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Further ACL injury more common in contralateral ACL after initial reconstruction
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LYON, France — After ACL reconstruction, further ACL injury rates were high, and injury occurred more commonly in the contralateral ACL than the reconstructed ACL graft, according to results of a study presented here.
“With regard to further injury, contralateral ACL injury is more common than ACL graft rupture,” Simon M. Thompson, MBBS, BSc(Hon), MSc MD(Res), FRCS(TR & Orth), said at the International Society for Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) Biennial Congress.
The longitudinal, prospective study included 90 patients who underwent isolated ACL reconstruction using middle-third patellar tendon autograft between January 1993 and April 1994 and met the inclusion criteria. Patients were evaluated annually for 5 years, and then again at 7, 10, 15 and 20 years postoperatively. Thompson and colleagues assessed outcomes for range of motion, Lachman and pivot-shift tests, instrumented ligament testing, single-legged hop test, Lysholm Knee Score, IKDC evaluation and radiographic assessment.
Results showed that by 20 years postoperatively, 31 of the patients had sustained a subsequent ACL injury, with eight occurring in the index limb and 27 occurring within the contralateral limb. Additionally, three patients injured both the reconstructed and contralateral ACL, according to the researchers.
In terms of age, patients younger than 18 years of age at the time of index surgery had a 56% chance of rupturing their contralateral ACL at 20 years compared with 25% of patients older than 18 years of age at the time of the initial surgery. Thompson noted a 23% failure of ACL reconstruction at 20 years when coronal graft angles were 17° or less and a 4% failure rate for graft angles greater than 17°.
At 20 years, the mean IKDC score was 86, mean Lysholm score was 92 and 50% of patients were participating in strenuous or very strenuous activity. The most common complaint after BTB surgery was anterior knee pain.
According to Thompson, 60% of patients had minimal degenerative chances in the knee at 20 years and 14% of patients experienced joint space narrowing up to 50%. Patients did not have joint space narrowing above 50%.
Results also showed women reported poorer outcomes compared with men.
“Here we looked at gender differences and they are almost certainly unfavorable for females,” Thompson said. “[Women] are more likely to have lower IKDC subjective scores, and they are more likely to report pain on strenuous activity, which means they are less likely to participate in strenuous activity.” – by Casey Tingle
Reference:
Thompson SM, et al. Paper #89. Presented at: International Society for Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine Biennial Congress; June 7-11, 2015; Lyon, France.
Disclosure: Thompson reports no relevant financial disclosures.