Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

Open Access 01-12-2017 | Knee

Adolescents and female patients are at increased risk for contralateral anterior cruciate ligament reconstruction: a cohort study from the Swedish National Knee Ligament Register based on 17,682 patients

Authors: Thorkell Snaebjörnsson, Eric Hamrin Senorski, David Sundemo, Eleonor Svantesson, Olof Westin, Volker Musahl, Eduard Alentorn-Geli, Kristian Samuelsson

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 12/2017

Abstract

Purpose

The impact of different surgical techniques in index ACL reconstruction for patients undergoing contralateral ACL reconstruction was investigated.

Methods

The study was based on data from the Swedish National Knee Ligament Register. Patients undergoing index ACL reconstruction and subsequent contralateral ACL reconstruction using hamstring graft under the study period were included. The following variables were evaluated: age at index surgery, gender, concomitant meniscal or cartilage injury registered at index injury, transportal femoral bone tunnel drilling and transtibial femoral bone tunnel drilling. The end-point of primary contralateral ACL surgery was analysed as well as the time-to-event outcomes using survivorship methods including Kaplan–Meier estimation and Cox proportional hazards regression models.

Results

A total of 17,682 patients [n = 10,013 males (56.6%) and 7669 females (43.4%)] undergoing primary ACL reconstruction from 1 January 2005 through 31 December 2014 were included in the study. A total of 526 (3.0%) patients [n = 260 males (49.4%) and 266 females (50.6%)] underwent primary contralateral ACL reconstruction after index ACL reconstruction during the study period. Females had a 33.7% greater risk of contralateral ACL surgery [HR 1.337 (95% CI 1.127–1.586); (P = 0 0.001)]. The youngest age group (13–15 years) showed an increased risk of contralateral ACL surgery compared with the reference (36–49) age group [HR 2.771 (95% CI 1.456–5.272); (P = 0.002)]. Decreased risk of contralateral ACL surgery was seen amongst patients with concomitant cartilage injury at index surgery [HR 0.765 (95% CI 0.623–0.939); (P = 0.010)]. No differences in terms of the risk of contralateral ACL surgery were found between anatomic and non-anatomic techniques of primary single-bundle ACL reconstruction, comparing transportal anatomic technique to transtibial non-anatomic, anatomic and partial-anatomic.

Conclusion

Age and gender were identified as risk factors for contralateral ACL reconstruction; hence young individuals and females were more prone to undergo contralateral ACL reconstruction. Patients with concomitant cartilage injury at index ACL reconstruction had lower risk for contralateral ACL reconstruction. No significant differences between various ACL reconstruction techniques could be related to increased risk of contralateral ACL reconstruction.

Level of evidence

Retrospective Cohort Study, Level III.

Andernord D, Bjornsson H, Petzold M, Eriksson BI, Forssblad M, Karlsson J, Samuelsson K (2014) 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 42(7):1574–1582CrossRefPubMed

Ardern CL, Osterberg A, Sonesson S, Gauffin H, Webster KE, Kvist J (2016) Satisfaction With knee function after primary anterior cruciate ligament reconstruction is associated with self-efficacy, quality of life, and returning to the preinjury physical activity. Arthroscopy 32(8):1631–1638.e1633CrossRefPubMed

Barber-Westin SD, Noyes FR (2011) Objective criteria for return to athletics after anterior cruciate ligament reconstruction and subsequent reinjury rates: a systematic review. Phys Sports Med 39(3):100–110CrossRef

Bourke HE, Salmon LJ, Waller A, Patterson V, Pinczewski LA (2012) Survival of the anterior cruciate ligament graft and the contralateral ACL at a minimum of 15 years. Am J Sports Med 40(9):1985–1992CrossRefPubMed

Desai N, Andernord D, Sundemo D, Alentorn-Geli E, Musahl V, Fu F, Forssblad M, Samuelsson K (2016) Revision surgery in anterior cruciate ligament reconstruction: a cohort study of 17,682 patients from the Swedish National Knee Ligament Register. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-016-4399-0 PubMedCentral

Halewood C, Amis AA (2015) Clinically relevant biomechanics of the knee capsule and ligaments. Knee Surg Sports Traumatol Arthrosc 23(10):2789–2796CrossRefPubMed

Kaeding CC, Pedroza AD, Reinke EK, Huston LJ, Spindler KP (2015) 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 43(7):1583–1590CrossRefPubMedPubMedCentral

Leys T, Salmon L, Waller A, Linklater J, Pinczewski L (2012) Clinical results and risk factors for reinjury 15 years after anterior cruciate ligament reconstruction: a prospective study of hamstring and patellar tendon grafts. Am J Sports Med 40(3):595–605CrossRefPubMed

Lubowitz JH (2014) Anatomic ACL reconstruction produces greater graft length change during knee range-of-motion than transtibial technique. Knee Surg Sports Traumatol Arthrosc 22(5):1190–1195CrossRefPubMed

10.

Mohtadi N, Chan D, Barber R, Paolucci EO (2016) Reruptures, reinjuries, and revisions at a minimum 2-year follow-up: a randomized clinical trial comparing 3 graft types for ACL reconstruction. Clin J Sport Med 26(2):96–107CrossRefPubMed

11.

Morgan MD, Salmon LJ, Waller A, Roe JP, Pinczewski LA (2016) Fifteen-year survival of endoscopic anterior cruciate ligament reconstruction in patients aged 18 years and younger. Am J Sports Med 44(2):384–392CrossRefPubMed

12.

Salmon L, Russell V, Musgrove T, Pinczewski L, Refshauge K (2005) Incidence and risk factors for graft rupture and contralateral rupture after anterior cruciate ligament reconstruction. Arthroscopy 21(8):948–957CrossRefPubMed

13.

Shelbourne KD, Gray T, Haro M (2009) Incidence of subsequent injury to either knee within 5 years after anterior cruciate ligament reconstruction with patellar tendon autograft. Am J Sports Med 37(2):246–251CrossRefPubMed

14.

Svantesson E, Sundemo D, Hamrin Senorski E, Alentorn-Geli E, Musahl V, Fu FH, Desai N, Stalman A, Samuelsson K (2016) Double-bundle anterior cruciate ligament reconstruction is superior to single-bundle reconstruction in terms of revision frequency: a study of 22,460 patients from the Swedish National Knee Ligament Register. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-016-4387-4 PubMed

15.

Thompson SM, Salmon LJ, Waller A, Linklater J, Roe JP, Pinczewski LA (2016) Twenty-year outcome of a longitudinal prospective evaluation of isolated endoscopic anterior cruciate ligament reconstruction with patellar tendon or hamstring autograft. Am J Sports Med 44(12):3083–3094CrossRefPubMed

16.

Tibor L, Chan PH, Funahashi TT, Wyatt R, Maletis GB, Inacio MC (2016) Surgical technique trends in primary ACL reconstruction from 2007 to 2014. J Bone Jt Surg Am 98(13):1079–1089CrossRef

17.

Walden M, Atroshi I, Magnusson H, Wagner P, Hagglund M (2012) Prevention of acute knee injuries in adolescent female football players: cluster randomised controlled trial. BMJ 344:e3042CrossRefPubMedPubMedCentral

18.

Webster KE, Feller JA (2016) Exploring the high reinjury rate in younger patients undergoing anterior cruciate ligament reconstruction. Am J Sports Med 44(11):2827–2832CrossRefPubMed

19.

Webster KE, Feller JA, Leigh WB, Richmond AK (2014) Younger patients are at increased risk for graft rupture and contralateral injury after anterior cruciate ligament reconstruction. Am J Sports Med 42(3):641–647CrossRefPubMed

20.

Wiggins AJ, Grandhi RK, Schneider DK, Stanfield D, Webster KE, Myer GD (2016) Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Am J Sports Med 44(7):1861–1876CrossRefPubMedPubMedCentral

21.

Wright RW, Magnussen RA, Dunn WR, Spindler KP (2011) Ipsilateral graft and contralateral ACL rupture at five years or more following ACL reconstruction: a systematic review. J Bone Jt Surg Am 93(12):1159–1165CrossRef

Title: Adolescents and female patients are at increased risk for contralateral anterior cruciate ligament reconstruction: a cohort study from the Swedish National Knee Ligament Register based on 17,682 patients
Authors: Thorkell Snaebjörnsson
Eric Hamrin Senorski
David Sundemo
Eleonor Svantesson
Olof Westin
Volker Musahl
Eduard Alentorn-Geli
Kristian Samuelsson
Publication date: 01-12-2017
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 12/2017
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-017-4517-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Adolescents and female patients are at increased risk for contralateral anterior cruciate ligament reconstruction: a cohort study from the Swedish National Knee Ligament Register based on 17,682 patients

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Please log in to get access to this content

Other articles of this Issue 12/2017

Conceptual and methodological considerations in the assessment of the neuromuscular function by means of tensiomyography

Articular cartilage paste graft for severe osteochondral lesions of the knee: a 10- to 23-year follow-up study

Patellar tendon length during knee flexion of meniscal-bearing and rotating total knee arthroplasty implants

Origin and insertion of the medial patellofemoral ligament: a systematic review of anatomy

Erratum to: Kinematics of ACL and anterolateral ligament. Part II: anterolateral and anterior cruciate ligament reconstruction

Comparison of patellofemoral outcomes after TKA using two prostheses with different patellofemoral design features