TY - JOUR
T1 - Anterior Cruciate Ligament Reconstruction in High School and College-Aged Athletes
T2 - Does Autograft Choice Influence Anterior Cruciate Ligament Revision Rates?
AU - MOON Knee Group
AU - Spindler, Kurt P.
AU - Huston, Laura J.
AU - Zajichek, Alexander
AU - Reinke, Emily K.
AU - Amendola, Annunziato
AU - Andrish, Jack T.
AU - Brophy, Robert H.
AU - Dunn, Warren R.
AU - Flanigan, David C.
AU - Jones, Morgan H.
AU - Kaeding, Christopher C.
AU - Marx, Robert G.
AU - Matava, Matthew J.
AU - McCarty, Eric C.
AU - Parker, Richard D.
AU - Vidal, Armando F.
AU - Wolcott, Michelle L.
AU - Wolf, Brian R.
AU - Wright, Rick W.
N1 - Funding Information:
There was a high incidence of both ACL graft revisions and contralateral normal ACL tears resulting in subsequent ACLR in this young athletic cohort. The incidence of ACL graft revision at 6 years after index surgery was 2.1 times higher with a hamstring autograft compared with a BTB autograft. anterior cruciate ligament ACL reconstruction ACL revision failure outcomes autograft edited-state corrected-proof typesetter ts1 The authors thank the research coordinators, analysts, and support staff from the MOON sites, whose efforts related to regulatory, data collection, participant follow-up, data quality control, analyses, and article preparation have made this consortium successful. The authors also thank all the participants who generously enrolled and participated in this study. Submitted February 22, 2019; accepted October 4, 2019. Presented at the annual meeting of the AOSSM, Boston, Massachusetts, July 2019. One or more of the authors has declared the following potential conflict of interest or source of funding: Research reported in this publication was partially supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Number R01AR053684 (K.P.S.). Its contents are solely the responsibility of the authors and do not necessarily represent official views of the National Institutes of Health. The project was also supported by the Vanderbilt Sports Medicine Research Fund, which received unrestricted educational gifts from Smith & Nephew Endoscopy and DonJoy Orthopedics. A.A. has received royalties from Arthrex and Smith & Nephew, has received consulting fees from Arthrex, has received hospitality payments from SouthTech Orthopedics and Stryker, and holds stock in Arthrosurface. R.H.B. has received consulting fees from Sanofi-Aventis, Arthrex, and Isto Technologies; compensation for services other than consulting from Arthrex and Smith & Nephew; education payments from Elite Orthopaedics and Arthrex; and a grant from Zimmer Holdings. W.R.D. has received hospitality payments, compensation for serving as faculty, and consulting fees from Linvatec and hospitality payments from Wright Medical Technology. D.C.F. has received research funding from Aesculap Biologics, Smith & Nephew, and Zimmer Biomet; consulting fees from Linvatec, Smith & Nephew, DePuy Synthes, Ceterix Orthopaedics, Medical Device Business Services, and Zimmer Biomet; honoraria from Vericel; and education payments from CDC Medical. M.H.J. is on the Scientific Advisory Board of Samumed. C.C.K. has received research funding from DJO and Zimmer Biomet, consulting fees from Zimmer Biomet, compensation for services other than consulting from Arthrex, and education payments from CDC Medical. R.G.M. has received education payments from Arthrex. M.J.M. has received consulting fees from Heron Therapeutics and Pacira Pharmaceuticals; education and hospitality payments from Arthrex, Elite Orthopaedics, and Apollo Surgical Group; and compensation for services other than consulting from Arthrex. E.C.M. has received royalties from Biomet Orthopedics and Biomet Sports Medicine; consulting fees from Zimmer Biomet, Biomet Orthopedics, and DePuy Orthopaedics; and compensation for services other than consulting from Arthrex. R.D.P. has received royalties or license fees from Zimmer Biomet and hospitality payments from Smith & Nephew and Musculoskeletal Transplant Foundation. K.P.S. has received royalties from nPhase; consulting fees from National Football League, Cytori, Mitek, and Flexion Therapeutics; research funding from Smith & Nephew Endoscopy and DonJoy Orthopedics; and hospitality payments from DePuy and Biosense Webster. A.F.V. has received consulting fees from Stryker; research funding from Aesculap Biologics; hospitality payments from Arthrex, Steris, and Smith & Nephew; and compensation for services other than consulting from Arthrex and Smith & Nephew. M.L.W. has received education payments from Gemini Mountain Medical. B.R.W. has received consulting fees, hospitality payments, and compensation for serving as faculty or a speaker for a nonaccredited and noncertified continuing education program from Linvatec and education payments from Wardlow Enterprises. 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 3 , 6 , 7 , 9 , 18 , 19 , 24 , 27 , 28 , 32 , 40 , 41 .
Publisher Copyright:
© 2020 The Author(s).
PY - 2020/2/1
Y1 - 2020/2/1
N2 - Background: Physicians’ and patients’ decision-making process between bone–patellar tendon–bone (BTB) and hamstring tendon autografts for anterior cruciate ligament (ACL) reconstruction (ACLR) may be influenced by a variety of factors in the young, active athlete. Purpose: To determine the incidence of both ACL graft revisions and contralateral ACL tears resulting in subsequent ACLR in a cohort of high school– and college-aged athletes who initially underwent primary ACLR with either a BTB or a hamstring autograft. Study Design: Cohort study; Level of evidence, 2. Methods: Study inclusion criteria were patients aged 14 to 22 years who were injured in sports, had a contralateral normal knee, and were scheduled to undergo unilateral primary ACLR with either a BTB or a hamstring autograft. All patients were prospectively followed for 6 years to determine whether any subsequent ACLR was performed in either knee after their initial ACLR. Multivariable regression modeling controlled for age, sex, ethnicity/race, body mass index, sport and competition level, baseline activity level, knee laxity, and graft type. The 6-year outcomes were the incidence of subsequent ACLR in either knee. Results: A total of 839 patients were eligible, of which 770 (92%) had 6-year follow-up for the primary outcome measure of the incidence of subsequent ACLR. The median age was 17 years, with 48% female, and the distribution of BTB and hamstring grafts was 492 (64%) and 278 (36%), respectively. The incidence of subsequent ACLR at 6 years was 9.2% in the ipsilateral knee, 11.2% in the contralateral normal knee, and 19.7% for either knee. High-grade preoperative knee laxity (odds ratio [OR], 2.4 [95% confidence interval [CI], 1.4-3.9]; P =.001), autograft type (OR, 2.1 [95% CI, 1.3-3.5]; P =.004), and age (OR, 0.8 [95% CI, 0.7-1.0]; P =.009) were the 3 most influential predictors of ACL graft revision in the ipsilateral knee. The odds of ACL graft revision were 2.1 times higher for patients receiving a hamstring autograft than patients receiving a BTB autograft (95% CI, 1.3-3.5; P =.004). No significant differences were found between autograft choices when looking at the incidence of subsequent ACLR in the contralateral knee. Conclusion: There was a high incidence of both ACL graft revisions and contralateral normal ACL tears resulting in subsequent ACLR in this young athletic cohort. The incidence of ACL graft revision at 6 years after index surgery was 2.1 times higher with a hamstring autograft compared with a BTB autograft.
AB - Background: Physicians’ and patients’ decision-making process between bone–patellar tendon–bone (BTB) and hamstring tendon autografts for anterior cruciate ligament (ACL) reconstruction (ACLR) may be influenced by a variety of factors in the young, active athlete. Purpose: To determine the incidence of both ACL graft revisions and contralateral ACL tears resulting in subsequent ACLR in a cohort of high school– and college-aged athletes who initially underwent primary ACLR with either a BTB or a hamstring autograft. Study Design: Cohort study; Level of evidence, 2. Methods: Study inclusion criteria were patients aged 14 to 22 years who were injured in sports, had a contralateral normal knee, and were scheduled to undergo unilateral primary ACLR with either a BTB or a hamstring autograft. All patients were prospectively followed for 6 years to determine whether any subsequent ACLR was performed in either knee after their initial ACLR. Multivariable regression modeling controlled for age, sex, ethnicity/race, body mass index, sport and competition level, baseline activity level, knee laxity, and graft type. The 6-year outcomes were the incidence of subsequent ACLR in either knee. Results: A total of 839 patients were eligible, of which 770 (92%) had 6-year follow-up for the primary outcome measure of the incidence of subsequent ACLR. The median age was 17 years, with 48% female, and the distribution of BTB and hamstring grafts was 492 (64%) and 278 (36%), respectively. The incidence of subsequent ACLR at 6 years was 9.2% in the ipsilateral knee, 11.2% in the contralateral normal knee, and 19.7% for either knee. High-grade preoperative knee laxity (odds ratio [OR], 2.4 [95% confidence interval [CI], 1.4-3.9]; P =.001), autograft type (OR, 2.1 [95% CI, 1.3-3.5]; P =.004), and age (OR, 0.8 [95% CI, 0.7-1.0]; P =.009) were the 3 most influential predictors of ACL graft revision in the ipsilateral knee. The odds of ACL graft revision were 2.1 times higher for patients receiving a hamstring autograft than patients receiving a BTB autograft (95% CI, 1.3-3.5; P =.004). No significant differences were found between autograft choices when looking at the incidence of subsequent ACLR in the contralateral knee. Conclusion: There was a high incidence of both ACL graft revisions and contralateral normal ACL tears resulting in subsequent ACLR in this young athletic cohort. The incidence of ACL graft revision at 6 years after index surgery was 2.1 times higher with a hamstring autograft compared with a BTB autograft.
KW - ACL reconstruction
KW - ACL revision
KW - anterior cruciate ligament
KW - autograft
KW - failure
KW - outcomes
UR - http://www.scopus.com/inward/record.url?scp=85077699265&partnerID=8YFLogxK
U2 - 10.1177/0363546519892991
DO - 10.1177/0363546519892991
M3 - Article
C2 - 31917613
AN - SCOPUS:85077699265
SN - 0363-5465
VL - 48
SP - 298
EP - 309
JO - American Journal of Sports Medicine
JF - American Journal of Sports Medicine
IS - 2
ER -