Analysis of influence factor for the failure of anterior cruciate ligament reconstruction_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Jian , WANG Haijun , LIN Lin ,  YU Jiakuo

Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, 100191, P.R. China;

Corresponding author：

YU Jiakuo, Email: yujiakuo@126.com

Keywords：

Anterior cruciate ligament; ligament reconstruction; influence factor

DOI：

10.7507/1002-1892.201904011

Video：

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Objective To investigate the influence of gender, age, activity level, and diameter of graft on the anterior cruciate ligament (ACL) reconstruction.Methods Between February 2012 and June 2017, 179 cases (111 males and 68 females) with an average age of 30.0 years (range, 11-63 years) were included in study. The patients underwent internal fixator removal at 2 years or more after single bundle ACL reconstruction with hamstring tendon autografts. All patients were sports injuries. The time from injury to operation ranged from 3 days to 26 years (median, 120 days). Lachman test and pivot shift test were positive. Univariate analysis was conducted on gender, age, post-operative activity level (Tegner score at the time of internal fixator removal), diameter of graft, and number of graft strands, and logistic regression was used to conduct multivariate analysis to screen the independent risk factors.Results All patients were followed up 24-90 months (mean, 29.1 months). At last follow-up, Lachman test was positive in 25 cases and pivot shift test was positive in 28 cases. The KT-2000 side-to-side difference was –1-7 mm (mean, 1.89 mm). Eleven patients (6.15%) failed after ACL reconstruction. Univariate and multivariate analyses showed that the age, gender, post-operative activity level, diameter of graft, and number of graft strands were not risk factors for the failure of ACL reconstruction (P>0.05).Conclusion There was no significant difference in the risk for ACL reconstruction failure among age, gender, and activity level. ACL reconstruction failure rate cannot be reduced by increasing the number of graft strands to increase the diameter of grafts.

Citation： WANG Jian, WANG Haijun, LIN Lin, YU Jiakuo. Analysis of influence factor for the failure of anterior cruciate ligament reconstruction. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(12): 1543-1546. doi: 10.7507/1002-1892.201904011 Copy

1.	Kamien PM, Hydrick JM, Replogle WH, et al. 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(8): 1808-1812.
2.	Treme G, Diduch DR, Billante MJ, et al. Hamstring graft size prediction: a prospective clinical evaluation. Am J Sports Med, 2008, 36(11): 2204-2209.
3.	Magnussen RA, Lawrence JT, West RL, et al. Graft size and patient age are predictors of early revision after anterior cruciate ligament reconstruction with hamstring autograft. Arthroscopy, 2012, 28(4): 526-531.
4.	Barrett AM, Craft JA, Replogle WH, et al. Anterior cruciate ligament graft failure: a comparison of graft type based on age and Tegner activity level. Am J Sports Med, 2011, 39(10): 2194-2198.
5.	Hamner DL, Brown CH Jr, Steiner ME, et al. Hamstring tendon grafts for reconstruction of the anterior cruciate ligament: biomechanical evaluation of the use of multiple strands and tensioning techniques. J Bone Joint Surg (Am), 1999, 81(4): 549-557.
6.	Wilson TW, Zafuta MP, Zobitz M. A biomechanical analysis of matched bone-patellar tendon-bone and double-looped semitendinosus and gracilis tendon grafts. Am J Sports Med, 1999, 27(2): 202-207.
7.	Grood ES, Walz-Hasselfeld KA, Holden JP, et al. The correlation between anterior-posterior translation and cross-sectional area of anterior cruciate ligament reconstructions. J Orthop Res, 1992, 10(6): 878-885.
8.	Maeda A, Shino K, Horibe S, et al. Anterior cruciate ligament reconstruction with multistranded autogenous semitendinosus tendon. Am J Sports Med, 1996, 24(4): 504-509.
9.	Snaebjörnsson T, Hamrin Senorski E, Ayeni OR, et al. Graft diameter as a predictor for revision anterior cruciate ligament reconstruction and KOOS and EQ-5D values: a cohort study from the Swedish National Knee Ligament Register Based on 2240 Patients. Am J Sports Med, 2017, 45(9): 2092-2097.
10.	Mariscalco MW, Flanigan DC, Mitchell J, et al. The influence of hamstring autograft size on patient-reported outcomes and risk of revision after anterior cruciate ligament reconstruction: a multicenter orthopaedic outcomes network (MOON) cohort study. Arthroscopy, 2013, 29(12): 1948-1953.
11.	Park SY, Oh H, Park S, et al. Factors predicting hamstring tendon autograft diameters and resulting failure rates after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2013, 21(5): 1111-1118.
12.	Wernecke GC, Constantinidis A, Harris IA, et al. The diameter of single bundle, hamstring autograft does not significantly influence revision rate or clinical outcomes after anterior cruciate ligament reconstruction. Knee, 2017, 24(5): 1033-1038.
13.	Inderhaug E, Drogset JO, Lygre SHL, et al. No effect of graft size or body mass index on risk of revision after ACL reconstruction using hamstrings autograft. Knee Surg Sports Traumatol Arthrosc, 2019. doi: 10.1007/s00167-019-05395-5.
14.	Vaillant ER, Parks BG, Camire LM, et al. Five-strand versus four-strand hamstring tendon graft technique for anterior cruciate ligament reconstruction: a biomechanical comparison. J Knee Surg, 2017, 30(9): 916-919.
15.	Broadhead ML, Singla AA, Bertollo N, et al. A biomechanical comparison of 4-strand and 5-strand anterior cruciate ligament graft constructs. Orthop Rev (Pavia), 2017, 9(1): 6989.
16.	Orsi AD, Canavan PK, Vaziri A, et al. The effects of graft size and insertion site location during anterior cruciate ligament reconstruction on intercondylar notch impingement. Knee, 2017, 24(3): 525-535.
17.	Smith JH, Houck DA, Hart JA, et al. Five-strand hamstring autografts for anterior cruciate ligament reconstruction: a systematic review. Orthop J Sports Med, 2019, 7(2): 2325967119826094.

1. Kamien PM, Hydrick JM, Replogle WH, et al. 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(8): 1808-1812.
2. Treme G, Diduch DR, Billante MJ, et al. Hamstring graft size prediction: a prospective clinical evaluation. Am J Sports Med, 2008, 36(11): 2204-2209.
3. Magnussen RA, Lawrence JT, West RL, et al. Graft size and patient age are predictors of early revision after anterior cruciate ligament reconstruction with hamstring autograft. Arthroscopy, 2012, 28(4): 526-531.
4. Barrett AM, Craft JA, Replogle WH, et al. Anterior cruciate ligament graft failure: a comparison of graft type based on age and Tegner activity level. Am J Sports Med, 2011, 39(10): 2194-2198.
5. Hamner DL, Brown CH Jr, Steiner ME, et al. Hamstring tendon grafts for reconstruction of the anterior cruciate ligament: biomechanical evaluation of the use of multiple strands and tensioning techniques. J Bone Joint Surg (Am), 1999, 81(4): 549-557.
6. Wilson TW, Zafuta MP, Zobitz M. A biomechanical analysis of matched bone-patellar tendon-bone and double-looped semitendinosus and gracilis tendon grafts. Am J Sports Med, 1999, 27(2): 202-207.
7. Grood ES, Walz-Hasselfeld KA, Holden JP, et al. The correlation between anterior-posterior translation and cross-sectional area of anterior cruciate ligament reconstructions. J Orthop Res, 1992, 10(6): 878-885.
8. Maeda A, Shino K, Horibe S, et al. Anterior cruciate ligament reconstruction with multistranded autogenous semitendinosus tendon. Am J Sports Med, 1996, 24(4): 504-509.
9. Snaebjörnsson T, Hamrin Senorski E, Ayeni OR, et al. Graft diameter as a predictor for revision anterior cruciate ligament reconstruction and KOOS and EQ-5D values: a cohort study from the Swedish National Knee Ligament Register Based on 2240 Patients. Am J Sports Med, 2017, 45(9): 2092-2097.
10. Mariscalco MW, Flanigan DC, Mitchell J, et al. The influence of hamstring autograft size on patient-reported outcomes and risk of revision after anterior cruciate ligament reconstruction: a multicenter orthopaedic outcomes network (MOON) cohort study. Arthroscopy, 2013, 29(12): 1948-1953.
11. Park SY, Oh H, Park S, et al. Factors predicting hamstring tendon autograft diameters and resulting failure rates after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2013, 21(5): 1111-1118.
12. Wernecke GC, Constantinidis A, Harris IA, et al. The diameter of single bundle, hamstring autograft does not significantly influence revision rate or clinical outcomes after anterior cruciate ligament reconstruction. Knee, 2017, 24(5): 1033-1038.
13. Inderhaug E, Drogset JO, Lygre SHL, et al. No effect of graft size or body mass index on risk of revision after ACL reconstruction using hamstrings autograft. Knee Surg Sports Traumatol Arthrosc, 2019. doi: 10.1007/s00167-019-05395-5.
14. Vaillant ER, Parks BG, Camire LM, et al. Five-strand versus four-strand hamstring tendon graft technique for anterior cruciate ligament reconstruction: a biomechanical comparison. J Knee Surg, 2017, 30(9): 916-919.
15. Broadhead ML, Singla AA, Bertollo N, et al. A biomechanical comparison of 4-strand and 5-strand anterior cruciate ligament graft constructs. Orthop Rev (Pavia), 2017, 9(1): 6989.
16. Orsi AD, Canavan PK, Vaziri A, et al. The effects of graft size and insertion site location during anterior cruciate ligament reconstruction on intercondylar notch impingement. Knee, 2017, 24(3): 525-535.
17. Smith JH, Houck DA, Hart JA, et al. Five-strand hamstring autografts for anterior cruciate ligament reconstruction: a systematic review. Orthop J Sports Med, 2019, 7(2): 2325967119826094.

Chinese Journal of Reparative and Reconstructive Surgery

Analysis of influence factor for the failure of anterior cruciate ligament reconstruction

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