Differences in Mechanisms of Failure, Intraoperative Findings, and Surgical Characteristics Between Single- and Multiple-Revision ACL Reconstructions: A MARS Cohort Study

James L Chen; Christina R Allen; Thomas E Stephens; Amanda K Haas; Laura J Huston; Rick W Wright; Brian T Feeley; Multicenter ACL Revision Study (MARS) Group

doi:10.1177/0363546513487980

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Differences in Mechanisms of Failure, Intraoperative Findings, and Surgical Characteristics Between Single- and Multiple-Revision ACL Reconstructions: A MARS Cohort Study

Journal article

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Differences in Mechanisms of Failure, Intraoperative Findings, and Surgical Characteristics Between Single- and Multiple-Revision ACL Reconstructions: A MARS Cohort Study

James L Chen, Christina R Allen, Thomas E Stephens, Amanda K Haas, Laura J Huston, Rick W Wright, Brian T Feeley and Multicenter ACL Revision Study (MARS) Group

The American journal of sports medicine, Vol.41(7), pp.1571-1578

07/2013

DOI: 10.1177/0363546513487980

PMCID: PMC3839418

PMID: 23698386

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https://www.ncbi.nlm.nih.gov/pmc/articles/3839418View

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Abstract

Background: The factors that lead to patients failing multiple anterior cruciate ligament (ACL) reconstructions are not well understood. Hypothesis: Multiple-revision ACL reconstruction will have different characteristics than first-time revision in terms of previous and current graft selection, mode of failure, chondral/meniscal injuries, and surgical charactieristics. Study Design: Case-control study; Level of evidence, 3. Methods: A prospective multicenter ACL revision database was utilized for the time period from March 2006 to June 2011. Patients were divided into those who underwent a single-revision ACL reconstruction and those who underwent multiple-revision ACL reconstructions. The primary outcome variable was Marx activity level. Primary data analyses between the groups included a comparison of graft type, perceived mechanism of failure, associated injury (meniscus, ligament, and cartilage), reconstruction type, and tunnel position. Data were compared by analysis of variance with a post hoc Tukey test. Results: A total of 1200 patients (58% men; median age, 26 years) were enrolled, with 1049 (87%) patients having a primary revision and 151 (13%) patients having a second or subsequent revision. Marx activity levels were significantly higher (9.77) in the primary-revision group than in those patients with multiple revisions (6.74). The most common cause of reruptures was a traumatic, noncontact ACL graft injury in 55% of primary-revision patients; 25% of patients had a nontraumatic, gradual-onset recurrent injury, and 11% had a traumatic, contact injury. In the multiple-revision group, a nontraumatic, gradual-onset injury was the most common cause of recurrence (47%), followed by traumatic noncontact (35%) and nontraumatic sudden onset (11%) (P < .01 between groups). Chondral injuries in the medial compartment were significantly more common in the multiple-revision group than in the single-revision group, as were chondral injuries in the patellofemoral compartment. Conclusion: Patients with multiple-revision ACL reconstructions had lower activity levels, were more likely to have chondral injuries in the medial and patellofemoral compartments, and had a high rate of a nontraumatic, recurrent injury of their graft.

autograft

ACL

ACL revision

allograft

Details

Title: Subtitle: Differences in Mechanisms of Failure, Intraoperative Findings, and Surgical Characteristics Between Single- and Multiple-Revision ACL Reconstructions: A MARS Cohort Study
Creators: James L Chen - Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
Christina R Allen - Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
Thomas E Stephens - Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
Amanda K Haas - Department of Orthopaedic Surgery, Washington University, St Louis, Missouri
Laura J Huston - Department of Orthopaedic Surgery, Vanderbilt University, Nashville, Tennessee
Rick W Wright - Department of Orthopaedic Surgery, Washington University, St Louis, Missouri
Brian T Feeley - Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
Multicenter ACL Revision Study (MARS) Group
Contributors: John P Albright (Contributor) - University of Iowa, Orthopedics and Rehabilitation
Resource Type: Journal article
Publication Details: The American journal of sports medicine, Vol.41(7), pp.1571-1578
DOI: 10.1177/0363546513487980
PMID: 23698386
PMCID: PMC3839418
NLM abbreviation: Am J Sports Med
ISSN: 0363-5465
eISSN: 1552-3365
Grant note: R01 AR060846 || AR / National Institute of Arthritis and Musculoskeletal and Skin Diseases : NIAMS
Language: English
Date published: 07/2013
Academic Unit: Orthopedics and Rehabilitation
Record Identifier: 9984040001402771

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