TY - JOUR
T1 - Incidence and Predictors of Subsequent Surgery After Anterior Cruciate Ligament Reconstruction
T2 - A 6-Year Follow-up Study
AU - MOON Knee Group
AU - Sullivan, Jaron P.
AU - Huston, Laura J.
AU - Zajichek, Alexander
AU - Reinke, Emily K.
AU - Andrish, Jack T.
AU - Brophy, Robert H.
AU - Dunn, Warren R.
AU - Flanigan, David C.
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 - Wolf, Brian R.
AU - Wright, Rick W.
AU - Spindler, Kurt P.
N1 - Funding Information:
One or more of the authors has declared the following potential conflict of interest or source of funding: Institutional funding was received from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant No. R01 AR053684 to K.P.S. [principal investigator]). J.P.S. has received education payments from Arthrex and Smith & Nephew. R.H.B. has received compensation for services other than consulting from Arthrex and Smith & Nephew; consulting fees from Sanofi-Aventis and Isto Technologies; hospitality payments from Elite Orthopaedics, Arthrex, Sanofi-Aventis, and Smith & Nephew; and a grant from Zimmer Biomet. W.R.D. has received consulting fees, compensation for services other than consulting, and hospitality payments from Linvatec and hospitality payments from Wright Medical. 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. C.C.K. has received research funding from DJO and Zimmer Biomet, consulting fees from Zimmer Biomet, education payments from CDC Medical, and compensation for services other than consulting from Arthrex. R.G.M. has received education payments from Arthrex. M.J.M. has received compensation for services other than consulting and education and hospitality payments from Arthrex, consulting fees from Heron Therapeutics and Pacira Pharmaceuticals, and education and hospitality payments from Elite Orthopaedics and Apollo Surgical Group. E.C.M. has received consulting fees from Zimmer Biomet, Biomet Orthopedics, and DePuy Orthopaedics and royalties from Biomet Orthopedics and Biomet Sports Medicine. R.D.P. has received royalties from Zimmer Biomet and hospitality payments from Zimmer Biomet, Smith & Nephew, and the Musculoskeletal Transplant Foundation. A.F.V. has received consulting fees from Stryker, research funding from Aesculap Biologics, compensation for services other than consulting from Arthrex and Smith & Nephew, and hospitality payments from Steris. B.R.W. has received consulting fees and compensation for serving as faculty or as a speaker from Linvatec and education payments from Wardlow Enterprises. R.W.W. holds stock in Responsive Arthroscopy. K.P.S. has received consulting fees from the National Football League, Cytori Therapeutics, Mitek, and Flexion Therapeutics; research funding from Smith & Nephew Endoscopy and DonJoy Orthopedics; royalties from nPhase; and hospitality payments from DePuy and Biosense Webster. 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.
Publisher Copyright:
© 2020 The Author(s).
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Background: The cause of subsequent surgery after anterior cruciate ligament (ACL) reconstruction varies, but if risk factors for specific subsequent surgical procedures can be identified, we can better understand which patients are at greatest risk. Purpose: To report the incidence and types of subsequent surgery that occurred in a cohort of patients 6 years after their index ACL reconstruction and to identify which variables were associated with the incidence of patients undergoing subsequent surgery after their index ACL reconstruction. Study Design: Cohort study; Level of evidence, 2. Methods: Patients completed a questionnaire before their index ACL surgery and were followed up at 2 and 6 years. Patients were contacted to determine whether any underwent additional surgery since baseline. Operative reports were obtained, and all surgical procedures were categorized and recorded. Logistic regression models were constructed to predict which patient demographic and surgical variables were associated with the incidence of undergoing subsequent surgery after their index ACL reconstruction. Results: The cohort consisted of 3276 patients (56.3% male) with a median age of 23 years. A 6-year follow-up was obtained on 91.5% (2999/3276) with regard to information on the incidence and frequency of subsequent surgery. Overall, 20.4% (612/2999) of the cohort was documented to have undergone at least 1 subsequent surgery on the ipsilateral knee 6 years after their index ACL reconstruction. The most common subsequent surgical procedures were related to the meniscus (11.9%), revision ACL reconstruction (7.5%), loss of motion (7.8%), and articular cartilage (6.7%). Significant risk factors for incurring subsequent meniscus-related surgery were having a medial meniscal repair at the time of index surgery, reconstruction with a hamstring autograft or allograft, higher baseline Marx activity level, younger age, and cessation of smoking. Significant predictors of undergoing subsequent surgery involving articular cartilage were higher body mass index, higher Marx activity level, reconstruction with a hamstring autograft or allograft, meniscal repair at the time of index surgery, or a grade 3/4 articular cartilage abnormality classified at the time of index ACL reconstruction. Risk factors for incurring subsequent surgery for loss of motion were younger age, female sex, low baseline Knee injury and Osteoarthritis Outcome Score symptom subscore, and reconstruction with a soft tissue allograft. Conclusion: These findings can be used to identify patients who are at the greatest risk of incurring subsequent surgery after ACL reconstruction.
AB - Background: The cause of subsequent surgery after anterior cruciate ligament (ACL) reconstruction varies, but if risk factors for specific subsequent surgical procedures can be identified, we can better understand which patients are at greatest risk. Purpose: To report the incidence and types of subsequent surgery that occurred in a cohort of patients 6 years after their index ACL reconstruction and to identify which variables were associated with the incidence of patients undergoing subsequent surgery after their index ACL reconstruction. Study Design: Cohort study; Level of evidence, 2. Methods: Patients completed a questionnaire before their index ACL surgery and were followed up at 2 and 6 years. Patients were contacted to determine whether any underwent additional surgery since baseline. Operative reports were obtained, and all surgical procedures were categorized and recorded. Logistic regression models were constructed to predict which patient demographic and surgical variables were associated with the incidence of undergoing subsequent surgery after their index ACL reconstruction. Results: The cohort consisted of 3276 patients (56.3% male) with a median age of 23 years. A 6-year follow-up was obtained on 91.5% (2999/3276) with regard to information on the incidence and frequency of subsequent surgery. Overall, 20.4% (612/2999) of the cohort was documented to have undergone at least 1 subsequent surgery on the ipsilateral knee 6 years after their index ACL reconstruction. The most common subsequent surgical procedures were related to the meniscus (11.9%), revision ACL reconstruction (7.5%), loss of motion (7.8%), and articular cartilage (6.7%). Significant risk factors for incurring subsequent meniscus-related surgery were having a medial meniscal repair at the time of index surgery, reconstruction with a hamstring autograft or allograft, higher baseline Marx activity level, younger age, and cessation of smoking. Significant predictors of undergoing subsequent surgery involving articular cartilage were higher body mass index, higher Marx activity level, reconstruction with a hamstring autograft or allograft, meniscal repair at the time of index surgery, or a grade 3/4 articular cartilage abnormality classified at the time of index ACL reconstruction. Risk factors for incurring subsequent surgery for loss of motion were younger age, female sex, low baseline Knee injury and Osteoarthritis Outcome Score symptom subscore, and reconstruction with a soft tissue allograft. Conclusion: These findings can be used to identify patients who are at the greatest risk of incurring subsequent surgery after ACL reconstruction.
KW - anterior cruciate ligament reconstruction
KW - articular cartilage
KW - loss of motion
KW - meniscus
KW - subsequent surgery
UR - http://www.scopus.com/inward/record.url?scp=85089129938&partnerID=8YFLogxK
U2 - 10.1177/0363546520935867
DO - 10.1177/0363546520935867
M3 - Article
C2 - 32736502
AN - SCOPUS:85089129938
SN - 0363-5465
VL - 48
SP - 2418
EP - 2428
JO - American Journal of Sports Medicine
JF - American Journal of Sports Medicine
IS - 10
ER -