Surgical Predictors of Early Revision Surgery After Anterior Cruciate Ligament Reconstruction: Results From the Swedish National Knee Ligament Register on 13, 102 Patients. (July 2014)

• Record Type: Journal Article
• Authors: Andernord, Daniel; Björnsson, Haukur; Petzold, Max; Eriksson, Bengt I.; Forssblad, Magnus; Karlsson, Jón; Samuelsson, Kristian
• Is Part Of: American journal of sports medicine. Volume 42:Number 7(2014:Jul.)
• Page Start: 1574
• Page End: 1582
• Publication Date: 2014-07
• Subjects: epidemiology -- sports medicine -- knee injury -- autografts -- hamstring tendon -- bone–patellar tendon–bone -- graft failure -- graft survival -- surgical revision; Sports medicine -- Periodicals; Sports injuries -- Periodicals; Orthopedic surgery -- Periodicals; 617.102705
• DOI: 10.1177/0363546514531396
• Languages: English
• ISSNs: 0363-5465

Abstract

Background: An important objective of anterior cruciate ligament (ACL) registries is to detect and report early graft failure and revision surgery after ACL reconstruction. Purpose: To investigate surgical variables and identify predictors of revision surgery after ACL reconstruction. Study Design: Prospective cohort study; Level of evidence, 2. Methods: This prospective cohort study was based on data from the Swedish National Knee Ligament Register during the years 2005 through 2011. Eight surgical variables were investigated: graft selection, graft width, single-bundle or double-bundle techniques, femoral graft fixation, tibial graft fixation, injury-to-surgery interval, injuries to menisci, and injuries to cartilage. The primary endpoint was the 2-year incidence of revision surgery. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated and adjusted for confounders by use of multivariate statistics. Results: A total of 13, 102 patients were included (5541 women [42%] and 7561 men [58%]; P < .001). Hamstring tendon autografts accounted for 90% (11, 764 patients) of all reconstructions, of which 96% were performed with a single-bundle technique (11, 339 patients). Patellar tendon autografts accounted for the remaining 10% (1338 patients). At index reconstruction, observed injuries to menisci and cartilage were common (40% and 28%, respectively). The overall 2-year incidence of revision surgery was 1.60% (women, 1.57%; men, 1.63%; P = .854). Patients with metal interference screw fixation of a semitendinosus tendon autograft on the tibia had a significantly reduced risk of early revision surgery (RR = 0.32; 95% CI, 0.12-0.90; P = .031). Conclusion: Metal interference screw fixation of a semitendinosus tendon autograft on the tibia was an independent predictor of significantly lower 2-year incidence of revision surgery. Graft selection, graft width, a single-bundle or a double-bundle technique, femoral graft fixation, the injury-to-surgery interval, and meniscus injury were not predictors of early revision surgery.