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Author Notes:

Joseph D. Lamplot, M.D., Department of Orthopaedic Surgery, Emory University School of Medicine, 4450 Falcon Pkwy, Flowery Branch, GA 30542. jlamplot@campbellcllinic.com

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Research Funding:

S.G.K. reports consultant and payment for lectures including service on speakers’ bureaus, royalties for Smith & Nephew, outside the submitted work. K.E.H. reports educational speaking consultant for Arthrex, outside the submitted work. M.W.P. reports consultant for Zimmer Biomet Holdings and payment for lectures including service on speakers’ bureaus from Arthrex, outside the submitted work. S.A.L. reports editorial or governing board, Arthroscopy; and Eastern Orthopedic Association, board or committee member, outside the submitted work. G.D.M. consults with commercial entities to support commercialization strategies and applications to the U.S. Food and Drug Administration but has no direct financial interest in the products. His institution receives current and ongoing grant funding from National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases grants U01AR067997, R01 AR070474, R01AR055563, R01AR076153, and R01 AR077248 and industry sponsored research funding related to injury prevention and sport performance to his institution. He receives author royalties from Human Kinetics and Wolters Kluwer and is an inventor of biofeedback technologies (Patent No: US11350854B2, Augmented and Virtual reality for Sport Performance and Injury Prevention Application, Approval Date: 06/07/2022, Software Copyrighted) designed to enhance rehabilitation and prevent injuries that receives licensing royalties.

Keywords:

  • anterior cruciate ligament (ACL)
  • injury rates
  • primary allograft anterior cruciate ligament reconstruction (ACLR)
  • allograft failure
  • complications
  • post-surgery
  • activity level
  • perceptions

Allograft Anterior Cruciate Ligament Reconstruction Fails at a Greater Rate in Patients Younger Than 34 Years

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Journal Title:

Arthroscopy, Sports Medicine, and Rehabilitation

Volume:

Volume 5, Number 4

Publisher:

, Pages 100741-None

Type of Work:

Article | Final Publisher PDF

Abstract:

Purpose To characterize the secondary anterior cruciate ligament (ACL) injury rates after primary allograft anterior cruciate ligament reconstruction (ACLR) and to identify the age cut-score at which the risk of allograft failure decreases. Methods All patients who underwent primary ACLR within a single orthopaedic department between January 2005 and April 2020 were contacted at a minimum of 2 years post-ACLR to complete a survey regarding complications experienced post-surgery, activity level, and perceptions of knee health. Patients were excluded for incidence of previous ACLR (ipsilateral or contralateral) and/or age younger than 14 years. Relative proportions were calculated, binary regression analysis was performed, and receiver operating characteristic analysis was used to identify the threshold age for maximal sensitivity and specificity to predict high risk of allograft failure, defined as undergoing revision ACLR. Results Of the 939 surveys completed, 398 patients underwent primary allograft ACLR (mean age 39.5 years; range 16.0-66.1 years; 54.3% female). The secondary ACL injury rate was 11.6% (5.8% ipsilateral revision ACLR, 5.8% contralateral ACL injury). Male and female patients had similar revision (5.5% male, 6.0% female, P = .82) and contralateral ACL injury rates (6.6% male, 5.1% female, P = .52). Receiver operating characteristic analysis indicated that age ≤34 years was threshold for differentiating high risk of allograft failure (area under the curve 0.65, 95% confidence interval 0.55-0.76; P = .014). Patients aged ≤34 years had a greater secondary injury rate than patients >34 years (20.4% (10.2% revision ACLR, 10.2% contralateral ACL injury) versus 6.9% (3.5% revision ACLR, 3.5% contralateral ACL injury; P < .001). Binary regression analysis demonstrated that decreasing age was associated with increased risk of graft failure (χ2 = 7.9, P = .02.). Conclusions Allograft ACLR showed similar failure rates between sexes but displayed suboptimal graft failure outcomes in younger and active patients. By age 34 years, the increased revision risk for younger patients diminished. Level of Evidence Level IV, therapeutic case series.

Copyright information:

© 2023 Published by Elsevier Inc. on behalf of the Arthroscopy Association of North America.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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