Failure rates after ACL repair may stabilize in young patients at midterm follow-up
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Key takeaways:
- Failure rates after ACL primary repair remained stable from 2-year to 5-year follow-up in patients 21 years or younger.
- Outcome measures did not significantly differ from 2-year to 5-year follow-up.
DENVER — Although patients aged 21 years or younger may experience a high risk for early failure after primary ACL repair, these patients may have no subsequent reinjuries at a minimum 5-year follow-up, according to presented results.
“Modern-day ACL primary repair shows promising and durable results at midterm outcomes compared to historic results, but it is important to consider age as a critical risk factor for reinjury with younger patients,” Sebastian Rilk, MD, a postdoctoral research fellow at Hospital for Special Surgery, told Healio about results presented at the American Orthopaedic Society for Sports Medicine Annual Meeting.
Rilk, Gregory S. DiFelice, MD, senior author and surgeon of the study, and colleagues collected failure and reoperation rates, patient-reported outcome measures, and instrumented anterior-tibial translation side-to-side difference among 113 patients who underwent primary ACL repair.
Rilk said patients older than 21 years demonstrated no significant changes in failure rates, which slightly increased from 3.5% at 2-year follow-up to 8.6% at minimum 5-year follow-up. In addition, failure rates remained stable at 37% from 2-year to minimum 5-year follow-up in patients aged 21 years or younger.
“Comparing all of the patient-reported outcome measurements at minimum 5-year follow-up to the 2-year follow-up, there were no significant differences,” Rilk said.
Logistic regression analysis indicated preoperative activity levels did not significantly impact failure rates, while “every 1-year increase in age showed a decrease of failure rates of 12.5%,” according to Rilk.
“Although this is the first mid-term outcome study and the largest cohort reported on modern-day ACL primary repair, we still have to reassess preoperative risk factors in a larger cohort, which we are currently doing,” he said. “We are currently assessing a cohort of 300 patients at minimum 2-year follow-up and performing a more granular analysis of preoperative demographics and clinical parameters to determine if it is age [that is the primary predictor of failure] or if age is just a confounder for some other variable. With this, we want to further improve the outcomes of ACL primary repair based on refined indications and to advance the evidence supporting the Preservation First approach championed by Dr. DiFelice that supports use of the full armamentarium of surgical techniques, from ACL repair and augmentation to reconstruction, in the treatment of ACL injuries.”
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Rilk S, et al. Paper 26. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 10-14, 2024; Denver.
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