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Archives of Orthopaedic and Trauma Surgery

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01-09-2018 | Arthroscopy and Sports Medicine

Differences between traumatic and non-traumatic causes of ACL revision surgery

Authors: Vera Jaecker, Tabea Zapf, Jan-Hendrik Naendrup, Ajay C. Kanakamedala, Thomas Pfeiffer, Sven Shafizadeh

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 9/2018

Abstract

Purpose

The purpose of this study was to evaluate and classify causes for anterior cruciate ligament (ACL) reconstruction failure. It was hypothesized that specific technical and biological reconstruction aspects would differ when comparing traumatic and non-traumatic ACL reconstruction failures.

Materials and methods

One hundred and forty-seven consecutive patients who experienced ACL reconstruction failure and underwent revision between 2009 and 2014 were analyzed. Based on a systematic failure analysis, including evaluation of technical information on primary ACL reconstruction and radiological assessment of tunnel positions, causes were classified into traumatic and non-traumatic mechanisms of failure; non-traumatic mechanisms were further sub-divided into technical and biologic causes. Spearman’s rank correlation coefficient and chi-squared tests were performed to determine differences between groups based on various factors including graft choice, fixation technique, technique of femoral tunnel positioning, tunnel malpositioning, and time to revision.

Results

Non-traumatic, i.e., technical, and traumatic mechanisms of ACL reconstruction failure were found in 64.5 and 29.1% of patients, respectively. Biological failure was found only in 6.4% of patients. Non-anatomical femoral tunnel positioning was found the most common cause (83.1%) for technical reconstruction failure followed by non-anatomical tibial tunnel positioning (45.1%). There were strong correlations between non-traumatic technical failure and femoral tunnel malpositioning, transtibial femoral tunnel drilling techniques, femoral transfixation techniques as well as earlier graft failure (p < 0.05).

Conclusions

Technical causes, particularly tunnel malpositioning, were significantly correlated with increased incidence of non-traumatic ACL reconstruction failure. Transtibial femoral tunnel positioning techniques and femoral transfixation techniques, showed an increased incidence of non-traumatic, earlier graft failure.

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Title: Differences between traumatic and non-traumatic causes of ACL revision surgery
Authors: Vera Jaecker
Tabea Zapf
Jan-Hendrik Naendrup
Ajay C. Kanakamedala
Thomas Pfeiffer
Sven Shafizadeh
Publication date: 01-09-2018
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 9/2018
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-018-2954-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Differences between traumatic and non-traumatic causes of ACL revision surgery

Abstract

Purpose

Materials and methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusions

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