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Predictors for additional anterior cruciate ligament reconstruction: data from the Swedish national ACL register

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To identify predictors for additional anterior cruciate ligament (ACL) reconstruction.

Methods

Patients from the Swedish national ACL register who underwent ACL reconstruction between January 2005 and February 2013 (follow-up duration 6–104 months) were included. Cox regression analyses included the following independent variables regarding primary injury: age, sex, time between injury and primary ACL reconstruction, activity at primary injury, concomitant injuries, injury side, graft type, and pre-surgery KOOS and EQ-5D scores.

Results

Among ACL reconstruction procedures, 93 % involved hamstring tendon (HT) autografts. Graft type did not predict additional ACL reconstruction. Final regression models only included patients with HT autograft (n = 20,824). Of these, 702 had revision and 591 contralateral ACL reconstructions. The 5-year post-operative rates of revision and contralateral ACL reconstruction were 4.3 and 3.8 %, respectively. Significant predictors for additional ACL reconstruction were age (fourfold increased rate for <16-year-old patients vs. >35-year-old patients), time between injury and primary surgery (two to threefold increased rate for ACL reconstruction within 0–90 days vs. >365 days), and playing football at primary injury.

Conclusion

This study identified younger age, having ACL reconstruction early after the primary injury, and incurring the primary injury while playing football as the main predictors for revision and contralateral ACL reconstruction. This suggests that the rate of additional ACL reconstruction is increased in a selected group of young patients aiming to return to strenuous sports after primary surgery and should be taken into consideration when discussing primary ACL reconstruction, return to sports, and during post-surgery rehabilitation.

Level of evidence

II.

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Acknowledgments

The study was financially supported by Futurum—the academy for healthcare, County Council, Jönköping, the Faculty of Health Sciences at Linköping University, and the Swedish National Centre for Research in Sports (CIF).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

The study has been approved by the appropriate ethics committee and was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. Participation in the Swedish national register is voluntary for surgeons and patients, and thus no written consent is necessary. All data are unidentifiable patient data.

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Authors and Affiliations

  1. Department of Physiotherapy, Ryhov County Hospital, 551 85, Jönköping, Sweden

    Anne Fältström

  2. Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden

    Martin Hägglund, Henrik Magnusson & Joanna Kvist

  3. Capio Artro Clinic AB, Sophiahemmet, Stockholm, Sweden

    Magnus Forssblad

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  1. Anne Fältström
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  2. Martin Hägglund
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  4. Magnus Forssblad
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Correspondence to Anne Fältström.

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Fältström, A., Hägglund, M., Magnusson, H. et al. Predictors for additional anterior cruciate ligament reconstruction: data from the Swedish national ACL register. Knee Surg Sports Traumatol Arthrosc 24, 885–894 (2016). https://doi.org/10.1007/s00167-014-3406-6

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  • DOI: https://doi.org/10.1007/s00167-014-3406-6

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