R. Bechler, MD	University Orthopedic Associates, LLC
Jeffrey H. Berg, MD	Town Center Orthopaedic Associates
Geoffrey A. Bernas, MD	State University of New York at Buffalo
Stephen F. Brockmeier, MD	University of Virginia
Robert H. Brophy, MD	Washington University, St. Louis
Charles A. Bush-Joseph, MD	Rush University Medical Center
J. Brad Butler, V, MD	Orthopedic and Fracture Clinic
John D. Campbell, MD	Bridger Orthopaedic and Sports Medicine
James L. Carey, M.D., M.P.H.	University of Pennsylvania, Philadelphia, PA
James E. Carpenter, MD	University of Michigan
Brian J. Cole, MD	Rush University Medical Center
Daniel E. Cooper, MD	W.B. Carrell Memorial Clinic
Jonathan M. Cooper, DO	HealthPartners Specialty Clinic
Charles L. Cox, MD	Vanderbilt University
R. Alexander Creighton, MD	University of North Carolina Medical Center
Diane L. Dahm, MD	Mayo Clinic Rochester
Tal S. David, MD	Arthroscopic and Orthopedic Sports Medicine Associates
Thomas M. DeBerardino, MD	University of Connecticut Health Center
Warren R. Dunn, MD, MPH	Vanderbilt University
David C. Flanigan, MD	The Ohio State University
Robert W. Frederick, MD	The Rothman Institute/ Thomas Jefferson University
Theodore J. Ganley, MD	The Children’s Hospital of Philadelphia
Charles J. Gatt, Jr., MD	University Orthopedic Associates, LLC
Steven R. Gecha, MD	Princeton Orthopaedic Associates
James Robert Giffin, MD	University of Western Ontario
Amanda K. Haas, M.A.	Washington University, St. Louis, MO
Sharon L. Hame, MD	David Geffen School of Medicine at UCLA
Jo A. Hannafin, MD, PhD	Hospital for Special Surgery
Christopher D. Harner, MD	University of Pittsburgh Medical Center
Norman Lindsay Harris, Jr., MD	Orthopaedic Associates of Aspen & Glenwood
Keith S. Hechtman, MD	UHZ Sports Medicine Institute
Elliott B. Hershman, MD	Lenox Hill Hospital
Rudolf G. Hoellrich, MD	Slocum Research and Education Foundation
Timothy M. Hosea, MD	University Orthopedic Associates, LLC
Laura J. Huston, M.S.	Vanderbilt University, Nashville, TN
David C. Johnson, MD	National Sports Medicine Institute
Timothy S. Johnson, MD	National Sports Medicine Institute
Morgan H. Jones, MD	Cleveland Clinic
Christopher C. Kaeding, MD	The Ohio State University
Ganesh V. Kamath, MD	University of North Carolina Medical Center
Thomas E. Klootwyk, MD	Methodist Sports Medicine Center-The Orthopedic Specialists
Brett (Brick) A. Lantz, MD	Slocum Research and Education Foundation
Bruce A. Levy, MD	Mayo Clinic Rochester
C. Benjamin Ma, MD	University of California, San Francisco
G. Peter Maiers, II, MD	Methodist Sports Medicine Center-The Orthopedic Specialists
Barton Mann, PhD	American Orthopaedic Society for Sports Medicine
Robert G. Marx, MD	Hospital for Special Surgery
Matthew J. Matava, MD	Washington University, St. Louis
Gregory M. Mathien, MD	Knoxville Orthopedic Clinic
David R. McAllister, MD	David Geffen School of Medicine at UCLA
Eric C. McCarty, MD	University of Colorado Denver School of Medicine
Robert G. McCormack, MD	University of British Columbia
Bruce S. Miller, MD, MS	University of Michigan
Carl W. Nissen, MD	Connecticut Children’s Medical Center
Daniel F. O’Neill, MD, Ed.D	Littleton Regional Hospital
LTC Brett D. Owens, MD	Keller Army Community Hospital-United States Military Academy
Richard D. Parker, MD	Cleveland Clinic
Mark L. Purnell, MD	Orthopaedic Associates of Aspen & Glenwood
Arun J. Ramappa, MD	Beth Israel Deaconess Medical Center
Michael A. Rauh, MD	State University of New York at Buffalo
Arthur Rettig, MD	Methodist Sports Medicine Center-The Orthopedic Specialists
Jon K. Sekiya, MD	University of Michigan
Kevin G. Shea, MD	Intermountain Orthopedics
Orrin H. Sherman, MD	NYU Hospital for Joint Diseases
James R. Slauterbeck, MD	University of Vermont College of Medicine
Matthew V. Smith, MD	Washington University, St. Louis
Jeffrey T. Spang, MD	University of North Carolina Medical Center
Kurt P. Spindler, MD	Vanderbilt University
Michael J. Stuart, MD	Mayo Clinic Rochester
LTC. Steven J. Svoboda, MD	Keller Army Community Hospital-United States Military Academy
Timothy N. Taft, MD	University of North Carolina Medical Center
COL Joachim J. Tenuta, MD	Keller Army Community Hospital-United States Military Academy
Edwin M. Tingstad, MD	Inland Orthopaedics/ Washington State University
Armando F. Vidal, MD	University of Colorado Denver School of Medicine
Darius G. Viskontas, MD	University of British Columbia, Royal Columbian Hospital
Richard A. White, MD	University of Missouri-Columbia
James S. Williams Jr., MD	Cleveland Clinic
Michelle L. Wolcott, MD	University of Colorado Denver School of Medicine
Brian R. Wolf, MD	University of Iowa Hospitals and Clinics
James J. York, MD	Chesapeake Orthopaedics & Sports Medicine Center

SFA Revision ACL Group

Abderahmane Sbihi, Patrick Djian, Jean-François Potel, Christophe Hulet, Frank Jouve, Christophe Bussière, François-Paul Ehkirch, Gilles Burdin, Frédéric Dubrana, Philippe Beaufils, Jean-Pierre Franceschi, Vincent Chassaing.