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Higher rate of early ACL graft ruptures found among young, male patients
Researchers noted at least one further ACL injury subsequent to the primary surgery in 35% of patients.
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Male patients younger than 18 years who underwent ACL reconstruction experienced a higher rate of early graft ruptures compared with older patients and femail patients of the same age, according to study results.
“In a large cohort of younger patients, one in three [patients] who had ACL reconstruction surgery before they were 20 years of age went on to have a second ACL injury,” Kate E. Webster, PhD, associate professor and director of the Sport Exercise and Rehabilitation Research Focus Area at La Trobe, told Orthopedics Today. “This included injury to either the reconstructed knee or the previously healthy contralateral knee.”
Graft rupture rate
At a mean follow-up of 5 years, Webster and her colleagues determined the number of subsequent ACL injuries for 354 consecutive patients who were younger than 20 years when they underwent their first primary hamstring tendon autograft ACL reconstruction.
With a follow-up rate of 89%, results showed 18% of patients experienced a graft rupture at an average time of 1.8 years after surgery. Of these, 47% occurred within the first postoperative year and 74% occurred within the first 2 years. Researchers found male patients younger than 18 years had a graft rupture rate of 28.3% compared with a 12.9% rate in female patients of the same age and a 13.8% rate in adult male patients. According to results, 17.7% of patients had a contralateral ACL injury at an average time of 3.7 years after surgery. However, there were no significant age- or sex-based differences for contralateral ACL injuries. Overall, results showed 35% of patients had at least one further ACL injury subsequent to the primary surgery.
“[The fact that] a third of younger patients have a second ACL injury is a scary and eye-opening statistic,” Webster said. “This is a significant concern from both sport-participation and injury-prevention perspectives, as well as for long-term knee health.”
Return to sport
While hamstring tendon autografts have been found to have high second injury rates in younger patients, Webster said research has shown promising results with the use of a quadriceps tendon, which “may be a suitable alternative to both hamstring and patellar tendon grafts in younger patients.”
“At OrthoSport Victoria, we have begun a comparative cohort study to compare outcomes between quadriceps and hamstring tendon grafts in younger patients,” Webster said. “The development and validation of return-to-sport criteria is another area that we are interested in, and the results of our study demonstrate a clear need for this, so all patients, including younger ones, can resume sport effectively and safely.” – by Casey Tingle
- Reference:
- Webster KE, et al. Am J Sports Med. 2016;doi:10.1177/0363546516651845.
- For more information:
- Kate E. Webster, PhD, can be reached at the School of Allied Health, College of Science, Health and Engineering, La Trobe University, Victoria 3086, Australia; email: k.webster@latrobe.edu.au.
Disclosure: Webster reports no relevant financial disclosures.