TY - JOUR
T1 - Physiologic Preoperative Knee Hyperextension Is a Predictor of Failure in an Anterior Cruciate Ligament Revision Cohort
T2 - A Report From the MARS Group
AU - The MARS Group
AU - Cooper, Daniel E.
AU - Dunn, Warren R.
AU - Huston, Laura J.
AU - Haas, Amanda K.
AU - Spindler, Kurt P.
AU - Allen, Christina R.
AU - Anderson, Allen F.
AU - DeBerardino, Thomas M.
AU - Lantz, Brett (Brick) A.
AU - Mann, Barton
AU - Stuart, Michael J.
AU - Albright, John P.
AU - Amendola, Annunziato (Ned)
AU - Andrish, Jack T.
AU - Annunziata, Christopher C.
AU - Arciero, Robert A.
AU - Bach, Bernard R.
AU - Baker, Champ L.
AU - Bartolozzi, Arthur R.
AU - Baumgarten, Keith M.
AU - Bechler, Jeffery R.
AU - Berg, Jeffrey H.
AU - Bernas, Geoffrey A.
AU - Brockmeier, Stephen F.
AU - Brophy, Robert H.
AU - Bush-Joseph, Charles A.
AU - Butler V, J. Brad
AU - Campbell, John D.
AU - Carey, James L.
AU - Carpenter, James E.
AU - Cole, Brian J.
AU - Cooper, Jonathan M.
AU - Cox, Charles L.
AU - Creighton, R. Alexander
AU - Dahm, Diane L.
AU - David, Tal S.
AU - Flanigan, David C.
AU - Frederick, Robert W.
AU - Ganley, Theodore J.
AU - Garofoli, Elizabeth A.
AU - Gatt, Charles J.
AU - Gecha, Steven R.
AU - Giffin, James Robert
AU - Hame, Sharon L.
AU - Hannafin, Jo A.
AU - Harner, Christopher D.
AU - Harris, Norman Lindsay
AU - Matava, Matthew J.
AU - Smith, Matthew V.
AU - Wright, Rick W.
N1 - Publisher Copyright:
© 2018 The Author(s).
PY - 2018/10/1
Y1 - 2018/10/1
N2 - Background: The occurrence of physiologic knee hyperextension (HE) in the revision anterior cruciate ligament reconstruction (ACLR) population and its effect on outcomes have yet to be reported. Hypothesis/Purpose: The prevalence of knee HE in revision ACLR and its effect on 2-year outcome were studied with the hypothesis that preoperative physiologic knee HE ≥5° is a risk factor for anterior cruciate ligament (ACL) graft rupture. Study Design: Cohort study; Level of evidence, 2. Methods: Patients undergoing revision ACLR were identified and prospectively enrolled between 2006 and 2011. Study inclusion criteria were patients undergoing single-bundle graft reconstructions. Patients were followed up at 2 years and asked to complete an identical set of outcome instruments (International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score, WOMAC, and Marx Activity Rating Scale) as well as provide information regarding revision ACL graft failure. A regression model with graft failure as the dependent variable included age, sex, graft type at the time of the revision ACL surgery, and physiologic preoperative passive HE ≥5° (yes/no) to assess these as potential risk factors for clinical outcomes 2 years after revision ACLR. Results: Analyses included 1145 patients, for whom 2-year follow-up was attained for 91%. The median age was 26 years, with age being a continuous variable. Those below the median were grouped as “younger” and those above as “older” (age: interquartile range = 20, 35 years), and 42% of patients were female. There were 50% autografts, 48% allografts, and 2% that had a combination of autograft plus allograft. Passive knee HE ≥5° was present in 374 (33%) patients in the revision cohort, with 52% being female. Graft rupture at 2-year follow-up occurred in 34 cases in the entire cohort, of which 12 were in the HE ≥5° group (3.2% failure rate) and 22 in the non-HE group (2.9% failure rate). The median age of patients who failed was 19 years, as opposed to 26 years for those with intact grafts. Three variables in the regression model were significant predictors of graft failure: younger age (odds ratio [OR] = 3.6; 95% CI, 1.6-7.9; P =.002), use of allograft (OR = 3.3; 95% CI, 1.5-7.4; P =.003), and HE ≥5° (OR = 2.12; 95% CI, 1.1-4.7; P =.03). Conclusion: This study revealed that preoperative physiologic passive knee HE ≥5° is present in one-third of patients who undergo revision ACLR. HE ≥5° was an independent significant predictor of graft failure after revision ACLR with a >2-fold OR of subsequent graft rupture in revision ACL surgery. Registration: NCT00625885 (ClinicalTrials.gov identifier).
AB - Background: The occurrence of physiologic knee hyperextension (HE) in the revision anterior cruciate ligament reconstruction (ACLR) population and its effect on outcomes have yet to be reported. Hypothesis/Purpose: The prevalence of knee HE in revision ACLR and its effect on 2-year outcome were studied with the hypothesis that preoperative physiologic knee HE ≥5° is a risk factor for anterior cruciate ligament (ACL) graft rupture. Study Design: Cohort study; Level of evidence, 2. Methods: Patients undergoing revision ACLR were identified and prospectively enrolled between 2006 and 2011. Study inclusion criteria were patients undergoing single-bundle graft reconstructions. Patients were followed up at 2 years and asked to complete an identical set of outcome instruments (International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score, WOMAC, and Marx Activity Rating Scale) as well as provide information regarding revision ACL graft failure. A regression model with graft failure as the dependent variable included age, sex, graft type at the time of the revision ACL surgery, and physiologic preoperative passive HE ≥5° (yes/no) to assess these as potential risk factors for clinical outcomes 2 years after revision ACLR. Results: Analyses included 1145 patients, for whom 2-year follow-up was attained for 91%. The median age was 26 years, with age being a continuous variable. Those below the median were grouped as “younger” and those above as “older” (age: interquartile range = 20, 35 years), and 42% of patients were female. There were 50% autografts, 48% allografts, and 2% that had a combination of autograft plus allograft. Passive knee HE ≥5° was present in 374 (33%) patients in the revision cohort, with 52% being female. Graft rupture at 2-year follow-up occurred in 34 cases in the entire cohort, of which 12 were in the HE ≥5° group (3.2% failure rate) and 22 in the non-HE group (2.9% failure rate). The median age of patients who failed was 19 years, as opposed to 26 years for those with intact grafts. Three variables in the regression model were significant predictors of graft failure: younger age (odds ratio [OR] = 3.6; 95% CI, 1.6-7.9; P =.002), use of allograft (OR = 3.3; 95% CI, 1.5-7.4; P =.003), and HE ≥5° (OR = 2.12; 95% CI, 1.1-4.7; P =.03). Conclusion: This study revealed that preoperative physiologic passive knee HE ≥5° is present in one-third of patients who undergo revision ACLR. HE ≥5° was an independent significant predictor of graft failure after revision ACLR with a >2-fold OR of subsequent graft rupture in revision ACL surgery. Registration: NCT00625885 (ClinicalTrials.gov identifier).
KW - anterior cruciate ligament
KW - graft failure
KW - graft tensioning
KW - knee hyperextension
UR - http://www.scopus.com/inward/record.url?scp=85048266485&partnerID=8YFLogxK
U2 - 10.1177/0363546518777732
DO - 10.1177/0363546518777732
M3 - Article
C2 - 29882693
AN - SCOPUS:85048266485
SN - 0363-5465
VL - 46
SP - 2836
EP - 2841
JO - American Journal of Sports Medicine
JF - American Journal of Sports Medicine
IS - 12
ER -