Differences in Mechanisms of Failure, Intraoperative Findings, and Surgical Characteristics Between Single- and Multiple-Revision ACL Reconstructions: A MARS Cohort Study. (July 2013)

• Record Type: Journal Article
• Authors: Chen, James L.; Allen, Christina R.; Stephens, Thomas E.; Haas, Amanda K.; Huston, Laura J.; Wright, Rick W.; Feeley, Brian T.
• Other Names: Albright John P. non-byline-author.; Amendola Annunziato (Ned) non-byline-author.; Anderson Allen F. non-byline-author.; Andrish Jack T. non-byline-author.; Annunziata Christopher C. non-byline-author.; Arciero Robert A. non-byline-author.; Bach Bernard R. non-byline-author.; Baker Champ L. non-byline-author.; Bartolozzi Arthur R. non-byline-author.; Baumgarten Keith M. non-byline-author.; Bechler Jeffery R. non-byline-author.; Berg Jeffrey H. non-byline-author.; Bernas Geoff non-byline-author.; Brockmeier Stephen F. non-byline-author.; Brophy Robert H. non-byline-author.; Bush-Joseph Charles A. non-byline-author.; Butler J. Brad non-byline-author.; Campbell John D. non-byline-author.; Carey James L. non-byline-author.; Carpenter James E. non-byline-author.; Cole Brian J. non-byline-author.; Cooper Daniel E. non-byline-author.; Cooper Jonathan M. non-byline-author.; Cox Charles L. non-byline-author.; Creighton R. Alexander non-byline-author.; Dahm Diane L. non-byline-author.; David Tal S. non-byline-author.; DeBerardino Thomas M. non-byline-author.; Dunn Warren R. non-byline-author.; Flanigan David C. non-byline-author.; Frederick Robert W. non-byline-author.; Ganley Theodore J. non-byline-author.; Gatt Charles J. non-byline-author.; Gecha Steven R. non-byline-author.; Giffin James Robert non-byline-author.; Hame Sharon L. non-byline-author.; Hannafin Jo A. non-byline-author.; Harner Christopher D. non-byline-author.; Harris Norman Lindsay non-byline-author.; Hechtman Keith S. non-byline-author.; Hershman Elliott B. non-byline-author.; Hoellrich Rudolf G. non-byline-author.; Hosea Timothy M. non-byline-author.; Johnson David C. non-byline-author.; Johnson Timothy S. non-byline-author.; Jones Morgan H. non-byline-author.; Kaeding Christopher C. non-byline-author.; Kamath Ganesh V. non-byline-author.; Klootwyk Thomas E. non-byline-author.; Lantz Brett (Brick) A. non-byline-author.; Levy Bruce A. non-byline-author.; Ma C. Benjamin non-byline-author.; Maiers G. Peter non-byline-author.; Mann Barton non-byline-author.; Marx Robert G. non-byline-author.; Matava Matthew J. non-byline-author.; Mathien Gregory M. non-byline-author.; McAllister David R. non-byline-author.; McCarty Eric C. non-byline-author.; McCormack Robert G. non-byline-author.; Miller Bruce S. non-byline-author.; Nissen Carl W. non-byline-author.; O'Neill Daniel F. non-byline-author.; Owens MAJ Brett D. non-byline-author.; Parker Richard D. non-byline-author.; Purnell Mark L. non-byline-author.; Ramappa Arun J. non-byline-author.; Rauh Michael A. non-byline-author.; Rettig Arthur C. non-byline-author.; Sekiya Jon K. non-byline-author.; Shea Kevin G. non-byline-author.; Sherman Orrin H. non-byline-author.; Slauterbeck James R. non-byline-author.; Smith Matthew V. non-byline-author.; Spang Jeffrey T. non-byline-author.; Spindler Kurt P. non-byline-author.; Stuart Michael J. non-byline-author.; Svoboda LTC Steven J. non-byline-author.; Taft Timothy N. non-byline-author.; Tenuta COL Joachim J. non-byline-author.; Tingstad Edwin M. non-byline-author.; Vidal Armando F. non-byline-author.; Viskontas Darius G. non-byline-author.; White Richard A. non-byline-author.; Williams James S. non-byline-author.; Wolcott Michelle L. non-byline-author.; Wolf Brian R. non-byline-author.; York James J. non-byline-author.;
• Is Part Of: American journal of sports medicine. Volume 41:Number 7(2013)
• Page Start: 1571
• Page End: 1578
• Publication Date: 2013-07
• Subjects: ACL -- ACL revision -- allograft -- autograft; Sports medicine -- Periodicals; Sports injuries -- Periodicals; Orthopedic surgery -- Periodicals; 617.102705
• DOI: 10.1177/0363546513487980
• Languages: English
• ISSNs: 0363-5465

Abstract

Background: The factors that lead to patients failing multiple anterior cruciate ligament (ACL) reconstructions are not well understood. Hypothesis: Multiple-revision ACL reconstruction will have different characteristics than first-time revision in terms of previous and current graft selection, mode of failure, chondral/meniscal injuries, and surgical charactieristics. Study Design: Case-control study; Level of evidence, 3. Methods: A prospective multicenter ACL revision database was utilized for the time period from March 2006 to June 2011. Patients were divided into those who underwent a single-revision ACL reconstruction and those who underwent multiple-revision ACL reconstructions. The primary outcome variable was Marx activity level. Primary data analyses between the groups included a comparison of graft type, perceived mechanism of failure, associated injury (meniscus, ligament, and cartilage), reconstruction type, and tunnel position. Data were compared by analysis of variance with a post hoc Tukey test. Results: A total of 1200 patients (58% men; median age, 26 years) were enrolled, with 1049 (87%) patients having a primary revision and 151 (13%) patients having a second or subsequent revision. Marx activity levels were significantly higher (9.77) in the primary-revision group than in those patients with multiple revisions (6.74). The most common cause of reruptures was a traumatic, noncontact ACL graft injury in 55% of primary-revision patients; 25% of patients had a nontraumatic, gradual-onset recurrent injury, and 11% had a traumatic, contact injury. In the multiple-revision group, a nontraumatic, gradual-onset injury was the most common cause of recurrence (47%), followed by traumatic noncontact (35%) and nontraumatic sudden onset (11%) ( P < .01 between groups). Chondral injuries in the medial compartment were significantly more common in the multiple-revision group than in the single-revision group, as were chondral injuries in the patellofemoral compartment. Conclusion: Patients with multiple-revision ACL reconstructions had lower activity levels, were more likely to have chondral injuries in the medial and patellofemoral compartments, and had a high rate of a nontraumatic, recurrent injury of their graft.