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Younger age seen as risk factor for surgery following ACL reconstruction

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Kurt P. Spindler

SAN DIEGO – Younger age at index surgery is a risk factor for subsequent surgery following primary ACL reconstruction, according a presentation at the 2011 Annual Meeting of the American Orthopaedic Society for Sports Medicine, here.

“Younger age at index of surgery drove the re-surgery rate,” Kurt P. Spindler, MD, said during his presentation of the 2- and 6-year results of the Multicenter Orthopaedic Outcomes Network (MOON) study.

Spindler and his team also found that cross-pin use also may be a significant risk factor for iliotibial band debridement. Female gender, body mass index and graft choice were not significant risk factors, he said.

The study included 988 patients who were prospectively enrolled in the MOON study from January 2002 to December 2003 at six sites. Surgery was performed by nine surgeons. Two- and 6-year follow-up for subsequent procedures were obtained in 91.8% and 91.3% of patients, respectively.

There were 241 subsequent surgeries on the ipsilateral leg (24.8%) and 118 on the contralateral knee (12.2%) at 6-year follow-up. On the ipsilateral knee, 19.1% were performed for arthrofibrosis, 26.1% were revision ACL reconstructions (6.4% of entire cohort), 9.1% had hardware removal and 31.5% had procedures done to the cartilage or the meniscus. For the contralateral knee, there was a 5.6% rate of primary ACL rupture. In the study, 665 reconstructions were single-incision and 308 were performed by a two-incision technique.

For the single-incision technique, 5.4% had subsequent procedures for arthrofibrosis, 2.4% for hardware removal, 8.3% for cartilage/meniscus issues and 7.5% underwent revision ACL reconstructions. For the two-incision technique, these were 3.2%, 1.9%, 6.8% and 4.2%, respectively. Patients with bone-tendon-bone (BTB) grafts had a 3% incidence of subsequent surgery for arthrofibrosis vs. 8.8% in the hamstring group. The investigators found that 3.7% of the BTB grafts were revised compared with 7.5% in the hamstring group. Hardware removal rates were 1.3% for BTB grafts and 4.2% for the hamstring group. At 6-year follow-up, 24.8% of ACL revision patients underwent subsequent surgery on their ipsilateral knees.

Reference:

• Hettrich C, Dunn WR, Reinke EK, MOON Group MDs, Spindler KP. What is the rate of subsequent surgery following ACL reconstruction? Short and mid-term follow-up from the MOON Cohort. Paper #2. Presented at the 2011 Annual Meeting of the American Orthopaedic Society for Sports Medicine. July 7-10. San Diego.
• Disclosure: Funding was provided by the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases. Spindler is also a consultant for Connective Orthopaedics.

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