Surgical Predictors of Clinical Outcome 6 Years After Revision ACL Reconstruction.
| Title: | Surgical Predictors of Clinical Outcome 6 Years After Revision ACL Reconstruction. |
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| Authors: | Wright RW; Vanderbilt University, Nashville, TN, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Huston LJ; Vanderbilt University, Nashville, TN, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Haas AK; Washington University in St Louis, St Louis, MO, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Pennings JS; Vanderbilt University, Nashville, TN, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Allen CR; Yale University, New Haven, CT, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Cooper DE; W.B. Carrell Memorial Clinic, Dallas, TX, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; DeBerardino TM; UT Health, San Antonio, TX, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Dunn WR; Fondren Orthopedic Group, Houston, TX, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Lantz BBA; Slocum Research and Education Foundation, Eugene, OR, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Spindler KP; Cleveland Clinic, Cleveland, OH, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Stuart MJ; Mayo Clinic, Rochester, MN, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Amendola AN; Duke University, Durham, NC, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Annunziata CC; Commonwealth Orthopaedics & Rehabilitation, Arlington, VA, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Arciero RA; University of Connecticut Health Center, Farmington, CT, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Bach BR Jr; Rush University Medical Center, Chicago, IL, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Baker CL 3rd; The Hughston Clinic, Columbus, GA, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Bartolozzi AR; 3B Orthopaedics, University of Pennsylvania Health System, Philadelphia, PA, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Baumgarten KM; Orthopedic Institute, Sioux Falls, SD, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Berg JH; Town Center Orthopaedic Associates, Reston, VA, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Bernas GA; State University of New York at Buffalo, Buffalo, NY, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Brockmeier SF; University of Virginia, Charlottesville, VA, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Brophy RH; Washington University in St Louis, St Louis, MO, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Bush-Joseph CA; Rush University Medical Center, Chicago, IL, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Butler JB 5th; Orthopedic and Fracture Clinic, Portland, OR, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Carey JL; University of Pennsylvania, Philadelphia, PA, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Carpenter JE; University of Michigan, Ann Arbor, MI, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Cole BJ; Rush University Medical Center, Chicago, IL, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Cooper JM; HealthPartners Specialty Center, St Paul, MN, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Cox CL; Vanderbilt University, Nashville, TN, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Creighton RA; University of North Carolina Medical Center, Chapel Hill, NC, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; David TS; Synergy Specialists Medical Group, San Diego, CA, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Flanigan DC; The Ohio State University, Columbus, OH, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Frederick RW; The Rothman Institute/Thomas Jefferson University, Philadelphia, PA, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Ganley TJ; Children's Hospital of Philadelphia, Philadelphia, PA, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Gatt CJ Jr; University Orthopaedic Associates LLC, Princeton, NJ, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Gecha SR; Princeton Orthopaedic Associates, Princeton, NJ, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Giffin JR; Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, ON, Canada.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Hame SL; University of California Los Angeles, Los Angeles, CA, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Hannafin JA; Hospital for Special Surgery, New York, NY, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Harner CD; University of Texas Health Center, Houston, TX, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Harris NL Jr; Grand River Health, Rifle, CO, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Hechtman KS; Miami Orthopedics and Sports Medicine Institute, Coral Gables, FL, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Hershman EB; Lenox Hill Hospital, New York, NY, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Hoellrich RG; Slocum Research and Education Foundation, Eugene, OR, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Johnson DC; National Sports Medicine Institute, Leesburg, VA, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Johnson TS; National Sports Medicine Institute, Leesburg, VA, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Jones MH; Brigham and Women's Hospital, Boston, MA, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Kaeding CC; The Ohio State University, Columbus, OH, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Kamath GV; University of North Carolina Medical Center, Chapel Hill, NC, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Klootwyk TE; Forte Sports Medicine and Orthopedics, Indianapolis, IN, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Levy BA; Orlando Health, Orlando, FL, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Ma CB; University of California, San Francisco, CA, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Maiers GP 2nd; Forte Sports Medicine and Orthopedics, Indianapolis, IN, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Marx RG; Hospital for Special Surgery, New York, NY, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Matava MJ; Washington University in St Louis, St Louis, MO, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Mathien GM; Knoxville Orthopedic Clinic, Knoxville, TN, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; McAllister DR; University of California Los Angeles, Los Angeles, CA, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; McCarty EC; University of Colorado Denver School of Medicine, Denver, CO, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; McCormack RG; University of British Columbia/Fraser Health Authority, Vancouver, BC, Canada.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Miller BS; University of Michigan, Ann Arbor, MI, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Nissen CW; Connecticut Children's Medical Center, Hartford, CT, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; O'Neill DF; The Alpine Clinic, Plymouth, NH, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Owens BD; Warren Alpert Medical School, Brown University, Providence, RI, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Parker RD; Cleveland Clinic, Cleveland, OH, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Purnell ML; Valley Ortho, Aspen, CO, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Ramappa AJ; Beth Israel Deaconess Medical Center, Boston, MA, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Rauh MA; State University of New York at Buffalo, Buffalo, NY, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Rettig AC; Forte Sports Medicine and Orthopedics, Indianapolis, IN, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Sekiya JK; University of Michigan, Ann Arbor, MI, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Shea KG; Stanford University, Palo Alto, CA, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Sherman OH; NYU Hospital for Joint Diseases, New York, NY, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Slauterbeck JR; UNC Health Southeastern, Lumberton, NC, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Smith MV; Washington University in St Louis, St Louis, MO, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Spang JT; University of North Carolina Medical Center, Chapel Hill, NC, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Svoboda SJ; MedStar Orthopaedic and Sports Center, Washington, DC, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Taft TN; University of North Carolina Medical Center, Chapel Hill, NC, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Tenuta JJ; Albany Medical Center, Albany, NY, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Tingstad EM; Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, WA, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Vidal AF; The Steadman Clinic, Vail, CO, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Viskontas DG; Fraser Orthopaedic Institute, New Westminster, Vancouver, BC, Canada.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; White RA; Fitzgibbon's Hospital, Marshall, MO, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Williams JS Jr; Cleveland Clinic, Euclid, OH, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Wolcott ML; University of Colorado Anschutz Medical Campus, Aurora, CO, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; Wolf BR; University of Iowa Hospitals and Clinics, Iowa City, IA, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.; York JJ; Luminis Health Orthopedics, Pasadena, MD, USA.; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA. |
| Corporate Authors: | MARS Group; Investigation performed at Vanderbilt University, Nashville, Tennessee, USA. |
| Source: | The American journal of sports medicine [Am J Sports Med] 2024 Nov; Vol. 52 (13), pp. 3286-3294. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Sage Publications Country of Publication: United States NLM ID: 7609541 Publication Model: Print Cited Medium: Internet ISSN: 1552-3365 (Electronic) Linking ISSN: 03635465 NLM ISO Abbreviation: Am J Sports Med Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2004- : Thousand Oaks, CA : Sage Publications; Original Publication: Baltimore, Williams & Wilkins. |
| MeSH Terms: | Reoperation*/statistics & numerical data ; Anterior Cruciate Ligament Reconstruction*; Anterior Cruciate Ligament Injuries/surgery ; Humans ; Male ; Female ; Adult ; Young Adult ; Prospective Studies ; Patient Reported Outcome Measures ; Treatment Outcome ; Follow-Up Studies ; Bone Screws ; Adolescent |
| Abstract: | Background: Revision anterior cruciate ligament (ACL) reconstruction has been documented to have inferior outcomes compared with primary ACL reconstruction. The reasons why remain unknown.; Purpose: To determine whether surgical factors performed at the time of revision ACL reconstruction can influence a patient's outcome at 6-year follow-up.; Study Design: Cohort study; Level of evidence, 2.; Methods: Patients who underwent revision ACL reconstruction were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline patient characteristics, surgical technique and pathology, and a series of validated patient-reported outcome instruments: Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) subjective form, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Marx activity rating score. Patients were followed up for 6 years and asked to complete the identical set of outcome instruments. Regression analysis was used to control for baseline patient characteristics and surgical variables to assess the surgical risk factors for clinical outcomes 6 years after surgery.; Results: A total of 1234 patients were enrolled (716 men, 58%; median age, 26 years), and 6-year follow-up was obtained on 79% of patients (980/1234). Using an interference screw for femoral fixation compared with a cross-pin resulted in significantly better outcomes in 6-year IKDC scores (odds ratio [OR], 2.2; 95% CI, 1.2-3.9; P = .008) and KOOS sports/recreation and quality of life subscale scores (OR range, 2.2-2.7; 95% CI, 1.2-4.8; P < .01). Use of an interference screw compared with a cross-pin resulted in a 2.6 times less likely chance of having a subsequent surgery within 6 years. Use of an interference screw for tibial fixation compared with any combination of tibial fixation techniques resulted in significantly improved scores for IKDC (OR, 1.96; 95% CI, 1.3-2.9; P = .001); KOOS pain, activities of daily living, and sports/recreation subscales (OR range, 1.5-1.6; 95% CI, 1.0-2.4; P < .05); and WOMAC pain and activities of daily living subscales (OR range, 1.5-1.8; 95% CI, 1.0-2.7; P < .05). Use of a transtibial surgical approach compared with an anteromedial portal approach resulted in significantly improved KOOS pain and quality of life subscale scores at 6 years (OR, 1.5; 95% CI, 1.02-2.2; P≤ .04).; Conclusion: There are surgical variables at the time of ACL revision that can modify clinical outcomes at 6 years. Opting for a transtibial surgical approach and choosing an interference screw for femoral and tibial fixation improved patients' odds of having a significantly better 6-year clinical outcome in this cohort. |
| Competing Interests: | One or more of the authors has declared the following potential conflict of interest or source of funding: This project was funded by grant No. 5R01-AR060846 from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases. All author disclosures are listed in the Appendix (available in the online version of this article). AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. |
| References: | Arthroscopy. 2021 Sep;37(9):2903-2914.e1. (PMID: 33887417); J Clin Orthop Trauma. 2019 Jan-Feb;10(1):138-142. (PMID: 30705549); JB JS Open Access. 2020 Apr 02;5(2):e0057. (PMID: 33123662); Am J Sports Med. 2021 Aug;49(10):2589-2598. (PMID: 34260326); World J Orthop. 2022 Sep 18;13(9):812-824. (PMID: 36189337); Am J Sports Med. 2014 Oct;42(10):2301-10. (PMID: 25274353); Int Orthop. 2013 Jul;37(7):1369-74. (PMID: 23624910); Am J Sports Med. 2022 Jul;50(9):2397-2409. (PMID: 35833922); Arthroscopy. 2014 Nov;30(11):1491-8. (PMID: 25064753); Knee Surg Sports Traumatol Arthrosc. 2006 Nov;14(11):1130-8. (PMID: 16951974); Arthroscopy. 2018 Feb;34(2):615-623. (PMID: 29066266); Orthopedics. 2017 Mar 1;40(2):e275-e280. (PMID: 27874911); Am J Sports Med. 2010 Oct;38(10):1979-86. (PMID: 20889962); Eur J Orthop Surg Traumatol. 2019 Jan;29(1):157-161. (PMID: 30022240); Am J Sports Med. 2023 Mar;51(3):605-614. (PMID: 36734487); Knee. 2019 Mar;26(2):292-301. (PMID: 30773253); Am J Sports Med. 2006 Oct;34(10):1604-14. (PMID: 16685086); Am J Sports Med. 2022 Dec;50(14):3762-3769. (PMID: 36326297); Am J Sports Med. 2017 Sep;45(11):2586-2594. (PMID: 28696164); Arch Orthop Trauma Surg. 2012 Jun;132(6):867-74. (PMID: 22350055) |
| Grant Information: | R01 AR060846 United States AR NIAMS NIH HHS |
| Contributed Indexing: | Keywords: anterior cruciate ligament reconstruction; outcomes; revision; surgical predictors |
| Entry Date(s): | Date Created: 20241106 Date Completed: 20241106 Latest Revision: 20250207 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC11796288 |
| DOI: | 10.1177/03635465241288227 |
| PMID: | 39503722 |
| Database: | MEDLINE |
Journal Article