Abstract
Background
Return to play after anterior cruciate ligament (ACL) reconstruction can increase risk for both ipsilateral graft rupture and contralateral ACL rupture. The risk for injury of the contralateral knee after ACL reconstruction could be nearly double that of ipsilateral graft rupture.
Questions/Purposes
We sought to identify independent, patient-related risk factors for contralateral ACL rupture following primary ACL reconstruction.
Methods
A national database was queried for patients who underwent primary ACL reconstruction from 2007 to 2015 with a minimum of 2 years of post-operative follow-up (n = 12,044). Patients who underwent subsequent primary ACL reconstruction on the contralateral extremity were then identified. A multivariate binomial logistic regression analysis was utilized to evaluate patient-related risk factors for contralateral ACL rupture, including demographic and comorbidity variables. Adjusted odds ratios and 95% confidence intervals were calculated for each risk factor.
Results
Of the 3707 patients who had a minimum of 2 years of database activity and comprised the study group, 204 (5.5%) experienced a contralateral ACL rupture requiring reconstruction. Independent risk factors for contralateral ACL rupture included age less than 20 years, female gender, tobacco use, and depression. Obesity, morbid obesity, type 1 diabetes, type 2 diabetes, and a history of anxiety were not significant predictors of contralateral injury.
Conclusion
We were able to adequately power an analysis to identify several significant patient-related risk factors for contralateral ACL rupture after primary ACL reconstruction, including younger age, female gender, tobacco use, and depression. This information can be used to counsel patients on the risk of injury to the contralateral knee.
Similar content being viewed by others
References
Andernord D, Desai N, Björnsson H, Gillén S, Karlsson J, Samuelsson K. Predictors of contralateral anterior cruciate ligament reconstruction. Am J Sports Med. 2015;43:295–302.
Arundale AJH, Capin JJ, Zarzycki R, Smith AH, Snyder-Mackler L. Two year ACL reinjury rate of 2.5%: outcomes report of the men in a secondary ACL injury prevention program (ACL-sports). Int J Sports Phys Ther.. 2018;13:422–431.
Brophy RH, Huston LJ, Wright RW, et al. Outcomes of ACL reconstruction in patients with diabetes. Med Sci Sports Exerc. 2016;48:969–973.
Cancienne JM, Brockmeier SF, Werner BC. Tobacco use is associated with increased rates of infection and revision surgery after primary superior labrum anterior and posterior repair. J Shoulder Elb Surg. 2016;25(11):1764–1768.
Colombet P, Saffarini M, Bouguennec N. Clinical and functional outcomes of anterior cruciate ligament reconstruction at a minimum of 2 years using adjustable suspensory fixation in both the femur and tibia: a prospective study. Orthop J Sport Med. 2018;6(10):2325967118804128.
DiSilvestro KJ, Jauregui JJ, Glazier E, et al. Outcomes of anterior cruciate ligament reconstruction in obese and overweight patients. Clin J Sport Med. 2017. https://doi.org/10.1097/JSM.0000000000000521.
Edwards PK, Ebert JR, Joss B, et al. Patient characteristics and predictors of return to sport at 12 months after anterior cruciate ligament reconstruction: the importance of patient age and postoperative rehabilitation. Orthop J Sport Med. 2018;6:232596711879757.
Kaeding CC, Pedroza AD, Reinke EK, et al. 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.
Kvist J, Kartus J, Karlsson J, Forssblad M. Results from the Swedish national anterior cruciate ligament register. Arthrosc J Arthrosc Relat Surg. 2014;30:803–810.
Lai CCH, Feller JA, Webster KE. Fifteen-year audit of anterior cruciate ligament reconstructions in the Australian Football League from 1999 to 2013: return to play and subsequent ACL injury. Am J Sports Med. 2018;46(14):3353–3360.
Mae T, Shino K, Matsumoto N, Yoneda K, Yoshikawa H, Nakata K. Risk factors for ipsilateral graft rupture or contralateral anterior cruciate ligament tear after anatomic double-bundle reconstruction. Asia-Pacific J Spor Med Arthrosc Rehabi Technol. 2014;1:90–95.
Magnussen RA, Meschbach NT, Kaeding CC, Wright RW, Spindler KP. ACL graft and contralateral ACL tear risk within ten years following reconstruction. JBJS Rev. 2015;3(1).
Maletis GB, Inacio MCS, Funahashi TT. Risk factors associated with revision and contralateral anterior cruciate ligament reconstructions in the Kaiser Permanente ACLR Registry. Am J Sports Med. 2015;43:641–647.
Nakase J, Tsuchiya H, Kitaoka K. Contralateral anterior cruciate ligament injury after anterior cruciate ligament reconstruction: a case controlled study. Sports Med Arthrosc Rehabil Ther Technol. 2012;4:46.
Novikov DA, Swensen SJ, Buza JA, Gidumal RH, Strauss EJ. The effect of smoking on ACL reconstruction: a systematic review. Phys Sportsmed. 2016;44:335–341.
Pierce T, Issa K, Cassidy K, Festa A, McInerney V, Scillia A. Risk factors for contralateral ACL injury: a single institution case–control study. J Knee Surg. 2018;31:846–850.
Ponce B, Cain E, Pflugner R, et al. Risk factors for revision anterior cruciate ligament reconstruction. J Knee Surg. 2015;29:329–336.
Salmon L, Russell V, Musgrove T, Pinczewski L, Refshauge K. Incidence and risk factors for graft rupture and contralateral rupture after anterior cruciate ligament reconstruction. Arthrosc J Arthrosc Relat Surg. 2005;21:948–957.
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.
Swärd P, Kostogiannis I, Roos H. Risk factors for a contralateral anterior cruciate ligament injury. Knee Surgery Sport Traumatol Arthrosc. 2010;18:277–291.
Webster KE, Feller JA, Leigh WB, Richmond AK. Younger patients are at increased risk for graft rupture and contralateral injury after anterior cruciate ligament reconstruction. Am J Sports Med. 2014;42:641–647.
Wright RW, Magnussen RA, Dunn WR, Spindler KP Ipsilateral graft and contralateral ACL rupture at five years or more following ACL reconstruction: a systematic review. J Bone Joint Surg Am. 2011;93:1159–1165.
Wu H-H, Liu M, Dines JS, Kelly JD, Garcia GH. Depression and psychiatric disease associated with outcomes after anterior cruciate ligament reconstruction. World J Orthop. 2016;7:709–717.
Zhang AL, Montgomery SR, Ngo SS, Hame SL, Wang JC, Gamradt SC. Analysis of rotator cuff repair trends in a large private insurance population. Arthroscopy. 2013;29:623–629.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Jourdan M. Cancienne, MD, and Robert Browning, MD, declare that they have no conflicts of interest. Brian C. Werner, MD, reports grants and personal fees as board or committee member from American Orthopedic Society for Sports Medicine and American Shoulder and Elbow Surgeons, as well as research support from Arthrex, Inc., Biomet, and Integra LifeScience, outside the submitted work.
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 2013.
Informed Consent
Informed consent was waived from all patients for being included in this study.
Required Author Forms
Disclosure forms provided by the authors are available with the online version of this article.
Additional information
Level of Evidence: Level IV, case series
Rights and permissions
About this article
Cite this article
Cancienne, J.M., Browning, R. & Werner, B.C. Patient-Related Risk Factors for Contralateral Anterior Cruciate Ligament (ACL) Tear After ACL Reconstruction: An Analysis of 3707 Primary ACL Reconstructions. HSS Jrnl 16 (Suppl 2), 226–229 (2020). https://doi.org/10.1007/s11420-019-09687-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11420-019-09687-x